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05 Endo > Dyslipidemia > Flashcards

Dyslipidemia Flashcards

1
Q

three components of total cholesterol

A

LDL, HDL, TAGs

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2
Q

t/f we treat total cholesterol

A

F, we treat components of tc. high hdl doesnt need to be treated

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3
Q

management of ldl

A

ldl apharesis for familial hypercholesterolemia - take blood and drain ldl then return blood

lifestyle changes (3 mos.)

medical therapy (statins, ezetimibe, pcsk-9)

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4
Q

source of tags

A

carbohydrates – make sure to tell patient what not to eat to lower tags (dont eat carbs)

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5
Q

ldl classification for serum tags

A

normal <150
borderline high 150-199
high 200-499
very high >/=500

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6
Q

when to start tag therapy

A

very high levels, other levels are diet and lifestyle modifications

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7
Q

causes of elevated tags

A

modifiable factors, t2dm, chronic renal failure, nephrotic syndrome, drugs, genetic dyslipidemias

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8
Q

drug of choice/treatment for elevated tags

A

lifestyle changes*, fenofibrate, omega fatty acids

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9
Q

hdl levels

A

> 50 mg/dl for women

>40 mg/dl for men

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10
Q

t/f larger lipoproteins have higher tendency to go underneath subendothelial lining in blood vessels

A

f, smaller lipoproteins have higher tendency

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11
Q

signaling molecules on the surface of molecules

A

APO A-I OR AII - anti atherogenic in hdl (friendly)
APO B100 - pro-atherogenic found in ldl and vldl (can cause atherosclerosis)
APO B-48 - benign found in cms

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12
Q

exogenous lipoprotein pathway

A

dietary cholesterol and tags enter through intestine
1st byproduct: CMs
2nd byproduct: cm remnants

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13
Q

endogenous lipoprotein pathway

A

cm remnants enter liver
1st byproduct: vldl
2nd by product: idl
3rd byproduct: ldl (can become atherosclerotic plaques)

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14
Q

low cv risk ldl

A

score <1%

goal: <116 mg/dl (3.0 mmol/l)

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15
Q

moderate cv risk

A

score >/=1% and < 5%
young patients with dm duration <10 years without other risk factors

goal: <100 mg/dl (2.6 mmol/l)

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16
Q

high risk

A

score >/=5% and <10%
tc >8 mmol/l (310 mg/dl) OR ldl >4.9 mmol/l (190 mg/dl) OR BP >/= 180/110
familial hypercholesterolemia without other risk factors
moderate ckd (gfr 30-59)
dm >/= 10 years, no organ damage

goal: <70 or 50 mg/dl (1.8 mmol/l)

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17
Q

very high risk

A 
score >/= 10%
ascvd
fh with ascvd
severe ckd (<30)
dm with organ damage
>/= 3 major risk factors
long duration t1dm

goal; <55 mg/dl
>/=50% reduction from baseline (1.4 mmol/l)

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18
Q

four statin benefit groups

A

clinical atherosclerotic cvd
t1/t2dm, 40-75 yo, ldl 70-189 mg/dl
nondiabetics, 40-75, ldl 70-189 mg/dl
ldl >/= 190

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19
Q

therapy for clinical atherosclerotic cvd

A

high intensity statin therapy

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20
Q

therapy for t1/t2dm, 40-75 yo, ldl 70-189 mg/dl

A

10 yr risk for ascvd

risk <7.5% moderate intensity statin therapy
risk >/= 7.5% high intensity statin therapy

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21
Q

therapy for nondiabetic, 40-75 yo, ldl 70-189 mg/dl

A

10 yr risk for ascvd

> /=7.5% moderate to high intensity statin therapy

22
Q

therapy for ldl >/= 190 mg/dl

A

high intensity statin therapy (may have fh)

