Management of Hyperlipidemia

Question 1

What are hereditary causes of hyperlipidemia?

Answer 1

familial hypercholesterolemia: Mutation in LDL receptor results in unregulated synthesis of LDL. Familial combined hyperlipidemia: increased secretions of VLDLs. Dysbetalipoproteinemia: defective form of apoE involved in catabolism of VLDL

Question 2

What is recommended as initial therapy in patients with acute coronary syndrome?

Answer 2

intensive statin therapy or if unable to tolerate statins than treated with another lipid lowering agent

Question 3

In what patient population is the target LDL below 70?

Answer 3

patients at very high risk for CHD events

Question 4

Which patients are at very high risk for CHD events?

Answer 4

established coronary heart disease plus: DM, smoking, metabolic syndrome, or acute coronary syndrome

Question 5

When should lipid panels be checked?

Answer 5

Beginning at age 20: obtain a fasting serum lipid profile of total cholesterol, LDL, HDL and triglycerides. Repeat testing every 5 years for acceptable values

Question 6

What are ranges for HDL?

Answer 6

< 40 low, > 60 high

Question 7

What are ranges for serum triglycerides?

Answer 7

< 150 normal, 150-199 boderline, 200-499 high, > 500 very high

Question 8

What are ranges for total cholesterol?

Answer 8

< 200 desirable, 200-239 borderline, > 240 high

Question 9

Name the 7 main statins

Answer 9

rosuvastatin (Crestor), Atorvastatin (Lipitor), Simvastatin (Zocar), Lovastatin (Mevacor), Pravastatin (Pravachol), Fluvastatin (Lescol), Simvastatin/Ezetimibe (Vytorin)

Question 10

How do statins work?

Answer 10

HMG-CoA reductase inhibitors. Lower LDL and decrease morbidity/mortality. Well tolerated.

Question 11

What are contraindications to statins?

Answer 11

pregnancy, active liver disease, unexplained elevated aminotransferase levels (ALTs), alcoholics

Question 12

What are SE of statins?

Answer 12

GI upset, HA, elevated LFTs, muscle pain/weakness, protenuria and renal failure.

Question 13

What drugs increase the SE of myopathy associated with statins?

Answer 13

erythromycin, niacin, gemfibrozil, cyclosporine

Question 14

Why should statins be taken in the evening or at bedtime?

Answer 14

Significant amount of cholesterol production seems to occur during sleep. Lovastatin (Mevacor) and Atorvastatin (Lipitor) are exceptions

Question 15

How do bile resins reduce hyperlipidemia?

Answer 15

Decrease cholesterol absorption through exogenous pathway. Are NOT absorbed through the GI tract. bind bile acids in the intestines, forming a complex that is excreted in the feces.

Question 16

How can niacin be used to reduce hyperlipidemia?

Answer 16

improve cholesterol levels when used at doses 100-300 times the recommended daily allowance. decreases VLDL synthesis in liver and increase lipoprotein lipase activity

Question 17

Name the bile acid resins

Answer 17

cholestryamine (Questran) and Colestipol (Colstid)

Question 18

What are CI to niacin?

Answer 18

hepatic dsyfxn, hypotension, peptic ulcer, gout, can worsen glucose control

Question 19

What are SE of niacin?

Answer 19

pruritis and flushing of face and neck, hepatotoxicity, uric acid and glucose increases

Question 20

How does Ezetimibe (Zetia) a cholesterol absorption inhibitor work to reduce hyperlipidemia?

Answer 20

Inhibits the absorption of cholesterol and causes a reduction of hepatic cholesterol store. complementary to that of the STATINS

Question 21

What are CI of ezetimibe (Zetia)?

Answer 21

if used with a statin hepatic disease or elevated ALTs

Question 22

What are SE of ezetimibe (Zetia)?

Answer 22

HA, diarrhea, abdominal pain

Question 23

What are the fibric acid derivatives?

Answer 23

Gemfibrozil (Lopid) and fenofibrate (Tricor)

Question 24

How are fibric acid derivatives used?

Answer 24

Good for lowering triglycerides from the stimulation of lipoprotein lipase, which enhances the breakdown of VLDL to LDL, but have minimal effect on LDL

Question 25

What are CI of fibric acid derivatives?

Answer 25

h/o gallstones, hepatic or renal dysfunction

Question 26

What are adverse effects of fibric acid derivatives?

Answer 26

GI, myopathy if taken with statins, jaundice, increased effects of warfarin

Question 27

What is xanthomas?

Answer 27

Soft, yellow skin plaques or nodules that contain deposits of lipoproteins inside histiocytes. found on skin of patients with hyperlipidemia

Question 28

What are the steps of the framingham risk scoring?

Answer 28

age, total cholesterol, HDL-cholesterol, systolic BP, smoking status (add all together)