Pharmacotherapy - Dyslipidemias - Quiz, Flashcards & Trivia

1. Typically, ______ are the medications of choice to treat high LDL cholesterol because of their ability to substantially reduce LDL cholesterol, ability to reduce morbidity and mortality from atherosclerotic disease, convenient once daily dosing, and low risk of side effects.

BAS

Statins

Niacin

Fibrates

Cholesterol absorption inhibitors

2. The risk of atherosclerosis is directly related to increasing levels of serum cholesterol.

True

False

3. Patients with metabolic syndrome are twice as likely to develop type 2 DM and four times more likely to develop CHD.

True

False

4. A fasting lipid profile is preferred so an accurate assessment of LDL cholesterol can be performed, and fasting will allow the clearance of triglycerides carried by ______________ from the circulation, allowing VLDL cholesterol to be determined.

LDL

Micelles

Chylomicrons

Foam cells

Macrophages

5. Estrogens decrease triglycerides.

True

False

6. The patient buys niacin and returns the next day saying that it caused too much flushing. What do you recommend?

Take the flush free formulation

Take 325mg of ASA or 200mg of ibuprofen 30 minutes before taking niacin.

Take 81mg of ASA or 200mg of ibuprofen a couple of hours before taking niacin.

7. Patients with serum triglycerides exceeding _____mg/dL are at increased risk of pancreatitis. Reducing triglycerides in these individuals becomes the primary target for intervention.

150

200

300

400

500

8. Which two statins decrease LDL the most?

Atorvastatin

Simvastatin

Rosuvastatin

Lovastatin

Pravastatin

Submit

9. He then tells you that his biggest fear is to get hepatoxicity. What do you tell him?

Niacin will probably cause hepatoxicity.

Taking doses less than 2000mg/day and avoiding SR formulations is not likely to cause hepatoxicity

Niacin usually causes nephrotoxicity at high doses, not hepatotoxicity

10. Which drug may increase triglycerides?

Statins

Bile acid sequestrants

Cholesterol absorption inhibitors

Fibric acid derivatives

Nicotinic acid

11. Metabolic syndrome criteria include: increased waist (male >40, female>35), triglycerides greater than or equal to 150, increased HDL (male < , female < ), and fasting blood sugar greater than or equal to 100.

40,40

40,50

50,40

50,50

12. "No flush" niacin products are generally effective.

True

False

13. Patients with metabolic syndrome have an additional lipid parameter that needs to be assessed, namely non-HDL cholesterol. The target for non-HDL cholesterol is...

Less than the patient's LDL cholesterol target + 30

Less than the patient's LDL cholesterol target - 30

14. A patient comes to the pharmacy and asks you whether taking a natural product containing plant sterols (such as Cholest Off) will actually decrease her LDL cholesterol. You tell her...

No, not really

Maybe, but it won't do much

Yes, it can lower it by 10 to 15%

15. Liver function tests should be obtained at baseline and ____________ after starting therapy or ANY dose escalation of a statin.

6 to 12 days

4 to 6 days

6 to 12 weeks (about every 3 months)

4 to 6 weeks (about every month)

4 to 6 months

16. Wine...

Increases HDL, decreases CRP

Decreases HDL, decreases CRP

Increases HDL, increases CRP

Decreases HDL, increases CRP

17. Which plays the largest role in reverse cholesterol transport?

LDL

HDL

Chylomicrons

VLDL

IDL

18. Main side effects of bile acid sequestrants are nausea, constipation, bloating, and flatulence, although these may be less with ______________. Increasing fluid and dietary fiber intake may relieve constipation and bloating. Impaired absorption of fat-soluble vitamins may also occur.

Cholestyramine

Colesevelam

Colestipol

19. Niacin is "pushes everything in the right direction" but it increases Lp(a).

True, it increases Lp(a)

False, it decreases Lp(a)

20. Which three drugs are the most effective agents in patients with hypertriglyceridemia?

Statins

Fibrates

Niacin

BAS

Fish oils

Submit

21. Limitations of niacin IR and SR are flushing and nephrotoxicity.

True

False

HEPATOTOXICITY

Explanation

HEPATOTOXICITY

22. A patient comes into her pharmacy and tells you that his doctor told him is Lp(a) was 45 mg/dL. He wants to know if there is anything he can do to get the number back to its normal level. You tell him...

The number is too low, try exercising then seeing your doctor again.

The number is too low, take niacin.

The number is too high, there isn't an effective treatment to reduce this number.

The number is too high, take niacin.

23. Individuals with established CHD, other clinical atherosclerotic disease (CAD) have a greater than 20% risk over a 10-year period of developing CHD. The ATP III guidelines set the target LDL cholesterol level at less than 100mg/dL (optional: less than 70) for high risk patients who have a history of one or more of the following:
Select all that apply.

MI or coronary interventions (bypass, PTCA, stents)

Unstable angina and chronic stable angina

PAD

Stroke/TIA

Diabetes

Submit

24. If serum triglycerides are greater than _____ mg/dL, the estimated value LDL equation (LDL = total cholesterol - (HDL cholesterol + triglycerides) becomes inaccurate and LDL cholesterol must be directly measured.

