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Pharmacology · chapter 21 · Lipid-Lowering Drugs

Introduction to Lipoprotein and Apolipoproteins

The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 6 practice questions with the reasoning.

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Key points

  1. What cholesterol is for

    Cholesterol is important for the structure of cell membranes and for the production of hormones, bile acids, and vitamin D.

  2. High cholesterol is often silent

    Many individuals with hypercholesterolemia have no symptoms; the diagnosis is made by monitoring their lipid panel.

  3. Familial hypercholesterolemia

    Familial hypercholesterolemia is a genetic disorder that manifests as very high cholesterol levels that can cause early cardiovascular disease.

  4. Homozygous form starts in childhood

    Clients with two copies of the gene have homozygous familial hypercholesterolemia. This is a much more severe form of the disease and manifests during childhood.

  5. Physical signs of familial disease

    Some of the signs and symptoms of familial hypercholesterolemia are bumps or lumps around the knees, knuckles, or elbows; swollen or painful Achilles tendon; yellowish areas around the eyes; and a whitish-gray color in the shape of a half-moon on the outer edge of the cornea, which are lipid deposits called arcus senilis (Centers for Disease Control and Prevention, 2020).

  6. What drives atherosclerosis

    Triglycerides carried by VLDL and LDL-cholesterol are mediators of atherosclerosis development.

  7. Bad and good cholesterol

    Therefore, LDL-cholesterol is often called “bad cholesterol.” HDL-cholesterol, on the other hand, is often called “good cholesterol” because it does not contribute to atherosclerosis; in fact, it removes cholesterol from the blood (Grundy et al., 2019).

  8. What a lipid panel measures

    A lipid panel measures LDL-cholesterol, HDL-cholesterol, and triglycerides. It also measures the total cholesterol level.

  9. HMG CoA reductase as a drug target

    Cholesterol is synthesized via an enzyme called HMG CoA reductase, which is a key drug target in lipid-lowering therapy.

  10. PCSK9 as a drug target

    A protein called PCSK9 interacts with the LDL receptors, leading to their degradation; this is another important drug target in lipid-lowering therapy.

  11. How plaque causes a heart attack

    Rupture of the fibrous plaque can cause a thrombus, or blood clot, to form at the site, possibly resulting in complete arterial occlusion and acute myocardial infarction.

  12. LDL is an independent risk factor

    Because of this pathophysiology, hypercholesterolemia due to elevated LDL-cholesterol is an independent risk factor for heart disease. Lipid-lowering therapy that targets LDL-cholesterol is used to decrease the risk for CAD.

  13. When triglycerides are treated

    Therefore, hypertriglyceridemia is generally not treated unless it is very severe (greater than 500 mg/dL), which can put the individual at risk for pancreatitis.

  14. Lifestyle changes come first

    In general, lifestyle changes are considered the first-line therapy to treat dyslipidemia and prevent CAD.

Terms to know

Dyslipidemia
Dyslipidemia is the general term to describe abnormal lipid levels or an imbalance of lipids in the blood.
Hyperlipidemia
Hyperlipidemia refers to excessive serum levels of lipids.
Lipoproteins
Lipoproteins Lipoproteins are combinations of lipids and proteins that carry cholesterol and triglycerides in the blood.
Chylomicrons
Chylomicrons are lipoproteins produced by enterocytes in the gut.
Atherosclerosis
Atherosclerosis refers to the formation of fatty material, called plaques, on inner arterial walls.

Practice questions

Stuck on select-all-that-apply? How to take them one option at a time.

The graded version needs JavaScript. Every question is below anyway, with the answer and why.

Every question here, with the answer

  1. A client asks why the provider ordered a lipid panel when the client feels fine. What is the nurse's best response?

    1. Many people with high cholesterol have no symptoms, so it is found by checking a lipid panel.
    2. High cholesterol always causes chest pain first.
    3. The test is used to measure blood sugar.
    4. A lipid panel is only done when there are symptoms.

    Answer: Many people with high cholesterol have no symptoms, so it is found by checking a lipid panel.

    Many people with hypercholesterolemia have no symptoms, so the diagnosis is made by monitoring the lipid panel. It does not always cause chest pain and does not measure blood sugar.

  2. A client's lipid panel shows a high HDL-cholesterol level. The client is worried. How should the nurse explain this result?

    1. High HDL increases the risk of pancreatitis.
    2. HDL is called good cholesterol because it helps remove cholesterol from the blood.
    3. HDL is the same as LDL.
    4. High HDL causes plaque in the arteries.

    Answer: HDL is called good cholesterol because it helps remove cholesterol from the blood.

    HDL-cholesterol does not contribute to atherosclerosis and removes cholesterol from the blood, so higher levels are beneficial. LDL, not HDL, drives plaque, and pancreatitis risk relates to very high triglycerides.

  3. A nurse is assessing a young adult with suspected familial hypercholesterolemia. Which findings support this condition? Select all that apply.

    1. A swollen or painful Achilles tendon
    2. A barrel-shaped chest
    3. Lumps around the knuckles or elbows
    4. A half-moon whitish-gray ring at the edge of the cornea
    5. Yellowish areas around the eyes

    Answer: A swollen or painful Achilles tendon, Lumps around the knuckles or elbows, A half-moon whitish-gray ring at the edge of the cornea, Yellowish areas around the eyes

    Lumps around joints, a swollen or painful Achilles tendon, yellowish areas around the eyes and arcus senilis are listed signs of familial hypercholesterolemia. A barrel chest is not mentioned.

  4. A client has a triglyceride level of 620 mg/dL. Which complication should the nurse recognise as the main concern?

    1. Pancreatitis
    2. Arcus senilis
    3. Hypoglycemia
    4. Vitamin D deficiency

    Answer: Pancreatitis

    Very severe hypertriglyceridemia, greater than 500 mg/dL, can put the client at risk for pancreatitis, which is why it is treated at that level. The other options are not linked to high triglycerides in the section.

  5. A client with high LDL-cholesterol asks what a heart-healthy diet includes. Which foods should the nurse recommend the client limit? Select all that apply.

    1. Whole grains
    2. Red meats
    3. Sugar-sweetened beverages
    4. Legumes
    5. Dairy products made from whole milk

    Answer: Red meats, Sugar-sweetened beverages, Dairy products made from whole milk

    Clients should limit sweets, sugar-sweetened beverages, red meats, saturated and trans fats, and whole-milk dairy. Whole grains and legumes are foods clients should eat.

  6. A client newly diagnosed with high cholesterol asks what the first step in treatment usually is. What should the nurse say?

    1. Nothing, because cholesterol does not affect the heart
    2. Lifestyle changes such as a heart-healthy diet
    3. Starting several drugs at once
    4. Surgery to remove plaque

    Answer: Lifestyle changes such as a heart-healthy diet

    Lifestyle changes are considered first-line therapy to treat dyslipidemia and prevent CAD. Surgery and multiple drugs are not the first step, and elevated LDL is an independent risk factor for heart disease.

Where every quote comes from

Section 21.1 Introduction to Lipoprotein and Apolipoproteins of Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris, Dorie Weaver, OpenStax, 2024. Read the whole section free at openstax.org.

The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.