Question 1

Monitoring of a patient who is on a lipid-lowering drug includes:&#10;A) Fasting total cholesterol every 6 months&#10;B) Lipid profile with attention to serum LDL 6 to 8 weeks after starting therapy, then again in 6 weeks&#10;C) Complete blood count, C-reactive protein, and erythrocyte sedimentation rate after 6 weeks of therapy&#10;D) All of the above&#10;

Accepted Answer

Monitoring of a patient who is on a lipid-lowering drug should include lipid profile with attention to serum LDL 6 to 8 weeks after starting therapy, then again in 6 weeks. Fasting total cholesterol every 6 months is not specific enough, and there is no need for complete blood count, C-reactive protein, and erythrocyte sedimentation rate unless clinically indicated.

Question 2

Sharlene is a 65-year-old patient who has been on a lipid-lowering diet and using plant sterol margarine daily for the past 3 months. Her LDL is 135 mg/dL. An appropriate treatment for her would be:&#10;A) A statin&#10;B) Niacin&#10;C) A fibric acid derivative&#10;D) Determined by her risk factors&#10;

Accepted Answer

Determined by her risk factors

Question 3

When considering which cholesterol-lowering drug to prescribe, which factor determines the type and intensity of treatment?&#10;A) Total LDL&#10;B) Fasting HDL&#10;C) Coronary artery disease risk level&#10;D) Fasting total cholesterol&#10;

Accepted Answer

The most important factor in determining the type and intensity of cholesterol-lowering treatment is the patient's overall coronary artery disease risk level. This takes into account factors such as age, sex, smoking status, blood pressure, and diabetes status. Based on this risk level, a healthcare provider can determine whether a patient should receive lifestyle modifications alone or in combination with statin therapy, as well as the appropriate intensity of statin therapy. Total LDL, fasting HDL, and fasting total cholesterol are important lab values to monitor in patients being treated for high cholesterol, but they do not necessarily determine the type or intensity of treatment.

Question 4

When starting a patient on a statin, education would include:&#10;A) If they stop the medication their lipid levels will return to pretreatment levels.&#10;B) Medication is a supplement to diet therapy and exercise.&#10;C) If they have any muscle aches or pain, they should contact their provider.&#10;D) All of the above&#10;

Accepted Answer

All of the options listed are important points to include in a patient's education when starting a statin. Educating the patient about the need to continue taking the medication even if their lipid levels improve and stressing the importance of regular follow-up with their provider are also important points to include in patient education.

Question 5

Before starting therapy with a statin, the following baseline laboratory values should be evaluated:&#10;A) Complete blood count&#10;B) Liver function (ALT/AST) and creatine kinase&#10;C) C-reactive protein&#10;D) All of the above&#10;

Accepted Answer

Liver function tests (ALT/AST) and creatine kinase are recommended before starting statin therapy to assess the risk of hepatotoxicity and myopathy, which are potential side effects of statins.

Question 6

Jose is a 12-year-old overweight child with a total cholesterol of 180 mg/dL and LDL of 125 mg/dL. Along with diet education and recommending increased physical activity, a treatment plan for Jose would include ____________ with a reevaluation in 6 months.

A) Statins
B) Niacin
C) Sterols
D) Bile acid-binding resins

Accepted Answer

Given that Jose is only 12 years old, pharmacological therapies like statins, niacin, and bile acid-binding resins may not be suitable for him due to their potential side effects. Sterols, on the other hand, are plant-derived compounds that can lower cholesterol levels, and are considered generally safe for children. Hence, sterols would be the best choice for Jose's case, along with lifestyle modifications. A reevaluation in 6 months can help determine if his cholesterol levels have decreased or if additional interventions are needed.

Question 7

What is considered the order of statin strength from lowest effect to highest?&#10;A) Lovastatin, Simvastatin, Rosuvastatin&#10;B) Rosuvastatin, Lovastatin, Atorvastatin&#10;C) Atorvastatin, Rosuvastatin, Simvastatin&#10;D) Simvastatin, Atorvastatin, Lovastatin&#10;

Accepted Answer

Lovastatin is considered to have the lowest potency among the options, followed by Simvastatin, with Rosuvastatin being one of the most potent statins available.