150

200

300

400

500

25. Omega-3s are triglyceride lowering at doses of 2000 to 5000 mg/day. At what dose are they cardioprotective?

500-1000

1000-2000

2000-3000

2000-5000

5000+

26. Gemfibrozil can signficantly increase the concentration of a statin. Amiodarone and simvastatin are especially bad together. What other drugs may increase the risk of myopathy with statins? Select all that apply.

Ketoconazole

Cyclosporine

Verapamil

Macrolide antibiotics (such as erythromycin and clarithromycin)

Other fibrates than gemfibrozil

Submit

27. The patient then tells you that he has diabetes. Is it safe for him to take niacin?

No

Yes, at doses less than 500 mg/day

Yes, at doses less than 1500 mg/day

28. Which of the following are risk factors for coronary heart disease? Select all that apply.

Male greater or equal to 55, female greater than or equal to 65.

Family history of premature CHD events (male first degree relative

Hypertension (SBP greater than or equal to 140, DBP greater than or equal to 90)

HDL (less than 40mg/dL)

Cigarette smoking within the past year

Male greater than or equa to 45, female greater than or equal to 55.

Cigarette smoking within the past MONTH.

Explanation

Male greater than or equa to 45, female greater than or equal to 55.

Cigarette smoking within the past MONTH.

Submit

29. An elderly normotensive woman comes up to you and asks you what her LDL goal should be. She has never smoked, does not have metabolic syndrome, does not have a family history of heart related problems, and has no other risk equivalents such as MI, angina, stents, PAD, diabetes, etc. You tell her...

She doesn't have any risk factors and not to worry.

Her age is a risk factor and her LDL should be less than 130 mg/dL

Her age is a risk factor and her LDL should be less than 100 mg/dL

None of above

With just one risk factor (such as old age) LDL goal can be less than 160.

Explanation

With just one risk factor (such as old age) LDL goal can be less than 160.

Pharmacotherapy - Dyslipidemias

1. Typically, ______ are the medications of choice to treat high LDL cholesterol because of their ability to substantially reduce LDL cholesterol, ability to reduce morbidity and mortality from atherosclerotic disease, convenient once daily dosing, and low risk of side effects.

2.

What first name or nickname would you like us to use?

2. The risk of atherosclerosis is directly related to increasing levels of serum cholesterol.

3. Patients with metabolic syndrome are twice as likely to develop type 2 DM and four times more likely to develop CHD.

4. A fasting lipid profile is preferred so an accurate assessment of LDL cholesterol can be performed, and fasting will allow the clearance of triglycerides carried by ______________ from the circulation, allowing VLDL cholesterol to be determined.

5. Estrogens decrease triglycerides.

6. The patient buys niacin and returns the next day saying that it caused too much flushing. What do you recommend?

7. Patients with serum triglycerides exceeding _____mg/dL are at increased risk of pancreatitis. Reducing triglycerides in these individuals becomes the primary target for intervention.

8. Which two statins decrease LDL the most?

9. He then tells you that his biggest fear is to get hepatoxicity. What do you tell him?

10. Which drug may increase triglycerides?

11. Metabolic syndrome criteria include: increased waist (male >40, female>35), triglycerides greater than or equal to 150, increased HDL (male < ____, female < ____), and fasting blood sugar greater than or equal to 100.

12. "No flush" niacin products are generally effective.

13. Patients with metabolic syndrome have an additional lipid parameter that needs to be assessed, namely non-HDL cholesterol. The target for non-HDL cholesterol is...

14. A patient comes to the pharmacy and asks you whether taking a natural product containing plant sterols (such as Cholest Off) will actually decrease her LDL cholesterol. You tell her...

15. Liver function tests should be obtained at baseline and ____________ after starting therapy or ANY dose escalation of a statin.

16. Wine...

17. Which plays the largest role in reverse cholesterol transport?

18. Main side effects of bile acid sequestrants are nausea, constipation, bloating, and flatulence, although these may be less with ______________. Increasing fluid and dietary fiber intake may relieve constipation and bloating. Impaired absorption of fat-soluble vitamins may also occur.

19. Niacin is "pushes everything in the right direction" but it increases Lp(a).

20. Which three drugs are the most effective agents in patients with hypertriglyceridemia?

21. Limitations of niacin IR and SR are flushing and nephrotoxicity.

22. A patient comes into her pharmacy and tells you that his doctor told him is Lp(a) was 45 mg/dL. He wants to know if there is anything he can do to get the number back to its normal level. You tell him...

24. If serum triglycerides are greater than _____ mg/dL, the estimated value LDL equation (LDL = total cholesterol - (HDL cholesterol + triglycerides) becomes inaccurate and LDL cholesterol must be directly measured.

25. Omega-3s are triglyceride lowering at doses of 2000 to 5000 mg/day. At what dose are they cardioprotective?

26. Gemfibrozil can signficantly increase the concentration of a statin. Amiodarone and simvastatin are especially bad together. What other drugs may increase the risk of myopathy with statins? Select all that apply.

27. The patient then tells you that he has diabetes. Is it safe for him to take niacin?

28. Which of the following are risk factors for coronary heart disease? Select all that apply.

11. Metabolic syndrome criteria include: increased waist (male >40, female>35), triglycerides greater than or equal to 150, increased HDL (male < , female < ), and fasting blood sugar greater than or equal to 100.