Management of Lipid Disorders

Question 1

first line of treatment with someone with dyslipidemia

Answer 1

life style modification

• also rule out other medical causes (no hypothyroidism,nephrotic syndrome etc)

Question 3

baseline CVD risk is usually estimated using framinghamd risk score. in terms of cholesterol targets, most guidelines focus on addressing __ and emphasize baseline cardiovascular risk. When do you start cholesterol lowering meds?

Answer 3

addressing LDL-C.

for low risk, treatment is not usually recommended, but if you have an intermediate framingham risk and LDL>3.5,mol, you sould treat. if you have a high framingham risk, treat all patients

• goal is to have a 50% reduction in LDL-C

Question 4

TG level that’s considered severe that you should treat with medications

Answer 4

TG>10mmol/L should be treated with drugs because of risk of pancreatitis.

-

Question 5

4 main treatments for cholesterol lowering

Answer 5

statins, ezetimibe, PCSK9 inhbitors, bile acid sequestratnts

Question 6

main treatment for trigclyerides

Answer 6

fibrates

Question 7

indications: first-line therapy for all
causes of hypercholesterolemia

MOA?

Answer 7

STATINS;

HMG CoA reductase is the
rate-limiting enzyme in cholesterol synthesis;
statins competitively inhibit this enzyme…
1. REDUCE cholesterol synthesis in liver 2. ­ INCREASE LDL receptor expression 3. ­REDUCE LDL clearance from the blood

Question 8

3 ways statins improve your cholesterol levels

Answer 8

Question 9

2 main aspects statins prevent against

Answer 9

cardiovascular disease and reduces mortality

Question 10

side effects of statins

Answer 10

Question 11

contraindications of statins

Answer 11

• pregnancy and nursing
• decompensated liver disease

Question 12

mechanism of ezetimibe

Answer 12

NPC1L1 inhibitor

Question 13

side effects and contraindications of ezetimibe

Answer 13

same as statins– dont use in pregnancy or with severe liver dysfunction

Question 14

____ is an add-on terapy in addition to statins, especially for people with high-risk cardiovascular disease profile

Answer 14

PCSK9 inhbitiors.

Question 15

PSCK9 inhibitor MOA

Answer 15

Question 16

t/f like statins, PCSK9 inhibitors also cause diarrhea and vomiting

Answer 16

false. generally well tolerated, may ve assocaited with injection site reactions or arthralgias.

Question 17

PCKS9 inhibitors are only given to people with __ ___ or who are high risk for cardiovascular disease as an add-on therapy to statins, +/- ezetimibe

Answer 17

for now, probably should be reserved for
people with familial
hypercholesterolemia and high risk
patients as add-on therapy to statin +/-
ezetimibe

Question 18

what type of medication is cholesytramine? what is its MOA?

Answer 18

it’s a bile acid sequestrant. it binds to bile salts and reduces bile reabsorptioin, increases bile synthesis (thus using up cholesterol) and there is an increase in LDL clearance from the blood because of increase LDL receptor expressoinin the liver.X

Question 19

T/F bile acid sequestrants are contraindicated in pregnancy.

Answer 19

false. its one of the only cholesterol lowering medications that can be usefd in pregnancy

Question 20

first line therapy for severe hypertriglcyeridemia

Answer 20

fibrates. also useful for combined hyperlipidemia, often as an add-on to a statin.

Question 21

mechanism of action of fibrates

Answer 21

activates PPARalpha.

• incrases FFA oxidation,
• decreases VLDL formation.

Question 22

contraindications for fibrates

Answer 22

renal failure, liver disease, gall bladder disease.

Question 23

note

Question 24

T/F OTC omega3 fatty acids work to reduce TGs

Answer 24

false.

Question 25

treatment typical approach:

1. hypercholesterolemia: consider ___
2. hypertriglcyeridemia: consider ___.
3. tx for hyperlipidemia (combined)?

Answer 25