23
Q

____ has emerged as one of the major risk factors for cv events

A

mixed dyslipidemia or atherogenic dyslipidemia

24
Q

triad of atherogenic dyslipidemia

A

elevated tags >/=150 mg/dl
near normal ldlc >/= 120 mg/dl
diminished hdlc men < 40 mg/dl, women <50 mg/dl

25
Q

atherogenic dyslipidemia in insulin resistance

A

page 5

26
Q

t/f diabetics with low ldl actually have low ldl

A

f, they have smaller denser ldl that can’t be measured

27
Q

____ can be removed from hdl in diabetics

A

apo a-I

28
Q

when apo a-I is removed in hdl it becomes ___

A

vldl

29
Q

t/f when diabetics have low hdl, the treatment is not to give hdl cholesterol

A

t, hdl cholesterol can lose its apo a-I and become vldl, and then become small, dense ldl

30
Q

eas/esc recommendation for treatment of dyslipidemia in T2DM AT VERY HIGH RISK

A

ldl-c reduction of >/= 50% from baseline

ldl-c goal of < 1.4 mmol/l (<55 mg/dl)

31
Q

eas/esc recommendation for treatment of dyslipidemia in T2DM AT HIGH RISK

A

ldl-c reduction of >/= 50% from baseline

ldl-c goal of < 1.8 mmol/l (<70 mg/dl)

32
Q

eas/esc recommendation for treatment of dyslipidemia in T1DM who are high/very high risk

A

statins

33
Q

if the ldl goal in diabetics is not reached, statin combination with ____ should be considered

A

ezetimibe

34
Q

genetics in familial hypercholesterolemia

A

lof mutation in ldlr
lof in apob
gof in pcsk9

35
Q

clinical presentation for familial hypercholesterolemia

A

elevated ldl-c (> 190/mg/dl) and premature cad

36
Q

in fh, _____ are dysfunctional

A

ldl receptors

37
Q

how to compute for cumulative ldl-c burden

A

circulating ldl-c x years of exposure

38
Q

ldl levels for hefh/hofh

A

hefh: ~200 mg/dl
hofh: ~750 mg/dl

39
Q

age of onset for hefh/hofm

A

hefh: atherosclerosis 60 yo, mi 30 yo
hofh: 2 yo/10 yo

40
Q

arcus cornealis

A

fat deposits in eye

starts as small visible white crescent and can become a corneal ring

more specific in individuals < 45 yo

41
Q

esc/eas guidelines for management of fh

A

50% reduction of ldl-c
<1.4 mmol/< 55 mg/dl ldl-c
not achieved: statin + ezetimibe
still not achieved: pcsk9 inhibitor

42
Q

statin moa

A

reduces synthesis of cholesterol in liver by competitively inhibiting hmg-coa reductase activity

43
Q

cholesterol absorption inhibitor (ezetimibe) moa

A

inhibits npc1l1 protein in intestine so there is not cholesterol absorption –> liver will upregulate ldlr to absorb ldl in blood

44
Q

pcsk9 inhibitor moa

A

inhibits the breakdown of ldl-r –> ldl-r can still work and absorb ldl from blood

45
Q

indication for psck9 inhibitors

A

when oral therapy is exhausted and patient is still having strokes/heart attacks

46
Q

primary statins for high intensity therapy

A

atorvastatin, rosuvastatin

> /= 50% reduction

47
Q

primary statins for mod intensity therapy

A

atorvastatin, rosuvastatin, simvastatin

30-49% reduction

48
Q

primary statins for low intensity therapy

A

simvastatin

<30% reduction

49
Q

other drugs for combination therapy

A

for intolerance to statins

fibrates, omega-3 fatty acids, ezetimibe

50
Q

drug of choice for diabetic patients with atherogenic dyslipidemia

A

statins

51
Q

t/f all dms regardless of their baseline ldl-c should be on statin therapy

A

t, primary treatment is treating the dm + statin therapy

52
Q

drug of choice for hdl

A

lifestyle modification

05 Endo (16 decks)

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