Hyperlipidemia

___________ carries 60 to 70% of total serum cholesterol; IDL is also included in this group  

• LDL

• HDL

• TG

• VLDL

__________ carries 20 to 30% of total serum cholesterol; reverse transportation of cholesterol

• VLDL

• HG

• HDL

• LDL

žVLDL secreted from the ______________ —converted to IDL then LDL

Plasma LDL taken up by receptors on _______________ (Choose all that apply)

• Liver

• Kidney

• Adrenal

• Peripheral cells

• Juxtaglomerular cells

• Thyroid

What are the secondary causes of hypercholesterolemia?

• Hypothyroidism

• Obstructive liver disease

• Nephrotic syndrome

• Anorexia nervosa

• Acute intermittent porphyria

Choose three medications that have secondary side effects of hypercholesterolemia?

• Thiazide diuretics

• Protease inhibitors

• β-blockers

• Interferons

• Estrogens

• Alcohol

What are the secondary causes of Hypertriglyceridemia?

• Hypothyroidism

• Obesity

• Nephrotic syndrome

• Diabetes

• Acute intermittent porphyria

Choose three medications that have secondary side effects of Hypertriglyceridemia?

• Thiazide diuretics

• Protease inhibitors

• β-blockers

• Interferons

• Estrogens

• Alcohol

What are the secondary causes of Hypocholesterolemia?

• Hypothyroidism

• Obesity

• Malnutrition

• Diabetes

• Malabsorption

What are the secondary causes of Low high-density lipoprotein?

• Hypothyroidism

• Obesity

• Malnutrition

• Diabetes

• Malabsorption

Signs of hyperlipidemia include a BMI > ___________kg/m2

Signs of hyperlipidemia include a waist size > ________ in (men), > _________ in (women)

What is the correct formula to measure total cholesterol

• TC=HDL+IDL+(TG/5)

• TC=HDL+VLDL+(TG/5)

• TC=HDL+LDL+TG

• TC=HDL+LDL+(TG/5)

The following are all Major Risk Factors (Exclusive of LDL Cholesterol) That Modify LDL Goals except

• Cigarette smoking

• Family history of premature CHD;CHD in male first degree relative

• Hypertension (BP >140/90 mmHg or on antihypertensive medication)

• Low HDL cholesterol (

• Age (men >/=45 years; women >/=55 years)

• High fat diet

What are the CHD Risk Equivalents?

• Multiple risk factors that confer a 10-year risk for CHD >20%

• Diabetes

• Peripheral arterial disease, abdominal aortic aneurysm, and symptomatic carotid artery disease

Therapeutic Lifestyle Changes (TLC) include all of the following except

• Encourage moderate physical activity

• Increase fiber intake

• Emphasize reduction insaturated fat & cholesterol

• Consider referral to a dietitian

• Increase physical activity to everyday for 30 minutes

Most patients should receive __________ TLC trial before initiating pharmacologic therapy unless very high risk

All the following are used Primary Prevention to Initiate LDL-lowering drug therapy except  

• Bile acid sequestrant

• Ezetimibe

• Statin

• Nicotinic acid

If a patient is taking Atorvastatin (Lipitor ®): 10 mg, what is the equivalent Fluvastatin (Lescol ®) dose?

If a patient is taking Atorvastatin (Lipitor ®): 10 mg, what is the equivalent Lovastatin (Mevacor ®) dose?

If a patient is taking Atorvastatin (Lipitor ®): 10 mg, what is the equivalent Pravastatin (Pravachol ®) dose?

If a patient is taking Atorvastatin (Lipitor ®): 10 mg, what is the equivalent Rosuvastatin (Crestor ®) dose?

If a patient is taking Atorvastatin (Lipitor ®): 10 mg, what is the equivalent Simvastatin (Zocor ®) dose?

Statin side effects are often class specific, not always agent specific

• True

• False

What two statins have no active metabolites?

• Lovastatin

• Simvastatin

• Pravastatin

• Fluvastatin

• Atorvastatin

• Rosuvastatin

What two statins are not lipophilic?

• Lovastatin

• Simvastatin

• Pravastatin

• Fluvastatin

• Atorvastatin

• Rosuvastatin

What two statins have long elimination half-life's?

• Lovastatin

• Simvastatin

• Pravastatin

• Fluvastatin

• Atorvastatin

• Rosuvastatin

Which statin requires dosage adjustment for severe renal impairment & hepatic disease

• Lovastatin

• Simvastatin

• Pravastatin

• Fluvastatin

• Atorvastatin

• Rosuvastatin

What statin(s) utilize the isoenzyme 3A4?

• Lovastatin

• Simvastatin

• Pravastatin

• Fluvastatin

• Atorvastatin

• Rosuvastatin

What statin(s) utilize the isoenzyme 2C9?

• Lovastatin

• Simvastatin

• Pravastatin

• Fluvastatin

• Atorvastatin

• Rosuvastatin

What statin(s) do NOT utilize any isoenzyme system?

• Lovastatin

• Simvastatin

• Pravastatin

• Fluvastatin

• Atorvastatin

• Rosuvastatin

Unexplained myalgias may occur on statins without CK elevation.

