Question 1

Monitoring of a patient who is on a lipid-lowering drug includes:

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:

Accepted Answer

D

Question 3

When considering which cholesterol-lowering drug to prescribe, which factor determines the type and intensity of treatment?

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:

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:

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.

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?

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:

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:

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:

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?

Accepted Answer

Bile acid-binding resins such as cholestyramine and colesevelam can be used in pregnancy as they are not absorbed systemically and do not cross the placenta. They can lower LDL levels by binding to bile acids in the intestine, leading to increased clearance of cholesterol from the body. Statins and fibrates are contraindicated during pregnancy due to possible teratogenic effects on the fetus, and niacin can cause fetal malformations and should also be avoided.

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:

Accepted Answer

Continuing the statin and adding in ezetimibe would be the most appropriate change in therapy for Phil. This would help to further lower his LDL level, while also addressing his elevated triglycerides. Discontinuing the statin and changing to a fibric acid derivative may be effective for lowering triglycerides, but would not address his high LDL level. Discontinuing the statin and changing to ezetimibe would also be an option, but this would leave Phil without a medication to address his high LDL level. Referring him to a specialist may be appropriate if his hyperlipidemia is particularly complex or difficult to manage, but is not necessary at this point.

Question 13

The overall goal of treating hyperlipidemia is:

Accepted Answer

The primary goal of treating hyperlipidemia is to reduce atherogenesis, which is the formation of fatty deposits in the arteries, thereby reducing the risk of cardiovascular diseases.

Question 14

Fiber supplements are great options for elderly patients who have the concurrent problem of:

Accepted Answer

Fiber supplements can be helpful for elderly patients with long-term issues of constipation. They can help add bulk to the stool and promote regular bowel movements. Fiber supplements may not be the best option for patients with end-stage renal failure on fluid restriction or recurrent episodes of diarrhea, as they can exacerbate fluid loss. Additionally, while fiber supplements can be taken alongside other medications, they are not indicated specifically for patients needing to take medications around the clock every 2 hours.

Question 15

First-line therapy for hyperlipidemia is:

Accepted Answer

Lifestyle changes, such as a healthy diet, exercise, and weight management, should always be the first-line therapy for hyperlipidemia. Medications (such as statins, niacin, or bile-acid binding resins) may be used in conjunction with lifestyle changes, but should not be the sole approach.

Question 16

Omega 3 fatty acids are best used to help treat:

Accepted Answer

Omega 3 fatty acids have been shown to be effective in reducing high triglyceride levels, but do not have a significant effect on HDL or LDL cholesterol levels. Therefore, the best choice is C, for high triglycerides.

Question 17

When are statins traditionally ordered to be taken?

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?

Accepted Answer

Someone with a family history of muscle issues when starting on statins may have a genetic predisposition to muscle problems and may be at higher risk for side effects from statin therapy.

Answer: B
 High lipids alone can be an indication for statin therapy regardless of BMI.

Answer: C
 The recent hysterectomy is not a contraindication to starting a statin medication; however, the premenopausal status of the woman may suggest caution in starting the medication due to potential side effects.

Answer: D
 A prediabetic male with metabolic syndrome is a candidate for statin therapy to decrease cardiovascular risk, as long as other medical conditions or contraindications are not present.

Quiz 39: Hyperlipidemia