Hyperlipidemia Flashcards
What type of statin is used for patients in group 4
Moderate or high intensity
Group 4 - LDL 70-189 + greater than 7.5% 10 year risk
Desirable level for triglycerides
Less than 150
How is exercise helpful in patients with hyperlipidemia
Increase HDL
Where would you find Tuberous Xanthoma
Knees, elbows, tendons
Yellow-orange nodules
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?
Older than 75 years old = moderate intensity
75 years old or younger = high intensity
(Group 1 = clinical ASCVD)
What “Cautions” should you consider before putting your patient on bile acid sequestrants
Triglycerides greater than 200 (less than 400, which is a contraindication)
What type of patients fall into “group 2” of determining need for a statin
LDL-C > 190
What type of diet should a patient go on if they have hyperlipidemia
DASH diet
Increase plant protein, decrease animal protein, low sodium, low fat dairy, fruits and veggies
Where would you find Eruptive Xanthoma
Extensor surfaces, buttocks
Red-yellow papules with abrupt onset
What do you need before you can prescribe a statin?
What do you do after you prescribe a statin?
Before: Baseline lipid AND LFT
After: test again 6-8 weeks later, then every 6-12 months
What type of protein should a patient eat if they are trying to adhere to the DASH diet? What type should they avoid?
Lots of plant protein
Minimal animal protein
What type of lipoprotein carrier is used in the reverse pathway
HDL
What “cautions” should you consider before putting your patient on fibrates
Interactions with other statins (other than simvastatin which is not a caution, it is a contraindication)
Interaction with warfarin
How do statins work? What two things do they do
- Stabilize vulnerable plaques
2. Reduce underlying inflammation
What are some non-medications that can help manage hyperlipidemia
Fish oil
Red yeast rice
Circulating lipids are carried on
Lipoproteins
What other blood test value can be useful as an “Additional consideration” for prescribing a statin
HS-CRP > 2 mg/dL
Protein the liver makes when there is inflammation
LDL carries _______ from the ___________ to the __________
LDL carries cholesterol from the liver to the cells
What do Cholesterol Absorption Inhibitors (Ezetamibe) do?
Lowers LDL
What would you find on a lipid panel of someone with Famililal hypercholesterolemia?
Increased LDL
As opposed to familial combined hyperlipidemia, which is a wide variety of lipid abnormalities
What type of patient falls into “group 4” of determining need for a statin
LDL-C 70-189
+
More than 7.5% 10 year risk
Your patient has hyperlipidemia and needs to go on a medication. She is also PREGGO. What medications are NOT OK to give her
Statins
Nicotinic acid (Niacin)
Cholesterol Absorption Inhibitos (Ezetamibe)
What would you find on the lipid panel of someone with Polygenic hypercholesterolemia
Increased LDL
High risk value for total cholesterol
240
What releases cholesterol when it dies and forms deposits
Foam cells
Familial combined hyperlipidemia involves how many genes? Is it common or rare?
Many genes
1-2% of the population, relatively common
Where would you find plane xanthoma?
“Various places”
Soft, yellow plaques
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?
10 year risk assessment
Greater than 7.5% = high intensity
Less than 7.5% = moderate intensity
(Group 3 = diabetes + LDL 70-189)
Borderline value for HDL
35-45
High risk value for LDL
160-189
Name that physical finding: white-gray ring around the cornea
Corneal Arcus
What type of lipoprotein carrier is used in the endogenous pathway
VLDL, IDL, LDL
What type of patient falls into “group 3” for determining need for a statin
Has diabetes + LDL-C 70-189
Name that physical finding: soft, yellow plaque
Plane xanthoma
Your patient has Tuberous Xanthoma. What could be the cause?
Familial Hypercholesterolemia
Tuberous Xanthoma = yellow-orange nodle on knees elbows and tendons
What are the contraindications of Nicotinic Acid (Niacin)
Active liver disease
Pregnant
What creates a “Cap” around cholesterol deposits
Collagen
What “cautions” should you consider before putting your patient on nictonic acid (Niacin)
Hyperuricemia
Hyperglycemia
Unstable angina
Interactions with other statins
What are the three pathways in which ciculating lipids can be carried on lipoproteins
- Exogenous
- Endogenous
- Reverse
Desirable level for LDL
60-130
Which medication(s) lower triglycerides
Fibrates
Statins (also lowers LDL)
What do PCSK9 inhibitors do?
