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CPE/CNE QUESTIONS Continuing Pharmacy Education Accreditation The Virginia Council on Pharmaceutical Education is approved by the American Council on Pharmaceutical Education as a provider of continuing pharmacy education. You can achieve 2 contact hours (0.2 CEUs) for the successful completion of this program. Pharmacists who complete an evaluation and pass a posttest with a score of at least 70% will receive continuing education credit. Credit will be awarded until August 31, 2003. ACPE Program ID Number: 155-999-01-055-H01. Continuing Nursing Education Accreditation This educational activity has been approved for 2 contact hours by The Institute for Johns Hopkins Nursing, which is accredited as a provider of continuing education in nursing by the American Nurses Credentialing Center s Commission on Accreditation. Credit will be awarded until August 31, 2003. Instructions After reading this supplement, select the one best answer to each of the following questions. At least 14 of the 20 answers must be correct to receive CPE or CNE credit. Estimated time for this activity is 2 hours. (For CPE test form and evaluation, see page S319. For CNE test form and evaluation, see page S320.) 1. Approximately how many Americans have established coronary heart disease (CHD)? a) 1 million b) 5 million c) 8 million d) 12 million e) 17 million 2. The National Cholesterol Education Program (NCEP) was established to: a) Help physicians identify patients with lipid abnormalities b) Set treatment guidelines for individual patients c) Set treatment guidelines for populations d) a and c only e) a, b, and c 3. New cholesterol guidelines issued by the Adult Treatment Panel (ATP) of the NCEP: a) Define low-density lipoprotein cholesterol (LDL-C) as the primary target for treatment b) Include dietary modification as part of the treatment plan c) Include pharmacologic therapy to reduce LDL-C in patients at risk for CHD d) Differ in their approach to risk assessment 4. The therapeutic lifestyle change recommended by ATP III emphasizes: a) A restriction of saturated fat b) A small-to-moderate restriction of total fat c) The use of dietary adjuncts such as fiber and soy protein d) a, b, and c 5. Which of the following is an example of noncoronary atherosclerosis? a) Peripheral artery disease b) Hypertension c) Obesity d) Type 2 diabetes 6. What is the LDL-C goal recommended by ATP III for patients without CHD, 2 CHD risk factors, and a 10% to 20% risk for a coronary event over the next 10 years? a) < 110 mg/dl b) < 120 mg/dl c) < 130 mg/dl d) < 140 mg/dl e) < 160 mg/dl 7. The risk for a coronary event associated with CHD or a CHD risk equivalent is defined as: a) < 10% over the next 10 years b) 10% to 20% over the next 10 years c) > 20% over the next 10 years d) 10% to 15% over the next 20 years 8. What is the LDL-C goal recommended by ATP III for patients with CHD risk or a CHD risk equivalent? a) < 100 mg/dl b) < 115 mg/dl c) < 125 mg/dl d) < 140 mg/dl e) < 150 mg/dl 9. The therapeutic diet recommended by ATP III restricts the calories from saturated fat to: a) < 5% b) < 7% c) 10% d) 15% e) 20% VOL. 7, NO. 9, SUP. THE AMERICAN JOURNAL OF MANAGED CARE S317

10. Statins reduce LDL-C levels by: a) Reducing cholesterol synthesis b) Lowering intracellular cholesterol c) Stimulating synthesis of the LDL-C receptor d) Increasing the uptake of non high-density lipoprotein cholesterol (HDL-C) particles from the systemic circulation 11. Statins may not be first-line therapy in which of the following patients? a) Patients with active liver disease b) Postmenopausal women with high LDL-C c) Men over the age of 65 with high LDL-C d) Patients with normal triglyceride levels and high cholesterol levels 12. Bile acid resins reduce LDL-C levels by: a) Reducing the recycling of bile acids from the intestine b) Increasing the synthesis of bile acids in the liver c) Reducing cholesterol concentrations in the liver d) a, b, and c 13. Bile acid resins such as colestipol and cholestyramine are associated with: a) Enhanced absorption of fat-soluble vitamins b) Constipation and flatulence