Pharmacotherapy Lecture 1

Front 1

Definition of dyslipidemia

Back 1

elevation of one or more of cholesterol (TC and/or LDL), elevated triglycerides (TG), low HDL, or some combination

Front 2

Purpose of chylomicrons

Back 2

carry dietary lipid

Front 3

Calculation for VLDL

Back 3

TG/5

Front 4

VLDL carries most of the TG in the _________ state

Back 4

fasting

Front 5

"bad cholesterol"

Back 5

LDL

Front 6

_______ transports the majority (60%-70%) of total cholesterol from the liver to the peripheral cells

Back 6

LDL

Front 7

"good cholesterol"

Back 7

HDL

Front 8

__________ transport TC from peripheral cells back to the liver by reverse cholesterol transport

Back 8

HDL

Front 9

IDL measured as part of _______

Back 9

LDL

Front 10

______ has strong correlation with heart disease

Back 10

LDL

Front 11

Core of lipoprotein contains:

Back 11

TG and CE

Front 12

Protein that make VLDL and LDL from HDL

Back 12

CETP

Front 13

apoA-I is in _______

Back 13

HDL

Front 14

Inhibit CETP will increase ______

Back 14

HDL

Front 15

What causes cardiovascular event?

Back 15

thrombosis

Front 16

Put these in order of endothelial dysfunction:

a. Fatty streak
b. complicated lesion/rupture
c. atheroma
d. intermediate lesion
e. fibrous plaque
f. foam cellsd

Back 16

f, a, d, c, e, b

Front 17

Most common CV death is ______

Back 17

Coronary heart disease, then stroke

Front 18

1% decrease in LDL = ___% of CHD

Back 18

1%

Front 19

1% increase in HDL = ___ decrease CHD

Back 19

2%

Front 20

T/F: increased risk of stroke correlated with elevated TC

Back 20

True

Front 21

T/F: statins may reduce stroke

Back 21

True; statins are approved for stroke prevention

Front 22

Most common type of familial dyslipidemia.

Back 22

polygenic hypercholesterolemia IIa

Front 23

Secondary dyslipidemia

Back 23

hypothyroidism: high TG, TC
Obstructive liver disease
chronic renal failure: high TG, TC
Nephrotic syndrome
Alcohol use: high TG, HDL

Front 24

Drugs that increase LDL and decrease HDL

Back 24

progestins, anabolic steroids, corticosteroids

Front 25

Drugs that increase TG

Back 25

thiazide diuretics, BB, oral estrogens

Front 26

what is xanthomas?

Back 26

cholesterol nodules in tissue

Front 27

Preferred option to screen for lipid.

Back 27

fasting TC, LDL, HDL, and TG every 5 years once > 20 years of age

Front 28

Proceed to complete lipoprotein profile if

Back 28

TC > 200 mg/dL or HDL < 40 mg/dL

Front 29

Friedwald Equation

Back 29

LDL = Total - HDL - VLDL

VLDL=TG/5, where TG < 400 mg/dL

Front 30

TC desirable #
borderline high #
high #

Back 30

<200
200-239
>240

Front 31

LDL optimal #
Near optimal
borderline high
high
very high

Back 31

<100
100-129
130-159
160-189
>190

Front 32

HDL low #
high #

Back 32

<40
>60

Front 33

TG desirable #
borderline high
high
very high

Back 33

<150
150-199
200-499
>500

Front 34

Advanced testing are:

Back 34

NMR lipoprofile: look at particle sizes and density
VAP testing: breaks down HDL and LDL into different density levels.

Front 35

What are the CHD risk equivalents?

Back 35

Diabetes
Peripheral Arterial Disease (PAD, PVD)
Abdominal Aortic Aneurysm (AAA)
Symptomatic carotid artery disease
Multiple risk factors that confer 10-year risk for CHD > 20%

Front 36

If pt has CHD or CHD risk equivalents 10-year risk > 20%, what is pt LDL goal?

Back 36

<100 mg/dL; optional <70 mg/dL

Front 37

pt with 2+ risk factors, LDL goal =

Back 37

<130

Front 38

pt with 0-1 risk factor, LDL goal =

Back 38

<160

Front 39

What are the risk factors that modify LDL goals?

Back 39

1. age (m > 45; w > 55)
2. family hx of premature CHD (m < 55 yo; w < 65 yo)
3. smoker
4. HTN (bp>140/90; or taking anti-HTN)
5. low HDL-C (<40 mg/dL)

Front 40

Framingham score does not include which risk factor?

Back 40

Family history

Front 41

Framingham risk calculation based on:

Back 41

gender, age, smoke, SBP, TC, HDL

Front 42

Life-habit risk factors:

Back 42

obesity BMI > 30
Physical inactivity
atherogenic diet

Front 43

Does life-habit risk factors change LDL goal?

Back 43

no

Front 44

Emerging risk factors are:

Back 44

lipoprotein (a)
Proinflammatory factors
C-reactive protein
Impaired fasting glucose
Subclinical atherosclerosis
Prothrombotic factors
Proinflammatory factors
C-reactive protein
Impaired fasting glucose
Subclinical atherosclerosis
Prothrombotic factors

Front 45

Metabolic syndrome risk factors are:

Back 45

abdominal obesity m>40 in; w>35 in
TG > 150
HDL, men<40, women < 50
BP >130/85
Fasting glucose >100 mg/dL

Front 46

non HDL-C =

Back 46

TC - HDL

Front 47

when pt TG>200 mg/dL
Primary goal is:
secondary goal is:

Back 47

primary: LDL
secondary: non-HDL

Front 48

if pt TG > 500 mg/dL, what is primary goal?

Back 48

reduce TG

Front 49

non-HDL goal for CHD risk equivalent; 2+ risk factor; <2 risk factors

Back 49

<130
<160
<190

Front 50

if TG are elevated, HDL is low, which drugs should be considered?

Back 50

fibrate or niacin with LDL lowering drug (statins)

Front 51

when is non-HDL a necessary secondary target of therapy?

Back 51

if TG > 200 mg/dL

Front 52

What % reduction in LDL is sufficient for LDL lowering therapy?

Back 52

30 -40%