Question 1

Mike is a 47 year old who has been on standard dose atorvastatin for 3 months and his repeat LDL is 124 mg/dL.He is a smoker and has a strong family history of cardiovascular disease.His treatment plan would include reinforcing diet,exercise,plant sterol intake,and:

A) Increasing his dose of atorvastatin
B) Changing to another statin
C) Adding niacin to the treatment regimen
D) Adding a bile acid-binding resin

Accepted Answer

Increasing the dose of atorvastatin is a common approach when LDL levels are not adequately controlled, especially in a patient with additional risk factors like smoking and family history of cardiovascular disease.

Question 2

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

In patients with persistently elevated LDL levels despite statin therapy, the addition of ezetimibe is recommended before switching to a different class of medications. Fibric acid derivatives are primarily used to lower triglyceride levels, and ezetimibe has been shown to significantly lower LDL levels when added to statin therapy. Referral to a specialist may be considered in cases where the patient has complex medical history or has not responded well to multiple therapies.

Question 3

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

Sterols

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 4

When starting a patient on a statin,education would include:&#10;A) If they stop the medication their lipid levels will return to pre-treatment 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

Accepted Answer

All of the choices are correct for education when starting a patient on a statin. It is important for patients to know that the medication is not a cure-all and should be used in conjunction with a healthy diet and exercise. Additionally, patients should be aware of the potential side effect of muscle aches and pains, which should be reported to their provider. Finally, patients should know that stopping the medication can result in a return of elevated lipid levels.

Question 5

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

Accepted Answer

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

Question 6

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 CK&#10;C) C-reactive protein&#10;D) All of the above

Accepted Answer

Liver function tests (ALT/AST) are recommended to establish a baseline before starting statin therapy due to the potential for liver-related side effects. CK (creatine kinase) may be checked if there is a risk of muscle-related side effects.

Question 7

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

Accepted Answer

Lifestyle changes such as diet modifications and increasing physical activity should always be the first-line therapy for hyperlipidemia. Statins may also be initiated if lifestyle changes alone are not effective or if a patient has a very high risk of cardiovascular disease. Niacin and bile acid-binding resins are typically considered second-line therapies.

Question 8

James is a 45 year old 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

Accepted Answer

The answer of James is a 45 year old with...

Question 9

Joanne is a 60 year old 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

Based on Joanne's age and LDL level, as well as her family history of coronary artery disease, a statin would be the appropriate next step in her treatment according to current guidelines. Niacin and fibrates have shown mixed results in reducing the risk of cardiovascular events, and plant sterols have already been tried without significant success.

Question 10

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,CRP,and ESR after 6 weeks of therapy&#10;D) All of the above

Accepted Answer

Lipid profile with attention to serum LDL 6 to 8 weeks after starting therapy then again in 6 weeks is the most appropriate for monitoring a patient who is on a lipid-lowering drug. While fasting total cholesterol can be useful, it does not provide information about the specific type of lipids being affected by the medication. Complete blood count, CRP, and ESR are not directly related to lipid-lowering therapy and are not necessary for routine monitoring.

Question 11

Sharlene is a 65 year old 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

Accepted Answer

The answer of Sharlene is a 65 year old who...

Question 12

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

Accepted Answer

The answer of When considering which cholesterol-lowering drug to prescribe...

Question 13

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

Accepted Answer

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

Question 14

Scott is presenting for follow up on his lipid panel.He had elevated total cholesterol,triglycerides,and an LDL of 122 mg/dL.He has already implemented diet changes and increased physical activity.He has mildly elevated liver studies.An appropriate next step for therapy would be:

A) Atorvastatin (Lipitor)
B) Niacin (Niaspan)
C) Simvastatin and ezetimibe (Vytorin)
D) Gemfibrozil (Lopid)

Accepted Answer

The answer of Scott is presenting for follow up on...

Question 15

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

Accepted Answer

The answer of Han is a 48-year-old diabetic with hyperlipidemia...

Deck 39: Hyperlipidemia