Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PHA 521 > HYPERLIPIDEMIA > Flashcards

HYPERLIPIDEMIA Flashcards

1
Q

Hyperlipidemia

A

dyslipidemia
dyslipoproteinemia

elevation of both cholesterol and triglycerides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Hypercholesterolemia

A

elevation of cholesterol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Hypertriglyceridemia

A

elevation of triglycerides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Primary Dyslipidemia

A

genetic abnormality of cholesterol metabolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Secondary Dyslipidemia

A 
diabetes mellitus
excessive alcohol use
hypothyroidism
cholestatic liver disease
renal disease
smoking
obesity
medications (OCPs, thiazide diuretics, beta blockers, some atypical antipsychotics, protease inhibitors)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Cholesterol

A

lipid that helps to form steroid hormones and bile acids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Triglycerides

A

lipid that helps transfer energy from food to cells

TG=fat

transported into skeletal muscle and adipose tissue to use as energy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Lipoproteins

A

how lipids are transported

contain proteins (apoproteins)

classified by density

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Low Density Lipoprotein

A

more triglycerides

“bad”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

High Density Lipoprotein

A

more apoproteins
low triglycerides
smaller size

“good”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Total Cholesterol

A

HDL+LDL+VLDL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Lipid Fractions: measured

A

most clinical labs measure

  • total cholesterol
  • triglycerides
  • HDL

LDL and VLDL are calculated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Lipid Fractions: calculated

A

most triglycerides are found in VLDL particles

VLDL cholesterol = TG/5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Friedewald Equation

A

[LDL-chol]=[total chol]-[HDL-chol]-([TG]/5)

  • must be fasting
  • TG>200 –> est LDL will be significantly incorrect
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Cardiovascular Disease

A

cvd=ascvd

  • coronary heart disease
  • cerebrovascular disease
  • peripheral artery disease
  • aortic atherosclerosis and thoracic or abdominal aortic aneurysm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

CVD primary prevention

A

no evidence of ascvd

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

CVD secondary prevention

A

known ascvd

goal: prevention of a second event

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

ASCVD

A

fatty material collects in arterial walls, hardening over time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

ASCVD: process started by…

A

excess cholesterol (VLDL, LDL)

result of abnormal cholesterol metabolism

  • genetic
  • insulin resistance
  • organ dysfunction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

ASCVD: process enhanced by…

A

lifestyle factors

  • saturated/trans fats
  • obesity
  • smoking
  • BP level
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Plaque Formation

A

small dense LDL enters and sticks to artery wall

  1. oxidation of LDL (pro-inflammatory, thrombotic)
  2. attracts macrophages (foam cells)
  3. endothelial dysfunction
  4. vasoconstriction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Plaque Ruptures

A

MI in coronaries

TIA or CVA in brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Cardiovascular Risk Factors: non-modifiable

A

age

  • M > 45
  • F > 55

sex
M>F

family hx of premature heart disease in first degree relative

  • M<55
  • F<65
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Cardiovascular Risk Factors: modifiable

A 
HTN
DM
dyslipidemia
kidney disease
obesity
smoking
HDL
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

CVD Risk Calculators

A

hard coronary framingham risk score
(designed to asses risk of heart disease only)

ACC/AHA risk estimator
(designed to assess risk of heart disease and stroke) (factors in race (AA) and diabetes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Lipids and CVD Risk

A

inc LDL –> inc ASCVD risk

inc HDL –> dec ASCVD risk

27
Q

Hyperlipidemia: physical exam

A

mostly asymptomatic

  • xanthomatous tendons
  • corneal arcus
  • lipemia retinalis
  • xanthelasma
  • eruptive xanthomas
28
Q

ATP III Guidelines: 1. obtain fasting lipid profile

A

<100 LDL = optimal
< 70 LDL for those with CAD

<40 HDL = low
(<50 HDL for F)
>60HDL = negative RF

29
Q

ATP III Guidelines: 2. identify presence of clinical atherosclerotic disease (CHD risk equivalent)

A

coronary artery disease

peripheral arterial disease

abdominal aortic aneurysm

diabetes mellitus

30
Q

ATP III Guidelines: 3. determine presence of major risk factors

A

smoking

hypertension

HDL<40

family history of premature coronary disease

M>45, F>55

31
Q

ATP III Guidelines: 4. if 2+ RF without CHD or CHD risk equivalent, assess 10 year CHD risk

A

> 20%: CHD risk equivalent

10-20%: need to find risk score

<10%: none or 1 RF

32
Q

ATP III Guidelines: 5. determine risk category

A

CHD, CHD risk equivalents(>20%): <70 LDL goal

2+ RF (<20%): <100 LDL goal

0-1 RF: <160 LDL goal

33
Q

ATP III Guidelines: 6. initiate therapeutic lifestyle changes

A

AHA low fat diet

dietary cholesterol intake

increase viscous fiber

add plant stanols/sterols

aggressive weight management

increased physical activity

34
Q

ATP III Guidelines: 7. consider adding drug therapy

A

simultaneously with TLC for CHD and CHD equivalents

if LDL levels high after 3 months TLC

35
Q

ATP III Guidelines: 8. identify metabolic syndrome

A

MS = 3+ RF

-abdominal obesity
(M>40”, F>35”)

-TG > 150

-low HDL
(M<40, F<50)

  • increased BP (>130/85)
  • impaired fasting glucose (>100)
36
Q

ATP III Guidelines: 9. treat elevated TG and low HDL

A 
TG: 
<150 = normal
150-199 = borderline
200-499 = high
>500 = very high

HDL

  • exercise
  • inc monosaturated fats
  • smoking cessation
  • moderate EtOH use