c) Bonding to positively charged drugs d) Enhanced absorption with other drugs 14. Colesevelam is a bile acid resin that: a) Reduces LDL-C levels by 15% to 18% b) Is not associated with flatulence or constipation c) Has been shown to be effective both as monotherapy and combination therapy in reducing LDL-C d) Reduces LDL-C when given in combination with simvastatin 15. The clinical features of nicotinic acid include: a) An absence of adverse effects b) No effect on reducing risk for coronary events c) Increases in HDL-C levels d) Increases in triglyceride levels 16. Effective combination regimens to lower both LDL-C and triglyceride levels include: a) A statin and fibrate b) A statin and niacin c) A bile acid resin and niacin d) a and b only e) a, b, and c 17. Large-scale primary- and secondary-prevention trials evaluating various statins have found that: a) These drugs reduce risk for a coronary event by 50% after 5 years of treatment. b) These drugs reduce risk for a coronary event by 10% after 5 years of treatment. c) These drugs reduce risk for a coronary event by 25% to 35% after 5 years of treatment. d) These drugs improve survival but have no effect on morbidity. 18. The Scandinavian Simvastatin Survival Study found that: a) The drug did not reduce the risk for intermittent claudication. b) Treatment was associated with significantly less need for hospitalization compared with placebo. c) The drug did not reduce the risk for carotid bruits. d) The drug did not reduce the risk for cerebrovascular accidents. e) The drug did not reduce the risk for angina. 19. The team management model for the management of patients with dyslipidemia and other CHD risk factors: a) Is driven by guidelines and protocols b) Operates under an established plan of care c) Provides patient education d) Has effective follow-up mechanisms in place 20. The best time interval for a follow-up visit in patients who require aggressive lipid management is: a) 2 weeks after the initiation of drug therapy b) 2 weeks after starting a step II diet c) 4 to 6 weeks after the initiation of therapy d) 3 months after the initiation of drug therapy e) 3 months after starting a step II diet (See following page for evaluation and test form.) S318 THE AMERICAN JOURNAL OF MANAGED CARE AUGUST 2001

Continuing Pharmacy Education Accreditation The Virginia Council on Pharmaceutical Education is approved by the American Council on Pharmaceutical Education as a provider of continuing pharmacy education. You can achieve 2 contact hours (0.2 CEUs) for the successful completion of this program. Pharmacists who complete an evaluation and pass a post-test with a score of at least 70% will receive continuing education credit. Credit will be awarded until August 31, 2003. CPE PROGRAM EVALUATION (155-999-01-055-H01) The Virginia Council on Pharmaceutical Education would like to have your opinion. Please fill out the questionnaire below, tear off along the dotted line, and mail along with your CPE test form. We thank you for your evaluation, which is most helpful. How would you rate this program overall? Excellent Good Fair Poor To what degree has this program improved your knowledge of the subject matter? Extensively Moderately Somewhat Not at all How relevant was the program content to your practice? Very relevant Relevant Somewhat relevant Not relevant How effectively did the program meet the learning objectives? Very effectively Effectively Somewhat effectively Not at all The program was free from undue commercial bias. Strongly agree Agree Disagree Strongly disagree How long did it take you to read the material and respond to the Continuing Pharmacy Education questions? (Please specify the number of hours.) Please send this evaluation, along with your answer sheet, to: Virginia Council on Pharmaceutical Education P.O. Box 980300 Richmond, VA 23298-0300 CPE TEST FORM ACPE Program ID Number: 155-999-01-055-H01 (PLEASE PRINT CLEARLY) Name Home Address City State/ZIP _ Daytime Phone # Social Security # 1. abcde 6. abcde 11. abcde 16. abcde 2. abcde 7. abcde 12. abcde 17. abcde 3. abcde 8. abcde 13. abcde 18. abcde 4. abcde 9. abcde 14. abcde 19. abcde 5. abcde 10. abcde 15. abcde 20. abcde In order to apply for continuing pharmaceutical education credit, please complete this post-program exam and evaluation, include payment in the form of a check made payable to VCPE in the amount of $10, and mail to: Virginia Council on Pharmaceutical Education P.O. Box 980300 Richmond, VA 23298-0300 VOL. 7, NO. 9, SUP. THE AMERICAN JOURNAL OF MANAGED CARE S319

