Hyperlipidemia Flashcards
2 main lipids in blood?
Cholesterol
Triglycerides
Chylomicrons are?
lipoproteins w/ high TAG content
creamy layer
Source of Chylomicrons?
dietary fat
Chylomicron travel route?
portal vein ->
liver ->
thoracic duct ->
circulation
Chylomicron purpose?
transfer food energy into mm and fat cells
VLDL manufactured where?
Liver from stores of fat and carbs
VLDL made mostly of?
triglycerides
VLDL metabolized down to?
LDL
LDL purpose?
deliver cholesterol for cell membranes and to make bile acid in the liver
↑ in LDL leads to?
atherosclerosis in arterial endothelium
3 ways to ↓ LDL?
1) ↓ cholesterol synth
(HMG-CoA reductase inhibitors - Statins)
2) ↓ cholesterol reabsorption
(plant sterols - omega3, red yeast rice; -ezetimibe)
3) ↑ cholesterol excretion
(bile acid sequestrants)
HDL made where?
liver and intestines
HDL made of?
apoproteins and cholesterol
HDL do what?
reverse cholesterol transport by moving chol into lipoprotiens or directly into live
3 ways to ↑ HDL?
1) exercise
2) estrogen
3) alcohol
5 things that ↓ HDL?
1) hypertriglyceridemia
2) smoking
3) anabolic steroids
4) genes
5) fat and lazy
3 systems that maintain cholesterol balance?
1) extrahepatic organs
2) liver
3) intestines
Acute illness can give what false result on cholesterol tests?
falsely low
Total cholesterol levels?
< 200 = good
200-239 = borderline
>=240 = high
Triglyceride levels?
=500 = very high
LDL levels?
=190 = very high
HDL levels?
=60 = high
Goal LDL for pt’s w/ CAD or DM?
<70
Hypertriglyceridemia is risk factor esp when accompanied by?
low HDL
Triglycerides >1000 risk for?
pancreatitis
Familial Hypertriglyceridemia definition?
cell-surface LDL receptors absent or defective:
homozygotes 8x normal LDL
heterozgotes 2x normal LDL
Familial Hypertriglyceridemia causes?
unregulated synth of LDL
early CHD
Xanthelasma is?
cholesterol-filled plaques on skin
(U) medial eyelids
soft, yellow
Eruptive Xanthomas are?
red-yellow papules on skin
w/ trigly >1000
Tuberous Xanthoma are?
yellow-orange nodules <= 2cm
(U) knees, elbows
Lipemia Retinalis is?
cream colored blood vessel in fundus
w/ trigly >2000
Coronary Heart Disease (CHD) definition?
narrowing of coronary bv,
leading cause of death M and F
CHD Non-modifiable risk factors?
FH: M 45, F 55
CHD modifiable risk factors?
HYPERLIPIDEMIA
HTN w/ BP >=140/90
HDL <40
fat and lazy
What is a negative risk factor for CHD?
HDL >=60
Coronary thombosis result of?
vulnerable plaques w/i wall of coronary arteries
Vulnerable plaques filled w/?
lipid core
lipid-laden macrophage foam cells
inflammatory cells
Role of lipid-laden macrophage foam cells in vulnerable plaques?
make tissue factor that stim rapid coag when in contact w/ blood
Statins use to tx CAD why?
cholesterol-lowering drugs:
stabilize vulnerable plaques
↓ underlying inflammation
↓ major vascular events
Hyperlipidemia tx?
diet
exercise
meds
Major way to ↑ HDL?
exercise
HMG-CoA Reductase Inhibitors work how?
competitive inhibition of HMG-CoA Reductase
cholesterol synth
Statins are first line tx for?
↑ LDL
(P) 2º benefit is some ↓ in trigly
Lipitor LDL reduction %age and does range?
38-54% LDL ↓
10-80 mg
Lipitor side-effects?
Myalgias Elevated LFTs (liver fxn)
What test monitors myalgias w/ Lipitor?
serum creatine kinase (↑ levels = must ∆ drug)
Alway obtain baseline for what when starting Lipitor?
Retest?
liver fxn (LFT)
3 month post start of tx
Alternate to statins if pt can’t tolerate them?
ezetimibe
bile acid requestrants
niacin
Fibrates used to tx CAD, mechanism?
LOWER TRIGLYCERIDES:
stim lipoprotein lipase
↓ VLDL secretion
stim fatty acid oxydation
Fibrates may also affect?
↑ HDL slightly
↓ LDL slightly
Fibrates best first-line med for whom?
diabetics w/ hypertriglyceridemia
Fibrate drug names?
Lopid
Tricor
Trilipix
Nicotinic Acid (niacin/vit B3) used to treat CAD, mechanism?
MODERATE ↑ HDL
↓ prodxn of VLDL
some ↓ LDL, trigly
Nicotinic Acid side effect?
cutaneous flushing
result of ↑ prostaglandin D2
Bile Acid Sequesterants used to tx CAD, mechanism?
forms complex w/ bile acids ->
releases chloride ions ->
prevents reuptake of bile salts ->
bile salt-bound LDL lost in feces
Bile Acid Sequesterants results in?
↓ LDL
*may ↑ trigly by 10%
Bile Acid Sequesterant drug names?
Questrant
Colestid
Bile Acid Sequesterant side-effects?
constipation
flatulence
dyspepsia (indigestion)
Cholesterol Absorption Inhibitor tx for CAD, mechanism?
↓ absorb of cholesterol at small intestine ->
↓ delivery to liver ->
↓ chol for liver to use ->
↑ clearance of cholesterol from blood
Cholesterol Absorption Inhibitor results in?
↓ LDL
Cholesterol Absorption Inhibitor drug name?
Zetia (ezetimibe)
Omega-3 FA tx for CAD, results in?
↓ trigly
Omega-3 FA drug name?
Omacor
Lovaza
