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Cardiology > Hyperlipidemia > Flashcards

Hyperlipidemia Flashcards

1
Q

syndrome in which measured serum lipid components deviate from optimal levels

A

hyperlipidemia

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2
Q

genetic mutation in the gene encoding the LDL receptor protein that causes elevated plasma cholesterol and premature CAD

A

familial hypercholesterolemia

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3
Q

familial hypercholesterolemia should be suspected in patients with _____ _____

A

tendon xanthomas

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4
Q

characterized as elevated triglycerides, LDL and early CAD

A

familial combined hyperlipidemia

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5
Q

mutation in apo B-100 that inhibits its binding to the LDL receptor that causes elevations in LDL

A

familial defective apolipoprotein B-100

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6
Q

what might present with severe hypercholesterolemia, tendon xanthomas, and premature atherosclerosis?

A

familial defective apolipoprotein B-100

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7
Q

what is increased levels of Lipoprotein A - Lp(a) - a risk factor for? (2)

A

CAD
stroke

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8
Q

what does a patient have if they present with elevations in cholesterol, triglycerides, and are likely to develop premature CAD?

A

remnant removal disease

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9
Q

what are the top 2 secondary causes of hyperlipidemia?

A

obesity
uncontrolled diabetes mellitus

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10
Q

measures the amount of hemoglobin that is attached to glucose

A

A1c

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11
Q

how is A1c damaged by high glucose?

A

high glucose damages hemoglobin

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12
Q

at what ages should men and women with low cardiovascular risk be screened?

A

males over 35
females over 45

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13
Q

at what ages should men and women with high cardiovascular risk be screened?

A

males 25-30
females 30-35

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14
Q

what 2 measurements should a hyperlipidemia screening include?

A

total cholesterol
HDL

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15
Q

which ratio is the better predictor of CHD risk than LDL cholesterol?

A

non-HDL cholesterol (total cholesterol) to HDL cholesterol

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16
Q

measurement of calcified atherosclerosis with a non-contrast CT scan of the heart

A

coronary artery calcium scoring (CAC)

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17
Q

because statins may cause muscle pain, what should we worry about?

A

rhabdomyolysis

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18
Q

what medication can a patient, use who does not meet cholesterol treatment goals with dietary modification and maximally-tolerated statin therapy?

A

Ezetimibe

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19
Q

what medication is recommended in combination with maximally tolerated statin therapy?

A

Bempedoic acid

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20
Q

fully humanized monoclonal antibodies that bind free plasma PCSK9 that lowers LDL-C levels (PCSK9 inhibitor)

A

Evolocumab
Alirocumab

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21
Q

what is the first step in treating hyperlipidemia?

A

lifestyle changes

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22
Q

what does ASCVD include?

A

coronary heart disease
stroke
peripheral arterial disease

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23
Q

by how much should LDL-C levels be lowered in group 1 patients with ASCVD?

A

at least 50%

24
Q

how much should LDL-C levels be in group 1 patients with multiple ASCVD events or 1 ASCVD event and high-risk conditions?

A

below 70

25
Q

what should we do if a patient cannot hit an LDL of 70 with statins?

A

add ezetimibe

26
Q

what should we do if a patient cannot hit an LDL of 70 with statins and ezetimibe?

A

add a PCSK9 inhibitor (evolocumab)

27
Q

what should we do in a group 2 patient with severe primary hypercholesterolemia?

A

start statin therapy

28
Q

what is the target in a group 2 patient with severe primary hypercholesterolemia?

A

100

29
Q

in a group 2 patient with severe primary hypercholesterolemia, what should we do if LDL remains over 100 on a statin therapy?

A

add ezetimibe

30
Q

in a group 2 patient with severe primary hypercholesterolemia, what should we do if LDL remains over 100 on a statin therapy and ezetimibe?

A

add PCSK9 inhibitor

31
Q

in patients 40-75 years of age with diabetes and an LDL of 70-189, what should we do?

A

high-intensity statin

32
Q

in patients 40-75 years of age with diabetes and an LDL of 70-189, what is the target?

A

decrease LDL by at least 50%

33
Q

in patients 40-75 years with LCL 70-189 and an estimated 10 year ASCVD risk over 7.5%, what should we do?

A

start a moderate-intensity statin

34
Q

in patients 40-75 years with LCL 70-189 and an estimated 10 year ASCVD risk 7.5-19.9%, what is the target?

A

decrease LDL by at least 30%

35
Q

in patients 40-75 years with LCL 70-189 and an estimated 10 year ASCVD risk over 20%, what is the target?

A

decrease LDL by at least 50%

36
Q

in patients 40-75 with LDC 70-189 and an estimated 10 year ASCVD risk of over 7.5% and who do not want to start statins, what should we consider?

A

coronary artery calcium study

37
Q

what CAC score is wanted?

A

zero

38
Q

what scores favor statin therapy, especially in those over 55 years of age?

A

1-99

39
Q

what scores is statin therapy indicated, unless there are extenuating circumstances?

A

100 or above

40
Q

when should lipid measurements take place after statin initiation or dose adjustment?

A

4-12 weeks (1-3 months)

41
Q

how often should lipid measurements be repeated when managing hyperlipidemia?

A

every 3-12 months as needed

42
Q

what are 4 side effects that patients may experience when taking a statin?

A
  1. pain/tenderness
  2. stiffness
  3. cramping
  4. weakness/fatigue
43
Q

what should I do if a patient on a statin presents with unexplained severe muscle symptoms and fatigue? (2)

A
  1. DC statin
  2. work up for rhabdomyolysis
44
Q

what does a work up for rhabdomyolysis include? (3)

A

CK
creatinine
UA for myoglobinuria

45
Q

what does myoglobinuria look like?

A

coca cola urine

46
Q

what should I do for a patient that presents with mild to moderate muscle symptoms on a statin?

A
  1. take a vacation from statin
  2. restart statin if symptoms resolve and no contraindications exist (same or lower dose)
47
Q

what should I do for a patient that presents with mild to moderate muscle symptoms on a statin and a relationship between the two exists? (3)

A
  1. DC statin
  2. let symptoms resolve
  3. start different statin on low dose with gradual increase
48
Q

what should I do for a patient over 75 years who does not have a history of heart attacks or ASCVD, but experiences muscle symptoms?

A

remove statin

49
Q

what should I do for a patient who presents with mild to moderate muscle symptoms that continue after 2 months of no statin treatment and CK levels do not resolve?

A

search for secondary cause

50
Q

elevated TG associated with cardiovascular disease

A

hypertriglyceridemia

51
Q

what level of triglycerides is a risk factor for pancreatitis?

A

near or above 100

52
Q

how do most levels of triglycerides improve?

A

lifestyle changes

53
Q

what do very high levels of triglycerides require?

A

drug therapy

54
Q

what can lower TG levels as much as 50%?

A

fish oil

55
Q

what is the bad news about high cholesterol and metabolic syndrome?

A

asymptomatic

Cardiology (19 decks)

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