Dyslipidemia and Cardiac PT Encounters Flashcards
A patient has chest pain and is not in severe repirtory distress or shock.
- The patient has sharp pleuritic pain that radiates to the shoulders and the back.
- The patient reports that they learn forward to relieve the pain.
What is your top Ddx?
Pericarditis
What lipoprotein is this?
Describe the general mechanism for Familial hypercholesterolemia
What are the Lipid effects of statins?
- What is Lymphangitis?
- What is seen on the skin?
- What can result from it?
What are the First drugs of choice to reduce blood-lipid levels? In what order to you give them?
- Statins
-
Least potent first then go down the line
- Simvastatin is least potent so you start them there.
- Pravastatin is MOST potent.
What is the Primary vs. Secondary Endpoint for cholesterol clinical trials
- Primary
- Better Cardiovascular Outcomes
- Secondary
- Lower LDL levels
What are the pros and cons of PCSK9 inhibitors?
Longterm effects are also unknown
- Concerning the 4 main healthy lifestyle changes that people can make to change their lipid profile for the better:
- What are they?
- Which one does not decrease LDL?
A patient has chest pain and is not in severe repirtory distress or shock.
- The patient has atypical angina pain, along with a low risk of coronary artery disase.
What is your top Ddx?
- Pulmonary Embolism
- Mitral Valve Prolapse
- Digestive Pain
- MSK Pain
- Psychogenic Pain
What is Mönckeberg medial sclerosis?
For Thoracic aorta dissection
- What are the essentials for dx?
- How do you dx? How do you classify it?
- What tests do you run?
- What are the associated symptoms?
- How do you manage it?
- include drugs
Describe how size relates to AAA rupture risk
What are the pathological outcomes of varicose veins?
D
Complete each step
Relate pulmonary embolism and DVT
What are the Bile-Acid Sequestrants (BAS)?
What is the channel that Ezetimibe actually blocks?
Describe the multiplicative effects of RFs for Atherosclerosis
What are the two common/concerning tyoes of cardiac related dyspenia?
- Dyspenia Types
-
Orthopenia
- shortness of breath (dyspnea) that occurs when lying flat, causing the person to have to sleep propped up in bed or sitting in a chair.
- Paroxysmal nocturnal dyspnea
- Attacks of severe shortness of breath and coughing that generally occur at night. It usually awakens the person from sleep, and may be quite frightening.
What enzyme is described?
- The response-to-injury hypothesis views atherosclerosis as a chronic inflammatory response of the arterial wall to endothelial injury. According to this model, atherosclerosis results from what process? (Describe the EC injury causes, the role of lipoproteins, platelets, monocytes, SMCs, and macrophages)
Label these
A
If a patient is having palpitations, what would make you immediately suspect that there is underlying arrhythmia?
- If the palpitations occur with syncope or presyncope.
- Known history of cardiac disease
What is Raynaud Phenomenon?
Which apolipoprotein is associated with these?
A
- Where do AAA’s occur?
- What is present in a majority of cases?
A
A
What is Niacin used for?
What are the clinical manifestations of an AAA?
What is Trousseau syndrome?
- Venous thrombi also can result from the elaboration of procoagulant factors from cancers; the resulting hypercoagulable state can manifest as thromboses in different vascular beds at different times, so-called “migratory thrombophlebitis” or “Trousseau syndrome.”
What are the components of Omega-3 Fatty Acids?
What is the name of OTC drug?
How does this plaque relate to the thinning of the vessel wall? What part of the vessel is most thinned, and how does this relate to the location of the plaque?
Describe how age relates to when Atherosclerosis and why MI’s increase in prevalence as PTs get older
If a cell needs cholesterol, what are the two ways that it can get it?
Make it or increase LDL receptors
What are the most used statins and why?
Top two drugs have the highest half-life and decrease LDL the most compared to others.
- What accounts for > 90% of cases of thrombophlebitis and phlebothrombosis - venous thrombosis accompanied by inflammation? What other sites of thrombi can cause this?
- What can cause portal vein thrombosis?
What is this?
D
Describe the historical characteristics of Atherosclerotic plaques
What is shown at each of the two arrows?
- Aorta with severe diffuse complicated lesions, including an ulcerated plaque (open arrow), and a lesion with overlying thrombus (closed arrow).
