Exam4 Hyperlipidemia Flashcards
high HDL is..
cardioprotective. can cancel out high ldl
risk of MI inc. 25% for every…
%5 decrease of HDL
HDL increased by…
work out, drink, estrogen
HDL decreased by…
HyperTAG, tobacco, obesity, roids.
2 main lipids in blood…
Cholesterol, Triglycerides
Cholesterol forms
backbone of steroid hormones and bile acids
Triglycerides transfer
energy from food into cells
lipoproteins carry both
triglycerides and cholesterol
Higher lipid content= lower the density. Order high to low lipid content (Cody Very Large Head)
Chylomicrons, VLDL, LDL, HDL
Chylomicrons, via diet fat, energy from food—> muscle and fat cells
portal vein—>liver, thoracic duct—-> circulation
VLDL, liver makes it from fat/carbs stores. Made mostly of..
TAG
VLDL—> LDL
LDL is ‘bad’ cholesterol
bad cholesterol because…
LDL mostly taken up by liver (becomes bile), while LDL in arteries leads to atherosclerosis
Familial Hypercholesterolemia…
defect in LDL receptor
LDL cholesterol where is makes cell membrane and bile acid
yucky
Reduce LDL, lower chol. synth via…
HMG-CoA reductase inhibitor STATINS
Reduce LDL, inc. cholesterol excretion via…
bile acid sequestrants block resorption, poop out cholesterol
Reduce LDL, reduce chol. absorption
Plant stanol esters, Ezetimibe
HDL made in liver and intestines, does what?
Reverse cholesterol transport (Transfer chol into other lipoproteins or into liver)
Net cholesterol balanced by 3 systems…
extrahepatics, liver, intestines
cholesterol balance…
chol. synth/absorption vs. chol. excretion
Fasting lipid panel (not for pregnant pt.)
TAG affected by eating, cholesterol is not
Desired level for TOTAL Cholesterol=
< 200
Best level for TAG=
< 150
< 100=
Best level for LDL, but you want <70 if CAD or DM!!
HDL levels: What’s high? low?
60+ is High, <40 Low
Low LDL can suggest…
AIDS, liver disease, Hyperthyroid, Chronic Anemia, etc. LOW LDL NOT ALWAYS GOOD
Checking w/ 12 hour fast, HyperTAG=
obesity, DM, lover disease, EtOH, Accutane
pancreatitis, eruptive skin xanthomas
HyperTAG >1000
Familial Hypercholesterolemia (absent LDL receptors)=
Early CHD
simvastatin targets LDL
TAG targeted by fibrate, niacin.
Hyperlipidemia has no symptoms, while Xanthelasma presents with…
yellow medial eyelids
familial hypercholesterolemia
HyperTAG >2000
creamy fundus= Lipemia Retinalis
Coronary Heart Disease via high Cholesterol
some risk factors you can’t change, but you CAN change…
HYPERLIPIDEMIA
HTN
HDL 60+ or <40
How does LDL or HDL work?
nobody knows
LDL? More like LameDL
HDL? More like HappyDL
Lipid core, lipid-laden macrophage foam and inflammatory cells= vulnerable plaques
tissue factor—> pro-coagulation—> stimulates thrombus, results in MI
STATINS for CAD, bring LDL to…
<70, but also treat ALL aspects of CAD
Tx diet, exercise, meds for…
Hyperlipidemia
diet to lower LDL, BP, CHD, stroke=
little red meat, more of the good stuff
Exercise increases..
HDL! 30 minutes moderate/daily
HMG-CoA Reductase Inhibitors (Statins)
FIRST LINE Tx to lower LDL, usually taken at night
rate-limiting step of cholesterol biosynth?
HMG-CoA
Statins benefit pts. with CHD, HTN, Hyperlipidemia, high total cholesterol, high LDL.
SIDE EFFECTS?
Myopathy- try to switch statins if so. Serum Creatine Kinase checks for Myopathy
Elevated LFTs- try EZETIMIBE if so.
Simvastatin in high dose can lead to
Myopathy
Fibrates used for?
HyperTAG. FIRST LINE for diabetics c hyperTAG
Nicotinic Acid (Niacin) used for?
increases HDL (watch for flushing)
How to lower LDL?
Bile acid sequestrants (statins are better)
use bile acid sequestrants in pts with hyperTAG?
NO! bas can raise TAG
Ezetimibe inhibits…
absorption of cholesterol. lowers LDL
Fish Oils decrease TAG
decrease TAG with fish oils
Fibrates and Fish Oils decrease…
TAG. ok i get it.
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