CNE PROGRAM EVALUATION Title of Program: 1. Listed below are the educational objectives. Please rate the extent to which you are now able to meet each of the objectives. Low High I. Assess and manage risk factors associated with hypercholesterolemia. 1 2 3 4 5 II. Discuss cholesterol management guidelines. 1 2 3 4 5 3. Please rate each presenter (and content) on a scale of 1 (low) to 5 (high) for each item: Peter H. Jones, MD Presenter had an effective presentation style Carol M. Mason, RNCS, ANP Presenter had an effective presentation style III. Identify current pharmacologic and nonpharmacologic approaches to treatment. 1 2 3 4 5 IV. Explain the team approach to lipid management in a managed care setting. 1 2 3 4 5 2. The objectives clearly related to the purpose/goals of the activity. 1 2 3 4 5 James M. McKenney, PharmD Presenter had an effective presentation style (PLEASE PRINT CLEARLY) Name Home Address City State/ZIP CNE TEST FORM _ Daytime Phone # Social Security # 1. abcde 6. abcde 11. abcde 16. abcde 2. abcde 7. abcde 12. abcde 17. abcde 3. abcde 8. abcde 13. abcde 18. abcde 4. abcde 9. abcde 14. abcde 19. abcde 5. abcde 10. abcde 15. abcde 20. abcde In order to apply for nursing contact hours, please mark your answers to the post-program exam on this form and complete the evaluation above. Send the completed form along with a check in the amount of $10 to: Jill Carter, Program Assistant The Institute for Johns Hopkins Nursing 525 N. Wolfe Street, #531 Baltimore, MD 21205-2110 Phone: 410-614-1119 S320 THE AMERICAN JOURNAL OF MANAGED CARE AUGUST 2001

... CONTINUING EDUCATION... GOAL To provide comprehensive and up-to-date information concerning developments in the management of cholesterol, including medical treatments and the cost implications to patients, healthcare providers, and society. TARGET AUDIENCE This activity is designed for pharmacists, lipid nurses, managed care decision makers, healthcare policy planners, and pharmacy and therapeutics committee members. LEARNING OBJECTIVES Upon completion of this educational supplement, the participant should be able to: Assess and manage risk factors associated with hypercholesterolemia. Discuss cholesterol management guidelines. Identify current pharmacologic and nonpharmacologic approaches to treatment. Explain the team approach to lipid management in a managed care setting. CONTINUING PHARMACY EDUCATION ACCREDITATION The Virginia Council on Pharmaceutical Education is approved by the American Council on Pharmaceutical Education as a provider of continuing pharmacy education. You can achieve 2 contact hours (0.2 CEUs) for the successful completion of this program. Pharmacists who complete an evaluation and pass a post-test with a score of at least 70% will receive continuing education credit. Credit will be awarded until August 31, 2003. ACPE Program ID Number: 155-999-01-055-H01. CONTINUING NURSING EDUCATION ACCREDITATION This educational activity has been approved for 2 contact hours by The Institute for Johns Hopkins Nursing, which is accredited as a provider of continuing education in nursing by the American Nurses Credentialing Center s Commission on Accreditation. Credit will be awarded until August 31, 2003. FUNDING This program is supported by an unrestricted educational grant from Sankyo Pharma Inc. The contents of this supplement may include information regarding the use of products that may be inconsistent with or outside the approved labeling for these products in the United States. Physicians should note that the use of these products outside current approved labeling is considered experimental and are advised to consult prescribing information for these products. THE AMERICAN JOURNAL OF MANAGED CARE