Which apolipoprotein is associated with chylomicrons and chylomicron remnants?
- Top: chylomicron
- Bottom: chylomicron remnants
What is shown?
Raynaud Phenomenon
What does this image show?
What lipoprotein is this?
Where do fibrates, niacin, and CEPT inhibitors fit into this figure, and what do they do?
- All increase HDL
- CETP inhibitors decrease LDL
What PT history and Symptoms/Signs are associated with Acute arterial occlusion?
What goes on the outer regions of a protein and what goes in the inner regions?
- Outer
- Peripheral proteins
- Phospholipids
- Some nonesterified cholesterol may sick through the phospholipids
- Inner
- Integral proteins
- Cholesteryl-ester
- Triglycerides
What are the ADRs and DDIs for Bile-Acid Sequestrants (BAS)? What do you need to monitor because of the ADRs and DDIs?
Need to stagger doses throughout the day of other oral drugs because of DDIs
What are the Bile-Acid Sequestrants drugs?
COLE-
E
- What are the ADRs subsequent monitoring parameters for Niacin?
- What conditions are contraindicated for Niacine use?
Atheromatous plaques
- What is at the core of these plaques, and what are the covered by?
- How does stenosis, thrombosis, and occlusion relate to these plaques?
What are they DDIs for fibrates?
What are the types of acute arterial Occlusions?
For Abdominal aneurysms
- What are the measurements for it?
- Symptoms?
- Risk factors?
- What are the TRIACYLGLYCEROL carriers?
- What are the CHOLESTEROL carriers?
What are the main drugs/drug types that are used to lower LDL levels?
What is described here?
Primary Raynaud phenomenon
C
(A is for AAA rupture)
What are the tests to confirm an Acute arterial occlusion?
Angiography or want a duplex urltrasound
HDL Mediates the Formation of LDL
What is happening from 1 to 4 in this figure?
What is shown in this vessel wall?
- A Fatty streak, demonstrating intimal, macrophage-derived foam cells (arrows).
For fibrates,
- What are the Laboratory test reactions?
- What are the ADRs?
- What are the Monitoring Parameters?
?Which statins are metabolized by CYP450, 3A4?
SAL
- What location in aortic dissection is associated with the most complications?
- What are the classifications of aortic dissection?
- What are the main cells that contribute to thrombosis, atherosclerosis, and hypertensive vascular lesions?
- What are the main cells that contribute to luminal occlusion?
What is cystic medial degeneration?
***Changes related to factors that cause aneurysms/dissections***
Define Ascites
Colleciton of fluid in the peritoneal cavity
Describe the measurements/locations associated with aortic dissection.
What kind of rupture results in massive hemorrhage or cardiac tamponade?
About ____ % of fatty acids are bound to albumin
What are the pre-2013 guidelines for HDL cholesterol levels that are considered “high risk”?
Describe the process in which inflammation contributes to the initiation, progression, and complications of atherosclerotic lesions.
What are the pre-2013 guidelines for HDL cholesterol levels that are considered “low risk”?
What kind of aneurysm is described?
Circumferential dilations up to 20 cm in diameter; these most commonly involve the aortic arch, the abdominal aorta, or the iliac arteries.
Fusiform aneurysms
What are the statins we need to remember?
My sim got the flu, so I gave them love and roses.
What is the difference between lipedema and lymphodema?
- Lipedema
- Edema from fluid retained in the interstital space by lipids in the dermis
- Lymphodema
- Edema from lymphatic drainage obstruction.
A patient has chest pain and is not in severe repirtory distress or shock.
- The patient has atypical angina pain, along with a high risk of coronary artery disase.
What is your top Ddx?
Myocardial Infarction or Ischemia
- Also think of pulmonary embolism, digestive pain, psychogenic pain.
What is the MOA for statins?
How does ezetimibe work?
- It Inhibits Uptake of Dietary Cholesterol
- Blocks NPC1L1, which is a gut transporter for dietary cholesterol
What is the purpose of the ACAT enzyme?
Convert intracellular cholesterol to the cholesteryl ester
Statins have Extensive first-pass metabolism. How do you get around this?
Prodrugs (Simvastatin and Lovastatin)
What is shown?
- Cross-section of aortic media from a patient with Marfan syndrome, showing marked elastin fragmentation and areas devoid of elastin that resembles cystic spaces (asterisks).