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PANCE 2.0 > Cardiology #4 (Hyperlipidemia) > Flashcards

Cardiology #4 (Hyperlipidemia) Flashcards

1
Q

What is the difference between hypertriglyceridemia and hypercholesterolemia?

A

Hypertriglyceridemia: elevated triglycerides or VLDL, or both
Hypercholesterolemia: elevated LDL

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2
Q

What are the three MC etiologies of hypercholesterolemia?

A
  • Pregnancy
  • Hypothyroidism
  • Kidney failure
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3
Q

What are common etiologies of hypertriglyceridemia?

A
  • DM
  • ETOH
  • obesity
  • steroids
  • estrogen
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4
Q

What are some clinical manifestations of hyperlipidemia?

A
  • Most patients are asymptomatic; however, hypertriglyceridemia may cause pancreatitis
  • May develop Xanthomas - fat buildup under the skin (Achilles tendon) or Xanthelasma (lipid plaques on eyelids)
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5
Q

Explain what the American College of Cardiology/American Heart Association recommends for screening for hyperlipidemia

A

Higher risk = > 1 risk factor (smoking, hypertension, family history) or 1 severe risk factor. Initiate screening at age 20-25 for males; 30-35 for females.

Lower risk: initiate screening at 35 for males, 45 for females.

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6
Q

What are the 5 Lipid Guidelines for initiating a statin therapy?

A

1) Type 1 or Type 2 DM between ages of 40-75
2) Without cardiovascular risk ages 40-75 and > 7.5% risk for having a heart attack or stroke within 10 years
3) People > 21 with LDL levels > 190 mg/dL
4) Any form of clinical atherosclerotic cardiovascular disease
5) < 19 years old with familial hypercholesterolemia

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7
Q

What is the best medication type to lower elevated LDL levels?

A

Statin

Bile Acid Sequestrants

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8
Q

What is the best medication type to lower elevated triglycerides?

A

Fibrates

Niacin

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9
Q

What is the best medication type to increase HDL?

A

Niacin, Fibrates

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10
Q

If the patient has Type II Diabetes, what medication should be given for cholesterol?

A

Statins, Fibrates

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11
Q

What is the mechanism of action of statins?

A

Inhibits the rate-limiting step in hepatic cholesterol synthesis via inhibition of the enzyme HMG-CoA reductase.

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12
Q

What are some adverse effects of statins?

A
  • Muscle damage (myositis, myalgias, rhabdomyolysis)
  • Increased LFT, hepatitis (MC)
  • GI symptoms
  • Diabetes Mellitus
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13
Q

What are some contraindications of statins?

A
  • Pregnancy
  • Persistently elevated LFTs
  • Breastfeeding
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14
Q

Nicotinic acid (Niacin) has an MOA of

A

Increases HDL (delays HDL clearance). Decreases hepatic production of LDL and VLDL. Decreases triglycerides

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15
Q

True or False: Niacin is the best drug to increase HDL levels?

A

True

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16
Q

Adverse effects of Niacin

A
  • Increased prostaglandins (flushing, warm sensation, pruritus, headache)
  • Dry skin, hyperglycemia, GI symptoms (reduced if taken with meals)
17
Q

What can be given prophylactically to reduce the flushing of Niacin?

A

NSAIDs or Aspirin

18
Q

What are two fibrates?

A
  • Fenofibrate

- Gemfibrozil

19
Q

What is the MOA of fibrates?

A

-Inhibit triglyceride synthesis, increase the activity of lipoprotein lipase

20
Q

Best drug to decrease triglycerides?

A

Fibrates

21
Q

Adverse effects of fibrates

A
  • Increased gallstones
  • GI symptoms
  • Headache
  • Dizziness
  • Myalgias, myositis
22
Q

What is the ONLY fibrate FDA approved to be used in combination with a statin?

A

Fenofibric acid

23
Q

Name three bile acid sequestrants

A

Cholestyramine
Colestipol
Colesevelam

24
Q

MOA of bile acid sequestrants

A
  • Binds bile acid in the intestine, blocking reabsorption of bile acids
  • Liver has to make new bile acids, so this reduces LDL receptors
  • Decreases LDL levels
25
Q

Name some facts about bile acid sequestrants

A
  • Used in combination with statins to reduce LDL levels
  • Safe in pregnancy
  • Cholestyramine is used to treat pruritus associated with biliary obstruction
26
Q

Adverse effects of bile acid sequestrants

A
  • GI side effects
  • Increased triglyceride levels
  • Osteoporosis with long-term use
27
Q

Bile acid sequestrants may impair absorption of what other medications?

A
  • Antibiotics
  • Digoxin
  • Warfarin
  • Fat-soluble vitamins

Therefore, take these medications 1 hour before or 4 hours after bile acid sequestrants

28
Q

Ezetimibe inhibits intestinal cholesterol absorption. It is often used with a statin to reduce LDL levels. What are some adverse effects?

A
  • Headache
  • Diarrhea
  • Increased LFTs (especially with statin use)

PANCE 2.0 (62 decks)

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