Pathophysiology
This particle plays a role in maintaining the consistency of the cell membrane
What is cholesterol?
This is the amount of weight loss recommended in overweight patients with lipid abnormalities.
What is 10% weight loss?
This is the most appropriate therapy for a 64-year-old patient without a history of diabetes or ASCVD and a 10-year ASCVD risk score of 15.6%.
A. Pravastatin 20 mg daily
B. Rosuvastatin 10 mg daily
C. Atorvastatin 40 mg daily
D. Pitavastatin 1 mg daily
What is B. rosuvastatin 10mg daily
Moderate intensity statin for primary prevention with a 10-year ASCVD score
The LDL cholesterol optimal concentration
What is <100mg/dL?
This is the lipoprotein with the most lipid content and least protein.
What is chylomicron?
These three elements need to be minimized or eliminated from your diet to improve dyslipidemia.
What are saturated fats, excessive carbohydrates, and alcohol?
The brand name of this lipid lowering agent is Zetia
What is Ezetimibe?
The following patient is at the highest risk for ASCVD.
A. 35-year-old with high blood pressure
B. 47-year-old with type 2 diabetes mellitus
C. 59-year-old with heart failure
D. 68-year-old with a history of MI and hypertension
What is patient D?
Very-high ASCVD--has more than 2 ASCVD events or 1 major ASCVD event and more than 2 high-risk conditions; had a major event (MI), and has 2 high-risk conditions (over 65 & HTN)
A 65-year-old woman with T2DM, HTN, osteoporosis, and Afib has a BP of 152/93 mmHg (150/90 mm Hg when repeated), HR of 70 beats/min, K of 3.3 mEq/L (mmol/L), and a SCr of 2.3 mg/dL (203 µmol/L). She has an “allergy” to hydrochlorothiazide (severe gout). Presently, she is on verapamil CD 480 mg PO QD.
This drug would be the most appropriate to add to her regimen.
A. Chlorthalidone 12.5 mg daily
B. Amlodipine 5 mg daily
C. Atenolol 25 mg daily
D. Valsartan 160 mg daily
What is D. valsartan
On CCB cannot add amlodipine (another CCB); BB not preferred for BP and HR in range; Chlorthalidone is similar to HCTZ that she has an allergy to; K is on the lower end
Water soluble carrier proteins packed with different lipid molecules
What are lipoproteins?
These are the 4 statin benefit groups or patient management groups based on the guidelines.
What are: secondary prevention; severe hypercholesterolemia (LDL>190); diabetes in adults; primary prevention?
This lipid lowering agent can lower LDL levels by 30-49%.
What is a moderate intensity statin?
An 80-year-old Black man has a PMH of hypertension for 10 years. His BP is 158/82 mmHg, heart rate is 73 bpm, SCr is 1.2 mg/dL, an eGFR 58 mL/min/1.73m2, and K is 4.3 mEq/L (mmol/L). He weighs 93 kg, is 67″ (170 cm) tall. He smokes one-half packs of cigarettes daily, and drinks 2 to 3 times a week.
He is adherent with Lotensin 40 mg PO QD and Norvasc 10 mg PO QD.
The following lifestyle changes would most likely produce the greatest decrease in BP.
A. Weight loss of 5 kg
B. Smoking cessation
C. Decrease dietary sodium by 500 mg/day
D. Decreasing alcohol consumption by 50%
What is A?
Weight loss is the most likely to result in the greatest BP lowering, particularly considering the patient is obese (his BMI is ≥ 30 kg/m2).
Smoking- addresses ASCVD risk not weight
Sodium- not enough
Alcohol- not at max
The following is preferred as initial antihypertensive therapy for a 63-year-old woman with HTN and a history of ischemic stroke (6 months ago), with a BP of 186/108 mmHg (184/106 mm Hg when repeated).
A. A thiazide with an ACEi
B. A thiazide with a nonselective β-blocker
C. A thiazide alone
D. An ACEi with an ARB
What is A?
Thiazide as monotherapy preferred after stroke or it with an ACEi if additional therapy needed--thiazide alone is not enough to lower BP for this pt
This is irreversible and the rate limiting step in cholesterol synthesis
What is the conversion of HMG-CoA into mevalonic acid and cholesterol via HMG-CoA reductase?
These 4 conditions are considered major ASCVD events that put patient at very high risk.
What are: recent ACS (within 12 months), MI, ischemic stroke, PAD?
An 80-year-old Black man has a PMH of hypertension for 10 years. His BP is 158/82 mmHg, heart rate is 73 bpm, SCr is 1.2 mg/dL, an eGFR 58 mL/min/1.73m2, and K is 4.3 mEq/L (mmol/L). He weighs 93 kg, is 67″ (170 cm) tall. He smokes one-half packs of cigarettes daily, and drinks 2 to 3 times a week.
He is adherent with Lotensin 40 mg PO QD and Norvasc 10 mg PO QD.
This is the most appropriate medication to add to his antihypertensive regimen?
A. Verapamil
B. Irbesartan
C. Chlorthalidone
D. Metoprolol succinate
What is C. Chlorthalidone?
The patient has uncontrolled hypertension
Goal of <130/80 mm Hg is appropriate
He is already on two first-line agents with an ACEi and a dihydropyridine CCB. The most appropriate addition to his current therapy would be a thiazide diuretic
A thiazide-type diuretic is a first-line agent for this patient who has no other compelling indications for specific antihypertensive drug therapy, and should be effective in lowering BP as an addition to his current regimen.
Already on another non-D
ACE/ARB combination
The Friedewald equation
What is TC - (HDL + TG/5)?
The following is preferred as add-on therapy for a patient who is post-MI (3 months ago) with a BP of 136/88 mm Hg (134/86 mm Hg when repeated) while treated with metoprolol succinate 200 mg daily
A. Chlorthalidone
B. Verapamil
C. Amlodipine
D. Lisinopril
What is D?
**post MI 3 months**== stable ischemic heart disease
On Beta-blocker first line for post-MI, preferred add on is ACE-i and ARB. Other options have impact on BP but not strong indication for stable ischemic heart disease
The production of this is affected by estrogen levels in the body
What is apolipoprotein A-1?
A 67 year old male with history of MI, DM and HTN who is already on a high intensity statin has an LDL of 85mg/dL. Is there a need for intervention and if so, what do you recommend?
Add ezetimibe to max statin (secondary prevention, very high risk, LDL>70)
These two drugs are part of the PCSK-9 inhibitors class.
What are Evolocumab and Alirocumab?
In a female patient, presence of TG of _________ in combination with waist circumference of _________ and blood glucose of ______ will indicate metabolic syndrome.
What is TG ≥ 175 mg/dL, waist circumference of ≥ 88 cm and BG ≥ 100mg/dL?
TP is a 68-year-old female with PAH. The patient describes worsening symptoms lately. The patient used to be able to walk the dog around the block but is no longer able to do so without feeling exhausted. The patient feels shortness of breath and fatigue even when resting in a recliner. Upon assessment, the patient is categorized as high risk and is currently treated with sildenafil 40 mg orally three times daily. This agent is the most appropriate to add now.
A. Epoprostenol
B. Ambrisentan
C. Riociguat
D. Selexipag
What is A. epoprostenol?
Patient is on sildenafil which is contraindicated with riociguat (additive risk of hypotension). Patient is high-risk so in need of parenteral therapy like a prostacyclin analog (epoprostenol). Oral therapy like ambrisentan and selexipag not preferred for high risk