2018 Lipidology 2% Flashcards
Type I (Chylomicrons)
Contain TGAs
Defect dec’d familial LPL, CII
Skin lesions: eruptive xanthomas*
Type II (LDL)
Contains: LDL
Defect - dec’d LDL recept
Skin lesions: Tendon xanthomas*
Type III (IDL)
Contains: LDL+TGAs
Defect Abnormal APoE
Skin lesions: Palmar/Tuberous Xanthomas (yellowish looking palm)
Type IV (VLDL)
Contains: TGAs
Defect dec’d familial LPL, CII
Skin Lesions: Eruptive Xanthomas
Type V (VLDL+Chylomicrons)
Contains: TGAs
Defect dec’d familial LPL, CII
Skin Lesions: Eruptive Xanthomas
Statins
Primary LDL tx, decr LDL **, decr. TGA, inc’d HDL
S/E - inc’d LFTs, CPK, wt gain, Glucose intolerance
Fibric Acid derivatives
Primary TGA tx (start when TG > 880)
Inc’d /N LDL, dec’d TGA, inc’d HDL
S/E Gallstone, hepatoma
Bile Acid derivatives
Secondary LDL tx
dec’d LDL, TGAs, inc’d HDL
S/E Bloating, constipation, nausea
Nicotinic Acid
Primary HDL, secondary LDL
dec’d LDL, very dec’d TGA, very inc’d HDL
S/E Abd pain, nausesa, flushing, dry skin
Ezetimibe
TGA tx, seconary LDL
dec’d LDL, dec’d TGA
Apo protien E def
Type III
Def of LDL rct’s
Type IIa
Tendon xanthomas
Type IIa
Pancreatitis
Type I, IV, V
Pt with LDL 140, TGA 600 -0 fhx hypertriglyceridemia
Fibrinc acid derivative (gemfibrozil, fenofibrate)
Which reduces fasting TG of 500 in pt with BMI 30
Losing 5-10% of body weight
Palmar Xanthoma
Most likely defect Apo E
xanthoma treatment
- First line = diet
- monounsaturated fats: olive oil, canola, peanut, sunflower oil,
- Omega 3 and 6 fatty acids
- < 200mg chol
- 15% calories from protein
- fiber 20-30g/day
- exercise
- smoking cessation
What do omega 3 fatty acids do
decrease TG
40yo no risk factors for CAD with LDL 175, wtd next
first diet, therapy, exercise
Pt with DM likely has…
inc’d LDL, inc’d TGA, dec’d HDL
Primary target for therapy in DM pt
LDL
What is initial drug for DM pt with LDL 160, TGA 250, HDL 45
Statin
57yo F with MI, quits smoking, changes diet, started on lipitor 40 LDL 180 to 140, TGA 350 to 250, in about 3 months, HDL 48 wtd?
increase atorvastatin to 80
Pt over age 50, LDL 140, CRP more than 2mg - what will dec mortality?
Statin
57yo F with MI, quits smoking, changes diet, started on lipitor 40 LDL 180 to 140, TGA 350 to 250, in about 3 months, HDL 48, you increased lipitor to 80……. now….. 8 wks later with genralized myalgias, CPK 75, AST/ALT 30/40?
statin induced myalgia
Best management - decrease dose of lipitor to 40
now patient tolerated reduced dose but LDL showed less than 50% drop in LDL.. wtd? add extimibe or bile acid sequesterant… if still doesn’t work then add PCSK9 inhibitor
67yo M c/o pain/wk legs, difficulty getting up from seated postion, stpped taking lipitor 3 mo ago after CPK elevated - - repeat CPK 1925 - not much change - mulscel bx necrotizing fibers no inflamm, no vaculole - dx?
Statin induced myopathy 2/2 to HMGCR
Hyperlipidemia in pregnancy
Colesevelam (welchol)
Lipitor 40-> 80 - AST/ALT up but not 2x ULN, LDL now 80 from 180 , HDL now 59 from 40, wtd?
continue current dose.
you decrease statin if LFTs s-5x above normal, and dc if >5x above normal.
40yo M strong fhx prem MI LDL 130, HDL 28, TGA 175 what is elevated?
Lp(a) (dec’d HDL)
tx: Niacin
Prevention of flushing aw Niacin
ASA 30min prior
Pt on simvastatin with weakness CPK 850, wtd
d/c simvastatin
Pt for regular checkup LDL 150 TG 160, HDL 80 wtd?
No need for meds
The MC heritable hyperlipidemia is familial combined hyperlipidemia. the best test would be ..
Apo protein B
eruptive xanthomas.. most likely deficit is
C2 deficiency
