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Foundations-Hypotension & Shock > Foundations-Hyperlipidemia > Flashcards

Foundations-Hyperlipidemia Flashcards

1
Q

List the two types of lipids

A
  1. Cholesterol

2. Triglycerides

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2
Q

Role of cholesterol

A

helps form steroid hormones & bile acids

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3
Q

Role of Triglycerides

A

helps transfer energy from food to cells

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4
Q

How are lipids transported

A

Lipoproteins

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5
Q

How are lipoproteins classified?

A
  1. Low density= more triglycerides

2. High density= more apoproteins (contains proteins)

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6
Q

Define Primary Prevention

A

Pt’s without evidence ASCVD

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7
Q

Define Secondary Prevention

A
  • Known ASCVD

- Goal is to prevent 2nd CV event

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8
Q

How is cholesterol carried? Equation…

A

Total cholesterol= HDL + VLDL + LDL

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9
Q

What do most clinical laboratories MEASURE?

A
  • Total cholesterol
  • Triglycerides
  • HDL
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10
Q

How do you calculate VLDL cholesterol?

A

Triglycerides/5

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11
Q

Friedewalk equation

A

LDL-Chol= (total cholesterol)- (HDL-Chol)- (Tg/5)

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12
Q

What is a normal triglyceride level

A

<150

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13
Q

What is the first step in plaque formation?

A

Oxidation of LDL

-Pro-inflammatory, thrombotic

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14
Q

What symptom would you expect to see with obstructive atherosclerotic plaque?

A

Exertional angina

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15
Q

What does the ACC/AHA CVD risk score include that the “hard” coronary framingham risk score doesn’t?

A
  • Race (AA or other)
  • DBP
  • Diabetes
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16
Q

What is the optimal LDL cholesterol level?

A

<100

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17
Q

What is high LDL cholesterol level?

A

160-189

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18
Q

What is very high LDL cholesterol level?

A

> or equal to 190

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19
Q

What is the LDL goal for those with CAD?

A

<70

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20
Q

What is the desirable cholesterol level?

A

<200

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21
Q

What is high cholesterol level?

A

> or equal to 240

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22
Q

What is low HDL for men?

A

<40

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23
Q

What is low HDL for women?

A

<50

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24
Q

What is high HDL?

A

> or equal to 60

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25
Q

How long do you have to fast for to check lipoprotein levels?

A

9-12 hrs

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26
Q

What are the major risk factors (other than LDL)–>Step 3 in ATP III guidelines

A
  • Smoking
  • HTN
  • HDL <40
  • Family hx of premature coronary dx
  • Men>45
  • Women >55
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27
Q

What is the LDL Goal for pt’s with a 10-year risk > or equal to 20%

A

<100

<70- optional

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28
Q

At what LDL level do you initiate TLC for pt’s with a 10-year risk > or equal to 20%

A

> or equal 100

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29
Q

At what LDL level do you consider drug therapy for pt’s with a 10-year risk > or equal to 20%

A

> or equal 130

30
Q

What is the LDL Goal for pt’s with a 10-year risk < or equal to 20% WITH 2+ risk factors

A

<130

<100- optional

31
Q

At what LDL level do you initiate TLC for pt’s with a 10-year risk < or equal to 20% WITH 2+ risk factors

A

> or equal 130

32
Q

At what LDL level do you consider drug therapy for pt’s with a 10-year risk < or equal to 20% WITH 2+ risk factors

A

10 yr risk 10-20%= > or equal 130

10 yr risk <10%= > or equal 160

33
Q

What is the LDL goal for 0-1 risk factor?

A

<160

34
Q

What LDL level do you initiate TLC for 0-1 risk factors

A

> or equal 160

35
Q

What LDL level do you consider drug therapy for 0-1 risk factors

A

> 190

36
Q

How much can maximizing TLC reduce LDL?