TG

  • maximize statin therapy
  • consider Rx with non statins
37
Q

ACC/AHA Guidelines: major ascvd events

A

acute coronary syndrome (within past 12 months)

history of MI

history of ischemic stroke

symptomatic PAD

  • claudication with ABI <0.85
  • previous revascularization surgery
  • amputation
38
Q

ACC/AHA Guidelines: high intensity statins

A

> 50% LDL

atorvastatin 80mg
rosuvastatin 20mg

39
Q

ACC/AHA Guidelines: moderate intensity statins

A

30-49% LDL

atorvastatin 10mg
rosuvastatin 10mg
simvastatin 20-40mg

pravastatin 40mg
lovastatin 40mg
fluvastatin 40mg
pitavastatin 1-4mg

40
Q

ACC/AHA Guidelines: low intensity statins

A

<30% LDL

simvastatin 10mg

pravastatin 10-20mg
lovastatin 20mg
fluvastatin 20-40mg

41
Q

ACC/AHA Guidelines

A

screening: 20+yo

no specified targeted goal for TC and LDL

clinical judgement and shared decision making are emphasized

42
Q

ACC/AHA Guidelines: statin benefit groups

A
  • secondary prevention in patients w/ clinical ascvd
  • severe hypercholesterolemia (LDL>190)
  • DM
  • primary prevention based on risk
43
Q

ACC/AHA Guidelines: secondary prevention in patients with clinical ascvd

A

goal: reduce LDL with HIGH INTENSITY statin

50% reduction

very high risk: consider adding non statin

44
Q

ACC/AHA Guidelines: severe hypercholesterolemia

A

maximally tolerated statin therapy recommended

45
Q

ACC/AHA Guidelines: DM

A

40-75yo: MODERATE INTENSITY statin

10yr risk:

  • multiple ascvd RF (HIGH INTENSITY statin)
  • > 20% (add EZITIMIBE to maximally tolerated statin)

20-39yo: with DM risk enhancers (consider initiating statin therapy)

46
Q

DM specific risk enhancers

A

long duration

  • type 2: 10 years
  • type 1: 20 years

albuminuria >30

eGFR<60

retinopathy

neuropathy

ABI<0.9

47
Q

ACC/AHA Guidelines: primary prevention based on risk

A

<5%: lifestyle changes

<5-7.5%: risk enhancers present –> discuss moderate intensity statin

> 7.5-20%: estimate+enhancers –> initiate moderate intensity statin

> 20%: initiate statin

48
Q

ACC/AHA Guidelines: ascvd risk enhancers

A

family history of premature ascvd

persistent elevated LDL

CKD

metabolic syndrome

F: preeclampsia, premature menopause, etc.

inlammatory disease (rheumatoid arthritis, psoriasis, HIV)

ethnicity

49
Q

Treatment: TLC

A

typical success: 5-10%

diet
-inc soluble fiber
-plant stanols, sterols
-garlic, soy protein, vitamin C, pecans
antioxidants
50
Q

Statins

A

HMG CoA reductase inhibitors

MOA: inhibit rate limiting enzyme formation of cholesterol

reduces mortality

best dosed at night

LDL dec 20-55%

51
Q

Statin: contraindications

A
  • pregnancy/breastfeeding
  • active liver disease
  • unexplained elevated LFTs
52
Q

Statins: side effects

A 
myalgias
myositis,myopathy
rhabdomyolysis
hepatotoxicity
increased diabetes risk
53
Q

Cholesterol Absorption Inhibitor

A

ex: ezetimibe

MOA:

  • decreases absorption of cholesterol in small intestine
  • upregulates LDL receptors on peripheral cells

dec LDL 15-20%

add to statin when LDL>70 in very high risk ascvd

contraindications: hepatic impairment, fibrates

54
Q

PCSK9 Inhibitor

A

ex: alirocumab, evolocumab

MOA: monoclonal antibodies blocks PCSK9 effect of degrading LDL receptors

dec LDL 50-60%

$$$$

consider:

  • familial hypercholesterolemia
  • very high risk ascvd on max tolerated LDL tx and LDL>70
  • statin intolerance
55
Q

Fibric Acid Derivatives

A

gemfibrozil, fenofibrate

MOA: reduced synthesis and increased breakdown of VLDL particles

drug of choice for TG>500 on initial presentation (dec TG 40%)

NOT recommended with statin use

side effects:

  • cholelithiasis
  • hepatitis
  • myositis
56
Q

Bile Acid Binding Resins

A

ex: choletyramine, colesevelam, colestipol

MOA: bind bile acids in the intestines

only lipid lower medication considered safe in pregnancy

side effect: GI symptoms

contraindications:

  • current/history of GI obstruction
  • hypertriglyceridemia
  • pancreatitis
57
Q

Niacin

A

reduces the production of VLDL particles

inc HDL 25-35%

side effect: flushing

contraindications

  • pregnancy/breastfeeding
  • active liver disease
  • active peptic ulcer

caution:

  • gout/hyperuricemia
  • DM
58
Q

Omega 3 Fatty Acids

A

improve TG

lower CV risk

anti inflammatory

59
Q

Familial Hypercholesterolemia

A

LDL receptors absent or dysfunctional

homozygote v. heterozygote

60
Q

Familial Hyperchylomicronemia

A

lipoprotein lipase abnormality

severe hypertriglyceridemia

61
Q

Mild Hypertriglyceridemia

A

200-499

possible other cause: high fat meal before testing

62
Q

Moderate Hypertriglyceridemia

A

> 500

start to worry about pancreatitis risk

63
Q

Severe Hypertriglyceridemia

A

> 1000

milky white serum

acute pancreatitis

PHA 521 (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions