5 Written Questions

1. age
   gender
   TC
   LDL
   smoking
   systolic BP
2. Bile Acid Sequestrants
   Welchol (colesevelam)
   Colestid (colestipol)
   Questran (cholestyramine)
   
   Bile Acid Sequestrants SE and patient teaching:
   constipation and bloating
   fiber supplement may reduce GI Se's
   
   
   Fibric Acid Derivatives
   Lopid (gemfibrozil)
   Tricor/Lofibra/Trilipix (fenofibrate)
   
   Fibric Acid Derivatives SE's
   GI distress
   Rhabdomyolysis is increased when combined with a statin
   
   
   Cholesterol Absorption Inhibitor
   Zetia (Zetimibe)
   MOA:
   decreases absorption of cholesterol from the brush border of the intestine
   
   Cholesterol Absorption Inhibitor SE's
   Mild GI distress
3. MOA:interffupts the conversion HMG-CaA to mevalonate which reduces cholesterol biosynthesis
   
   Examples of statins:
   Lipitor (atorvastatin)
   Lescol (fluvastatin)
   Mevacor (Lovastatin)
   Pravachol (Pravastatin)
   Crestor (rosuvastatin)
   Zocor (simvastatin)
   
   SE's
   Mild GE distress
   HA
   Myalgia
   rarely Rhabdomyolysis leading to renal faliure
   Need to evaluate liver function at baseline and 2 mo after starting therapy
   Drug interaction with Grapefruit juice, Azoles, CCB's.
4. LDL, cholesterol levels less than 100mg/dl
   HDL cholesterol levels above 40mg/dl in men
   HDL cholesterol levels above 50mg/dl in women
   Triglyceride levels less than 150 mg/dl
   total cholesterol levels less than 200mg/dl
5. increase in bad cholesterol and triglycerides in the blood
   TC total cholesterol
   TG: triglycerides
   LDL: low density lipoproteins
   
   decrease good choleterol
   HDL, high density lipoproteins
   
   result is increased risk
   coronary disease
   cerebrovascular disease
   peripheral vascular arterial disease

5 Multiple Choice Questions

1. How many risk factors does MM have?
   What should her LDL goal be according to NCEP recommendations?
   1. Counting Risk Factors
   2. CHD Risk Factors
   3. The lipid panel
   4. Cholesterol Goals
2. patient must be fasting for 12 hours
   HDL
   TC
   Triglycerides
   LDS is estimiated using the Friedewald equation
   HDL-TC-LDL-.20 (Triglycerides)
   Triglycerides must be <400 mg/dl for this equation to work
   1. CHD Risk Factors
   2. Dislipidemia
   3. Atherosclerosis
   4. The lipid panel
3. Lovaza
   
   MOA: The MOA of Lovaza is not completely understood. Active components are DHA and EPA.
   
   Dosing
   4g/daily
   
   SE:
   increase bleeding time
   eructation (fishy)
   dyspepsia
   Possible DDI with anticoagulents
   1. Cholesterol Medications
   2. Atherosclerosis
   3. Fish Oil Supplementation
   4. Dislipidemia
4. HMG-CoA reductase inhibitors decrease cholesterol biosynthesis
   resins bind bile acids causing the liver to convert choleterol to bile acids
   Niacin prevents free fatty acids from traveling to the liver to the made into VLDL
   Zetia inhibits cholesterol absorption .
   Fibric Acids decrease lipogenisis in the liver
   omage 3 fish oils
   1. Non Drug Therapy
   2. Cholesterol Goals
   3. Drug Therapy MOA's
   4. Targget LDL Goals
5. Therapeutic Lifestyle Changes (TLC) are the first step
   increase exercise to at least 30 min a day 5 times a week
   decrease caloric intake to lose weight
   change in diet: eat less fat and increase fiber
   foods high in cholesterol are organ meats, egg yolks, full fat diary products
   good sources of fiber are oats, cereal fruits (oranges), certain vegetables (carrots) and beans.
   increase omega 3 fatty acids, such as tuna and salmon, and canola oil.
   1. CHD Risk Factors
   2. The lipid panel
   3. Atherosclerosis
   4. Non Drug Therapy

5 True/False Questions

1. Niacin Vitamin B3 → increase in bad cholesterol and triglycerides in the blood
   TC total cholesterol
   TG: triglycerides
   LDL: low density lipoproteins
   
   decrease good choleterol
   HDL, high density lipoproteins
   
   result is increased risk
   coronary disease
   cerebrovascular disease
   peripheral vascular arterial disease

   True        False

2. Cholesterol Goals → Statins are the first drug of choice for treatment of most patients at risk for coronary and other atherosclerotic vascular disease.
   
   These agents can decrease the incidence of major coronary events and death in such patients
   
   Additional agents can be added to achieve a desired cholesterol lowering effect.

   True        False

3. Targget LDL Goals → Risk category LDL goal
   ChD and CHD risk equivalent
   10 year risk>20% <100 (<70)
   
   2+ risk factors (10 year risk 10-20%) <130 (<100)
   
   2+risk factors (10 yr risk <10%) <130
   
   0-1 risk factor <160

   True        False

4. Atherosclerosis → CAD
   Angina
   HF
   MI
   Stroke
   PAD: peripheral artery disease
   RAS: renal arterial stensois

   True        False

5. CHD Risk Factors → How many risk factors does MM have?
   What should her LDL goal be according to NCEP recommendations?

   True        False