Question 8

Joanne is a 60-year-old patient with an LDL of 132 and a family history of coronary artery disease. She has already tried diet changes (increased fiber and plant sterols) to lower her LDL and after 6 months her LDL is slightly higher. The next step in her treatment would be:

A) A statin
B) Niacin
C) Sterols
D) A fibric acid derivative

Accepted Answer

Given Joanne's family history of coronary artery disease and her inability to sufficiently lower her LDL through diet changes, a statin would be the most appropriate next step in treatment. Clinical guidelines generally recommend statin therapy for patients with an intermediate or high risk of cardiovascular disease, which includes individuals with a family history of the condition. Statins are well-established as safe and effective for lowering LDL cholesterol levels and reducing the risk of cardiovascular events. Niacin and fibric acid derivatives may also be considered as adjunct therapies, but are typically not first-line treatments. Sterols are dietary supplements that may help manage cholesterol levels, but are not as potent as medications like statins.

Question 9

Han is a 48-year-old diabetic with hyperlipidemia and high triglycerides. His LDL is 112 mg/dL and he has not tolerated statins. He warrants a trial of a:&#10;A) Sterol&#10;B) Niacin&#10;C) Fibric acid derivative&#10;D) Bile acid-binding resin&#10;

Accepted Answer

Given Han's high triglycerides and inability to tolerate statins, a fibric acid derivative such as gemfibrozil or fenofibrate would be an appropriate choice. Niacin may also be effective in reducing triglycerides and raising HDL, but it can cause significant side effects such as flushing and liver toxicity. Sterols and bile acid-binding resins are not indicated for the treatment of high triglycerides or hyperlipidemia.

Question 10

James is a 45-year-old patient with an LDL level of 120 and normal triglycerides. Appropriate first-line therapy for James may include diet counseling, increased physical activity, and:&#10;A) A statin&#10;B) Niacin&#10;C) Sterols&#10;D) A fibric acid derivative&#10;

Accepted Answer

The answer of James is a 45-year-old patient with an...

Question 11

Jamie is a 34-year-old pregnant woman with familial hyperlipidemia and elevated LDL levels. What is the appropriate treatment for a pregnant woman?&#10;A) A statin&#10;B) Niacin&#10;C) Fibric acid derivative&#10;D) Bile acid-binding resins&#10;

Accepted Answer

The answer of Jamie is a 34-year-old pregnant woman with...

Question 12

Phil is a 54-year-old male with multiple risk factors who has been on a high-dose statin for 3 months to treat his high LDL level. His LDL is 135 mg/dL and his triglycerides are elevated. A reasonable change in therapy would be to:

A) Discontinue the statin and change to a fibric acid derivative.
B) Discontinue the statin and change to ezetimibe.
C) Continue the statin and add in ezetimibe.
D) Refer him to a specialist in managing patients with recalcitrant hyperlipidemia.

Accepted Answer

The answer of Phil is a 54-year-old male with multiple...

Question 13

The overall goal of treating hyperlipidemia is:&#10;A) Maintain an LDL level of less than 160 mg/dL&#10;B) To reduce atherogenesis&#10;C) Lowering apo B, one of the apoliproteins&#10;D) All of the above&#10;

Accepted Answer

The answer of The overall goal of treating hyperlipidemia is:&#10;A)...

Question 14

Fiber supplements are great options for elderly patients who have the concurrent problem of:&#10;A) End-stage renal failure on fluid restriction&#10;B) Recurrent episodes of diarrhea several times a day&#10;C) Long-term issues of constipation&#10;D) Needing to take multiple medications around the clock every 2 hours&#10;

Accepted Answer

The answer of Fiber supplements are great options for elderly...

Question 15

First-line therapy for hyperlipidemia is:&#10;A) Statins&#10;B) Niacin&#10;C) Lifestyle changes&#10;D) Bile acid-binding resins&#10;

Accepted Answer

The answer of First-line therapy for hyperlipidemia is:&#10;A) Statins&#10;B) Niacin&#10;C)...

Question 16

Omega 3 fatty acids are best used to help treat:&#10;A) High HDL&#10;B) Low LDL&#10;C) High triglycerides&#10;D) Any high lipid value&#10;

Accepted Answer

The answer of Omega 3 fatty acids are best used...

Question 17

When are statins traditionally ordered to be taken?&#10;A) At bedtime&#10;B) At noon&#10;C) At breakfast&#10;D) With the evening meal&#10;

Accepted Answer

The answer of When are statins traditionally ordered to be...

Question 18

Which the following persons should not have a statin medication ordered?&#10;A) Someone with 3 first- or second-degree family members with history of muscle issues when started on statins&#10;B) Someone with high lipids, but low BMI&#10;C) Premenopausal woman with recent history of hysterectomy&#10;D) Prediabetic male with known metabolic syndrome&#10;

Accepted Answer

The answer of Which the following persons should not have...

Deck 39: Hyperlipidemia