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Clin Med Exam 1 (Shelby) > Hyperlipidemia > Flashcards

Hyperlipidemia Flashcards

1
Q

What type of statin is used for patients in group 4

A

Moderate or high intensity

Group 4 - LDL 70-189 + greater than 7.5% 10 year risk

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3
Q

Desirable level for triglycerides

A

Less than 150

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4
Q

How is exercise helpful in patients with hyperlipidemia

A

Increase HDL

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6
Q

Where would you find Tuberous Xanthoma

A

Knees, elbows, tendons

Yellow-orange nodules

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7
Q

Your patient falls into group 1 for determining need for a statin. What else do you need to determine before deciding between high and moderate intensity statin?

A

Older than 75 years old = moderate intensity

75 years old or younger = high intensity

(Group 1 = clinical ASCVD)

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8
Q

What “Cautions” should you consider before putting your patient on bile acid sequestrants

A

Triglycerides greater than 200 (less than 400, which is a contraindication)

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10
Q

What type of patients fall into “group 2” of determining need for a statin

A

LDL-C > 190

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11
Q

What type of diet should a patient go on if they have hyperlipidemia

A

DASH diet

Increase plant protein, decrease animal protein, low sodium, low fat dairy, fruits and veggies

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13
Q

Where would you find Eruptive Xanthoma

A

Extensor surfaces, buttocks

Red-yellow papules with abrupt onset

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16
Q

What do you need before you can prescribe a statin?

What do you do after you prescribe a statin?

A

Before: Baseline lipid AND LFT

After: test again 6-8 weeks later, then every 6-12 months

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19
Q

What type of protein should a patient eat if they are trying to adhere to the DASH diet? What type should they avoid?

A

Lots of plant protein

Minimal animal protein

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21
Q

What type of lipoprotein carrier is used in the reverse pathway

A

HDL

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22
Q

What “cautions” should you consider before putting your patient on fibrates

A

Interactions with other statins (other than simvastatin which is not a caution, it is a contraindication)
Interaction with warfarin

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24
Q

How do statins work? What two things do they do

A
  1. Stabilize vulnerable plaques

2. Reduce underlying inflammation

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25
Q

What are some non-medications that can help manage hyperlipidemia

A

Fish oil

Red yeast rice

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27
Q

Circulating lipids are carried on

A

Lipoproteins

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28
Q

What other blood test value can be useful as an “Additional consideration” for prescribing a statin

A

HS-CRP > 2 mg/dL

Protein the liver makes when there is inflammation

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29
Q

LDL carries _______ from the ___________ to the __________

A

LDL carries cholesterol from the liver to the cells

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30
Q

What do Cholesterol Absorption Inhibitors (Ezetamibe) do?

A

Lowers LDL

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31
Q

What would you find on a lipid panel of someone with Famililal hypercholesterolemia?

A

Increased LDL

As opposed to familial combined hyperlipidemia, which is a wide variety of lipid abnormalities

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32
Q

What type of patient falls into “group 4” of determining need for a statin

A

LDL-C 70-189

+

More than 7.5% 10 year risk

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36
Q

Your patient has hyperlipidemia and needs to go on a medication. She is also PREGGO. What medications are NOT OK to give her

A

Statins
Nicotinic acid (Niacin)
Cholesterol Absorption Inhibitos (Ezetamibe)

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38
Q

What would you find on the lipid panel of someone with Polygenic hypercholesterolemia

A

Increased LDL

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41
Q

High risk value for total cholesterol

A

240

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42
Q

What releases cholesterol when it dies and forms deposits

A

Foam cells

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43
Q

Familial combined hyperlipidemia involves how many genes? Is it common or rare?

A

Many genes

1-2% of the population, relatively common

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44
Q

Where would you find plane xanthoma?

A

“Various places”

Soft, yellow plaques

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45
Q

Your patient falls into group 3 for determining a need for a statin. What else do you need to determine before deciding between moderate and high intensity statin?

A

10 year risk assessment

Greater than 7.5% = high intensity

Less than 7.5% = moderate intensity

(Group 3 = diabetes + LDL 70-189)

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51
Q

Borderline value for HDL

A

35-45

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52
Q

High risk value for LDL

A

160-189

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53
Q

Name that physical finding: white-gray ring around the cornea

A

Corneal Arcus

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54
Q

What type of lipoprotein carrier is used in the endogenous pathway

A

VLDL, IDL, LDL

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55
Q

What type of patient falls into “group 3” for determining need for a statin

A

Has diabetes + LDL-C 70-189

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56
Q

Name that physical finding: soft, yellow plaque

A

Plane xanthoma

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58
Q

Your patient has Tuberous Xanthoma. What could be the cause?

A

Familial Hypercholesterolemia

Tuberous Xanthoma = yellow-orange nodle on knees elbows and tendons

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59
Q

What are the contraindications of Nicotinic Acid (Niacin)

A

Active liver disease

Pregnant

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60
Q

What creates a “Cap” around cholesterol deposits

A

Collagen

61
Q

What “cautions” should you consider before putting your patient on nictonic acid (Niacin)

A

Hyperuricemia
Hyperglycemia
Unstable angina
Interactions with other statins

63
Q

What are the three pathways in which ciculating lipids can be carried on lipoproteins

A
  1. Exogenous
  2. Endogenous
  3. Reverse
64
Q

Desirable level for LDL

A

60-130

65
Q

Which medication(s) lower triglycerides

A

Fibrates

Statins (also lowers LDL)

66
Q

What do PCSK9 inhibitors do?