Lowers LDL
Borderline value for total cholesterol
200-239
Name that physical finding: yellow-orange nodule
Tuberous Xanthoma
Which medication CAN be combined with statins
Bile Acid Sequestrants
Cholesterol Absorption Inhibitors (Ezetamibe)
Lipid panels are done fasted. Which measurement on the lipid panel is most affected by meals?
Triglycerides
Statins are the only proven medication to decrease incidence of:
Major vascular events and coronary mortality
Your patient falls into group 2 of determining need for a statin. What do you do next
Give them a high intensity statin
Group 2 = LDL-C > 190
What are the contraindications for Fibrates
Renal disease
Gall stones
Taking Simvastatin
What type of patient education about taking statins should you give your patient?
Take a bedtime because cholesterol is produced at night
Your patient has eruptive Xanthoma. What could be the cause?
Familial Hyperlipidemia OR triglycerides greater than 1500
1500!!!
(Eruptive Xanthoma is red-yellow papules with abrupt onset on extensor surfaces and buttocks)
Why are PCSK9’s not often used to lower LDL
Expensive
Injection only
Having an HDL less that _____ is a modifiable risk factor for CHD
40 mg/dL
High risk value for triglycerides
200-499
What type of patients fall into “group 1” when determining need for a statin
Clinical ASCVD
Acute coronary syndrome, MI, angina, stroke/TIA
Chylomicrons carry _________ from the ________ to the ________
Chylomicrons carry dietary lipids from the intestine to the liver, adipose, muscle
Your patient has Plane Xanthoma… what could be the cause?
Familial OR secondary hyperlipidemia
… basically anything. This is not very specific
Plane xanthoma = soft yellow papule in various places
If your patient is on Simvastatin, what medication is a HUGE NO NO to give them
Fibrates
Which medication has the side effect of INCREASING triglycerides (NOT GOOD)
Bile acid sequestrants
Name that physical finding: red-yellow papules with an abrupt onset
Eruptive Xanthoma
What are the contraindications of Cholesterol Absorption Inhibitors (Ezetamibe)
Active Liver Disease
Pregnant
HDL carries ____________ from the ___________ to the __________
HDL carries collected cholesterol from the tissues to the liver
Which medication has the side effect of gallstones
Fibrates
What are the contraindications of Bile Acid Sequestrants
Triglycerides over 400
What enzyme do statins inhibit? What is the result of this inhibition?
HMG-CoA reductase
Decreases cholesterol production, liver enzyme increase production of LDL receptors, LDL enters liver and digested
Which is more common, inherited hyperlipidemia or secondary hyperlipidemia
Inherited is more common
High risk value for HDL
Less than 35
What “cautions” should you consider before putting a patient on a statin
Chronic liver disease
Chronic kidney disease
CYP3A4 drug interactions
Which medication has the side effect of rhabdomyalisis
Statins
What do Bile Acid Sequestrants do?
Lower LDL
What can produce a falsely low cholesterol level
Acutely ill - up to 60 days
What can happen if a collagen cap surrounding a cholesterol deposit ruptures
A thrombus can form, potential infarct
Which medication has the side effect of flushing
Nicotinic Acid (Niacin)
What are the side effects of Bile Acid Sequestrants
Increases triglycerides!!!!
GI symptoms
What are the contraindications for statins
Active liver disease
Pregnant
Total cholesterol equation =
HDL + LDL + ( Triglycerides/5 )
Desierable value for total cholesterol
Less than 200
LDL diffused through the endothelium at a rate __________
Dependent on concentration in the blood
Which medication increases HDL and lowers LDL
Nicotinic Acid (Niacin)
Your patient has corneal Acrus. What could be the cause?
If they are under 40, hyperlipidemia
What are foam cells
Macrophages that have absorbed LDL
Borderline value for triglycerides
150-199
Having an HDL greater than ______ is a NEGATIVE modifiable risk factor for CHD
60 mg/dL
When should you screen adolescents for hyperlipidemia
- 9-11 years old
- Again 17-21 years old
- and if you have high suspicion
Borderline value for LDL
130-159
What would you find on a lipid panel of someone with Familial Combined Hyperlipidemia?
Wide variety of lipid abnormalities
As opposed to familial hypercholesterolemia, which is only increased LDL
Desirable level for HDL
60
VLDL carries _______ from the ________ to the ________
VLDL carries new triglycerides from the liver to the adipose
What type of lipoprotein carrier is used in the exogenous pathway
Chylomicron
Familial hypercholesterolemia involves how many genes?
Is it common or rare?
1 gene
Rare
