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Cardiology: Exam > Hyperlipidemia > Flashcards

Hyperlipidemia Flashcards

1
Q

Increased levels of lipids in the blood, including Cholesterol and Triglycerides.

A

Hyperlipidemia

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2
Q

Makes Lipoproteins less dense.

A

Triglycerides

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3
Q

Makes Lipoproteins more dense.

A

Apoproteins

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4
Q

What is the desirable range for Total Cholesterol?

A

< 200 mg/dL

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5
Q

What is the High Risk range for Total Cholesterol?

A

240+ mg/dL

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6
Q

What is the desirable range for Triglycerides?

A

< 150 mg/dL

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7
Q

What is the High Risk range for Triglycerides?

A

200 - 499 mg/dL

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8
Q

What is the desirable range for HDL?

A

60+ mg/dL

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9
Q

What is the high risk range for HDL?

A

< 35 mg/dL

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10
Q

What is the desirable range for LDL?

A

60 - 130 mg/dL

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11
Q

What is the high risk range for LDL?

A

160 - 189 mg/dL

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12
Q

What is the desirable Cholesterol:HDL ratio?

A

4.0

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13
Q

What is the high risk Cholesterol:HDL ratio?

A

6.0

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14
Q

What lipid level remains reasonably stable overtime?

A

Total Cholesterol

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15
Q

What lipid levels tend to fluctuate more?

A

HDL + TG

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16
Q

Plaques in arterial walls of patients with atherosclerosis contain large amount of?

A

Cholesterol

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17
Q

Protein that breaks down LDL receptors.

A

Proprotein Convertase Subtilisin Kexin Type 9 (PCSK9)

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18
Q

With Familial Hypercholesterolemia, most commonly genetic defects involve what?

A

Absent or Defective LDL Receptors

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19
Q

Reducing cholesterol levels in patients without coronary heart disease.

A

Primary Prevention

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20
Q

Reducing cholesterol levels in patients with established Cardiovascular Disease.

A

Secondary Prevention

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21
Q

What are some clinical presentations of Hyperlipidemia?

A

Eruptive Xanthomas
Tendinous Xanthomas
Lipemia Retinalis

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22
Q

How is Hyperlipidemia typically diagnosed?

A

Labs

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23
Q

According to the AHA, when should you screen for Hyperlipidemia?

A

Adults 20+ years old

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24
Q

How often should you repeat screening for Hyperlipidemia?

A

Average or Low Risk = Every 5 Years
High Risk = Every Year

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25
Q

What should individuals without Cardiovascular Disease have calculated?

A

10-Year-Risk of Cardiovascular Disease

26
Q

Individuals with a LDL of what should be treated regardless of the 10-Year-Risk.

A

LDL > 190 mg/dL

27
Q

What is the single best test for additional risk stratification of Cardiovascular Disease?

A

Coronary Artery Calcium Score
(Non-contrast Cardiac CT)
Takes 10-15 minutes

28
Q

What is almost always the first-line therapy for Hyperlipidemia?

A

Statins

29
Q

The 2018 AHA Multi-society Guidelines defines four groups of patients who would benefit for STATIN medications. Name those groups.

A
  1. Atherosclerotic Cardiovascular Disease
  2. LDL > 190
  3. Age 40 - 75 with Diabetes + LDL ≥ 70
  4. Age 40 - 75 without ASCVD or Diabetes and LDL of 70-189 + CVD Risk of ≥ 7.5%
30
Q

Medications that inhibit the rate-limiting enzyme in the formation of cholesterol.

A

Statins (HMG-CoA Reductase Inhibitors)

31
Q

What are the High Intensity Statins?

A

Atorvastatin (40 - 80 mg per day)
Rosuvastatin (20 - 40 mg per day)

32
Q

How much do High-Intensity Statins lower LDL by?

A

50%

33
Q

How much do Moderate-Intensity Statins lower LDL by?

A

30 - 50%

34
Q

What are the Second-Line medications for Hyperlipidemia?

A

Ezetimibe
PCSK9 Inhibitors
Bempedoic Acid

35
Q

When are Second-Line medications recommended for Hyperlipidemia?

A
  1. CVD with an LDL of 55 or 70 mg/dL
  2. Familial Hypercholesterolemia with LDL > 190 and remains above 100 mg/dL treatment threshold
  3. Statin Intolerance
36
Q

What are the 8 classes of medications used to treat Hyperlipidemia?

A

Statins
Ezetimibe
PCSK9 Inhibitors
Omega-3 Fatty Acids
Bempedoic Acid
Bile-Acid-Binding Resins
Fibrates
Niacin

37
Q

What are some adverse side effects of Statins?

A

Muscle Aches
Myositis
Rhabdomyolysis
Liver Disease
Diabetes (10% risk if Metabolic Syndrome)

38
Q

What Statin medication is associated with elevated risk of muscle injury or myopathy?

A

Simvastatin (80mg)

39
Q

Medication that inhibits absorption of dietary and biliary cholesterol across the intestinal wall by inhibiting a cholesterol transporter.

A

Ezetimibe (Zetia)

40
Q

Ezetimibe can reduce LDL by how much when used as a monotherapy?

A

15 - 20%

41
Q

What is an advantage of Ezetimibe?

A

Side Effects are Uncommon

42
Q

Medication that can lower LDL by 50-60% and is used to treat Familial Hypercholesterolemia and patients with CVD or High Risk of CVD and need further lowering of LDL.

A

PCSK9 Inhibitors
(Alirocumab + Evolocumab)

43
Q

How are PCSSK9 Inhibitors administered?

A

SQ every 2 - 4 weeks

44
Q

What is an advantage PCSK9 Inhibitors?

A

Side Effects are Uncommon

45
Q

What is a disadvantage of PCSK9 Inhibitors?

A

EXPENSIVE

46
Q

When are PCSK9 Inhibitors recommended?

A

Addition to Statins with:
Calcium Scores > 1000
High Risk Patients for CVD

47
Q

Medication that targets cholesterol synthesis in the liver and can increase the risk of tendon rupture.

A

Bempedoic Acid

48
Q

Consumed in the diet and are prominent feature of mediterranean-style diets.

A

Omega-3 Fatty Acids

49
Q

How much can Omega-3 Fatty Acids lower triglycerides by?

A

30%

50
Q

Medication that can reduce LDL but may increase TG levels.

A

Bile Acid-Binding Resins

51
Q

What patients should not receive Bile-Acid-Binding-Resins?

A

TG > 500 mg/dL

52
Q

What is the only medication safe for treating Hyperlipidemia during Pregnancy?

A

Bile-Acid-Binding Resins

53
Q

Name some Bile Acid-Binding Resins.

A

Cholestyramine
Colesevelam
Colestipol

54
Q

Medication that results in significant reductions in plasma triglycerides and increases HDL

A

Fibric Acid Derivatives
(Gemfibrozil + Fenofibrate)

55
Q

By how much can Fibric Acid Derivates reduced triglycerides by?

A

40%

56
Q

What are some side effects of Fibric Acid Derivates?

A

Cholelithiasis
Hepatitis
Myositis

57
Q

Medication that reduces production of VLDL particles.

A

Niacin (Nicotinic Acid)

58
Q

Niacin can increase HDL by how much?

A

25-35%

59
Q

What is the primary therapy for High Blood Triglycerides?

A

Dietary

60
Q

Patients with serum triglycerides above 1000 mg/dL are at an increased risk of what?

A

Pancreatitis

61
Q

When do most clinicians treat Triglyceride levels?

A

Above 500 mg/dL

Cardiology: Exam (5 decks)

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