• True

• False

Statins Lowers LDL-C and Raises HDL-C by

• 5%–25%, 15%–35%

• 15%–30%, 3%–5%

• 21%–63%, 3%–16%

• 10%–30%, 3%–15%

Bile Acid Resins Lowers LDL-C and Raises HDL-C by

• 5%–25%, 15%–35%

• 15%–30%, 3%–5%

• 21%–63%, 3%–16%

• 10%–30%, 3%–15%

Niacin Lowers LDL-C and Raises HDL-C by

• 5%–25%, 15%–35%

• 15%–30%, 3%–5%

• 21%–63%, 3%–16%

• 10%–30%, 3%–15%

Which one of the following is a proper recommendation regarding general therapeutic lifestyle changes?

• Limit carbohydrates to less than 40% of calories daily.

• Increase monounsaturated fats to 30% of total calories.

• Encourage alcohol consumption of at least three drinks per day.

• Take a supplement with an antioxidant such as vitamin A for additional cardioprotection.

• Limit cholesterol consumption to less than 200 mg/d.

Identify a baseline laboratory test required before statin treatment.

• White blood cell count

• Complete blood cell count

• Liver function test

• Serum creatinine

• Creatinine clearance

Which of the following is NOT a secondary cause of hyperlipidemia?

• High LDL

• Hypothyroidism

• Diabetes

• Renal disease

• Beta-Blockers

Polygenic hypercholesterolemia is characterized by which of the following?

• LDL = 150-450 mg/dL

• LDL = 160-250 mg/dL

• Triglycerides greater than 400 mg/dL

• HDL = 50 mg/dL

• LDL = 160-250 mg/dL + triglycerides greater than 400 mg/dL

Which of the following medications requires dose adjustment in patients with renal insufficiency?

• Milrinone

• Hydralazine

• Metoprolol

• Dopamine

• Nesiritide

J. I. is a 57-year-old African American woman who presents to your pharmacy asking for advice on her new “cholesterol pill.” Her medical history is significant for obesity and asthma. She has no other significant medical conditions. Her social history indicates that she does not drink, but she has smoked a pack of cigarettes daily for the past 7 years. Her family history indicates that her mother suffered a myocardial infarction at age 63, while her father had a myocardial infarction at age 60. Her current medications include ranitidine 75 daily prn for “heartburn” along with a new prescription for simvastatin 20 mg/daily. A physical assessment reveals the following: BP 112/83 mm Hg, pulse 73 bpm, weight 173 lbs, and height 5 feet 3 inches. You find that her lipid measurements are as follows: LDL, 177 mg/dL; HDL, 43 mg/dL; and triglycerides, 153 mg/dL. When should J. I.’s lipid therapy be evaluated for effectiveness in correcting her dyslipidemia?

• Two weeks

• Six weeks

• Three months

• Six months

• Yearly

Combining ezetimibe with which one of the following medications may result in an increased risk of gallbladder disease?

• Fenofibrate

• Lovastatin

• Colestipol

• Immediate-release nicotinic acid

• Omega-3 fatty acids

Which of the following classes of drugs works by reducing the production of mevalonate, ultimately inhibiting the rate limiting step in cholesterol synthesis?

• HMG-CoA reductase inhibitors

• Bile acid sequestrants

• Fibric acids

• Nicotinic acid

• Omega-3 fatty acids

J. I. is a 57-year-old African American woman who presents to your pharmacy asking for advice on her new “cholesterol pill.” Her medical history is significant for obesity and asthma. She has no other significant medical conditions. Her social history indicates that she does not drink, but she has smoked a pack of cigarettes daily for the past 7 years. Her family history indicates that her mother suffered a myocardial infarction at age 63, while her father had a myocardial infarction at age 60. Her current medications include ranitidine 75 daily prn for “heartburn” along with a new prescription for simvastatin 20 mg/daily. A physical assessment reveals the following: BP 112/83 mm Hg, pulse 73 bpm, weight 173 lbs, and height 5 feet 3 inches. You find that her lipid measurements are as follows: LDL, 177 mg/dL; HDL, 43 mg/dL; and triglycerides, 153 mg/dL. Which of the following represents the most appropriate lipid goal for J. I.?

• A total cholesterol level of less than 200 mg/dL

• An HDL of at least 60 mg/dL

• An LDL level less than 160 mg/dL

• An LDL level less than 130 mg/dL

• A triglyceride level less than 150 mg/dL

A TLC diet could include:

• Antioxidant therapy such as vitamin E

• Less than 7% of total calories from saturated fat

• 150-250 g/d of fiber

• 2-4 drinks of alcohol per day

• Assessing the effectiveness of TLC at 12-week intervals

Which of the following medications has the following warning: "For patients switching from immediate-release niacin, therapy with this drug should be initiated with a low dose and then titrated to the desired therapeutic response"?

• Pravigard

• Vytorin

• Advicor

• Atorvastatin

• Ezetimibe

Which of the following nonpharmacologic therapies can moderately lower the LDL level if taken in sufficient amounts?

• Antioxidants such as vitamin C

• Alcoholic beverages

• Foods high in saturated fats

• Foods high in soluble fiber such as fruits and whole grains

• Foods high in protein such as lean meats

How long should one wait before taking colestipol if one is taking other medications?

• Two hours after taking another medication and 2 hours before taking another medication

• Four hours after taking another medication and 4 hours before taking another medication

• One hour after taking another medication and 1 hour before taking another medication

• One hour after taking another medication and 4 hours before taking another medication

• Four hours after taking another medication and 1 hour before taking another medication