A

Lowers LDL

69
Q

Borderline value for total cholesterol

A

200-239

70
Q

Name that physical finding: yellow-orange nodule

A

Tuberous Xanthoma

71
Q

Which medication CAN be combined with statins

A

Bile Acid Sequestrants

Cholesterol Absorption Inhibitors (Ezetamibe)

72
Q

Lipid panels are done fasted. Which measurement on the lipid panel is most affected by meals?

A

Triglycerides

73
Q

Statins are the only proven medication to decrease incidence of:

A

Major vascular events and coronary mortality

74
Q

Your patient falls into group 2 of determining need for a statin. What do you do next

A

Give them a high intensity statin

Group 2 = LDL-C > 190

75
Q

What are the contraindications for Fibrates

A

Renal disease
Gall stones
Taking Simvastatin

77
Q

What type of patient education about taking statins should you give your patient?

A

Take a bedtime because cholesterol is produced at night

78
Q

Your patient has eruptive Xanthoma. What could be the cause?

A

Familial Hyperlipidemia OR triglycerides greater than 1500

1500!!!

(Eruptive Xanthoma is red-yellow papules with abrupt onset on extensor surfaces and buttocks)

79
Q

Why are PCSK9’s not often used to lower LDL

A

Expensive

Injection only

80
Q

Having an HDL less that _____ is a modifiable risk factor for CHD

A

40 mg/dL

81
Q

High risk value for triglycerides

A

200-499

83
Q

What type of patients fall into “group 1” when determining need for a statin

A

Clinical ASCVD

Acute coronary syndrome, MI, angina, stroke/TIA

85
Q

Chylomicrons carry _________ from the ________ to the ________

A

Chylomicrons carry dietary lipids from the intestine to the liver, adipose, muscle

87
Q

Your patient has Plane Xanthoma… what could be the cause?

A

Familial OR secondary hyperlipidemia

… basically anything. This is not very specific

Plane xanthoma = soft yellow papule in various places

89
Q

If your patient is on Simvastatin, what medication is a HUGE NO NO to give them

A

Fibrates

92
Q

Which medication has the side effect of INCREASING triglycerides (NOT GOOD)

A

Bile acid sequestrants

93
Q

Name that physical finding: red-yellow papules with an abrupt onset

A

Eruptive Xanthoma

94
Q

What are the contraindications of Cholesterol Absorption Inhibitors (Ezetamibe)

A

Active Liver Disease

Pregnant

97
Q

HDL carries ____________ from the ___________ to the __________

A

HDL carries collected cholesterol from the tissues to the liver

98
Q

Which medication has the side effect of gallstones

A

Fibrates

100
Q

What are the contraindications of Bile Acid Sequestrants

A

Triglycerides over 400

101
Q

What enzyme do statins inhibit? What is the result of this inhibition?

A

HMG-CoA reductase

Decreases cholesterol production, liver enzyme increase production of LDL receptors, LDL enters liver and digested

102
Q

Which is more common, inherited hyperlipidemia or secondary hyperlipidemia

A

Inherited is more common

103
Q

High risk value for HDL

A

Less than 35

105
Q

What “cautions” should you consider before putting a patient on a statin

A

Chronic liver disease
Chronic kidney disease
CYP3A4 drug interactions

110
Q

Which medication has the side effect of rhabdomyalisis

A

Statins

111
Q

What do Bile Acid Sequestrants do?

A

Lower LDL

114
Q

What can produce a falsely low cholesterol level

A

Acutely ill - up to 60 days

115
Q

What can happen if a collagen cap surrounding a cholesterol deposit ruptures

A

A thrombus can form, potential infarct

116
Q

Which medication has the side effect of flushing

A

Nicotinic Acid (Niacin)

117
Q

What are the side effects of Bile Acid Sequestrants

A

Increases triglycerides!!!!

GI symptoms

118
Q

What are the contraindications for statins

A

Active liver disease

Pregnant

120
Q

Total cholesterol equation =

A

HDL + LDL + ( Triglycerides/5 )

123
Q

Desierable value for total cholesterol

A

Less than 200

124
Q

LDL diffused through the endothelium at a rate __________

A

Dependent on concentration in the blood

125
Q

Which medication increases HDL and lowers LDL

A

Nicotinic Acid (Niacin)

126
Q

Your patient has corneal Acrus. What could be the cause?

A

If they are under 40, hyperlipidemia

133
Q

What are foam cells

A

Macrophages that have absorbed LDL

137
Q

Borderline value for triglycerides

A

150-199

138
Q

Having an HDL greater than ______ is a NEGATIVE modifiable risk factor for CHD

A

60 mg/dL

139
Q

When should you screen adolescents for hyperlipidemia

A
  1. 9-11 years old
  2. Again 17-21 years old
  • and if you have high suspicion
140
Q

Borderline value for LDL

A

130-159

141
Q

What would you find on a lipid panel of someone with Familial Combined Hyperlipidemia?

A

Wide variety of lipid abnormalities

As opposed to familial hypercholesterolemia, which is only increased LDL

142
Q

Desirable level for HDL

A

60

155
Q

VLDL carries _______ from the ________ to the ________

A

VLDL carries new triglycerides from the liver to the adipose

160
Q

What type of lipoprotein carrier is used in the exogenous pathway

A

Chylomicron

163
Q

Familial hypercholesterolemia involves how many genes?

Is it common or rare?

A

1 gene

Rare

Clin Med Exam 1 (Shelby) (10 decks)

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