A

25-30%

37
Q

List the Metabolic Syndrome Risk factors

A
  1. Abdominal obesity
    - Waist circumference >40 men
    - Waist circumference >35 women
  2. Triglycerides >150
  3. Low HDL
  4. Increased BP- >or equal 130/85
  5. Impaired fasting glucose >100 mg

*3 or more=metabolic syndrome

38
Q

What is a high triglyceride range?

A

200-499

39
Q

What is a very high triglyceride level?

A

> or equal 500

40
Q

If triglycerides are > or equal 500, why should you first lower triglycerides?

A

to prevent pancreatitis

41
Q

What is the ACC/AHA 2013 screening age recommendation

A

> or equal 21 yrs

42
Q

List the 4 major groups of ppl who should be treated with STATINs

A
  1. Anyone w/ ASCVD
  2. Extremely elevated LDL, >190
  3. 40-75 y.o w/ DM w/ LDL 70-189
  4. 40-75 w/ 10 year risk > or equal 7.5% per new risk calculator
43
Q

How much does high intensity treatment reduce LDL?

A

50%

44
Q

List the two statins recommended for high intensity treatment

A
  1. Atorvastatin 40 or 80 mg

2. Rosuvastatin 20 or 40 mg

45
Q

How much does moderate intensity treatment reduce LDL?

A

30-50%

46
Q

List the three statins recommended for moderate intensity tx

A
  1. Atorvastatin 10-20 mg
  2. Simvastatin 20-40 mg
  3. Pravastatin 40 mg
47
Q

ALL TLC combined can decrease your LDL by how much?

A

30%

48
Q

What are the overall benefits of statins?

A

Reduces:

  • Fatal and non-fatal MI
  • Incidence of CVA
  • ALL causes of mortality
49
Q

Why are statins best dosed at night?

A

Cholesterol is synthesized at night

50
Q

What enzyme do statins inhibit?

A

HMG-COA reductase inhibitors

51
Q

How much do statins decrease LDL?

A

20-55+%

52
Q

Contraindications to statins

A
  1. Pregnancy/breastfeeding
  2. Active liver dz
  3. unexplained elevated LFTs
53
Q

Major side effects of statins

A 
RHIMM: 
Rhabdo
Hepatotoxicity
Increased diabetes risk
Myalgia
Myopathy
54
Q

What is the MOA of statins?

A

inhibit the rate-limiting enzyme in the formation of cholesterol

55
Q

What is the MOA of cholesterol absorption inhibitor

A

Decreases absorption of cholesterol in small intestine, upregulates LDL receptors on peripheral cells

56
Q

List an example of a cholesterol absorption inhibitor?

A

ezetimibe

57
Q

How much do cholesterol absorption inhibitors decrease LDL?

A

15-20%

58
Q

Contraindications to cholesterol inhibitor absorption inhibitors?

A

-Do not use with fibrates

59
Q

What is the MOA of fibric acid derivatives?

A

Reduced synthesis and increased breakdown of VLDL particles

60
Q

List examples of f fibric acid derivatives

A

gemfibrozil, fenofibrate

61
Q

What is the drug of choice for TG >500

A

gemfibrozil, fenofibrate

62
Q

How much do fibric acid derivatives decrease TG?

A

40%

63
Q

Contraindications to fibric acid derivatives

A

Not recommended with statin use

64
Q

What drug would you prescribe for moderately high LDL and very low HDL?

A

Niacin

65
Q

What is considered the only safe lipid-lowering medication in pregnancy?

A

Bile-Acid binding resins

66
Q

List examples of bile-acid binding resins

A

cholestyramine, colesevelam, colestipol

67
Q

MOA of PCSK9 inhibitors

A

Blocks PCSK9 effects of degrading LDL receptors= more receptors that are continually active so MORE LDL is bound

68
Q

How much does PCSK9 inhibitors lower LDL

A

50-60%

69
Q

What genetic disorder has absent or dysfunctional LDL receptors?

A

Familial hypercholesterolemia

70
Q

What genetic disorder has a lipoprotein lipase abnormality and causes severe hypertriglyceridemia?

A

Familial hyperchylomicronemia

Foundations-Hypotension & Shock (2 decks)

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