Hyperlipidemia Flashcards

1
Q

Where does the majority of cholesterol come from and what is the second most common source?

A

the majority is made in the liver

some comes from diet

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2
Q

Important facts about familial Hypercholesterolemia

A

monogenic
hetero 2x
homo 8x the normal value of LDL
treat with statin

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3
Q

important facts about polygenic hypercholesterolemia

A

multiple genes involved
increased LDL levels
premature onset of CHD
treat with statin

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4
Q

important facts about familial combined hyperlipidemia

A

polygenic
wide variety of lipid abnormalities
treat with statin

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5
Q

some causes of secondary hyperlipidemia

A
diabetes
excessive alcohol
smoking
obesity
hypothyroidism
chronic renal disease
liver disease
medications
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6
Q

at what point is HDL a risk factor and when is it a negative risk factor

A

HDL is less than 40 is a risk factor

HDL is greater than or equal to 60 is a negative risk factor

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7
Q

What does a fasting lipid panel consist of and how long should you fast

A

total cholesterol, triglycerides, LDL, and HDL
Total cholesterol = HDL + LDL + (triaglycerides/5)

12 hours

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8
Q

Lipid profile desireable, borderline, high risk

Cholesterol

A

<200, 200-239, 240

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9
Q

Lipid profile desireable, borderline, high risk

Triaglycerides

A

<150, 150-199, 200-499

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10
Q

Lipid profile desireable, borderline, high risk

HDL Cholesterol

A

60, 35-45, <35

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11
Q

Lipid profile desireable, borderline, high risk

LDL Cholesterol

A

60-130, 130-159, 160-189

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12
Q

cholesterol filled, soft, yellow plaques that appear in various places

A

plane xanthomas

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13
Q

yellow-orange nodules often located over knees and elbows
can also be in the tendons
associated with familial hypercholesterolemia

A

tuberous xanthoma

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14
Q

crops of small red-yellow papules with abrupt onset
extensor surfaces and buttocks most common areas
caused by elevated triglycerides often > 1500 mg/dL
may indicate familial HDL

A

eruptive xanthomas

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15
Q

white grey ring around the cornea

common in pts over 40 without elevated lipids

A

corneal arcus

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16
Q

diet approaches to stop hypertension DASH diet

A

rich in fruits and vegetables
moderate in low-fat dairy products
low in animal protein
low sodium

17
Q

exercise benefits

A

can increase HDL

3-4 session/week 40 min mod-vigorous

18
Q

Statins mechanism of action

A
  • inhibit HMG-CoA reductase a rate limiting step in cholesterol synth
  • increases production of LDL receptors
  • receptors bind LDL and VLDL
  • LDL and VLDL enter liver and are digested
19
Q

Statin contraindications

A

absolute: active liver disease, pregnancy

Use with caution: concomitant use of CYP3A4 inhibitors and various drugs, chronic kidney/liver disease

20
Q

how often should lipid panel be taken during statin therapy

A

every 4-12 weeks after initiation or dose adjustment and then repeat every 3-12 months as needed

21
Q

Bile acid sequestrants aka Resins mechanism and facts

A

bind bile acids in the intestine
Decrease LDL by upto 24%
act synergistically with statins
SAFE DURING PREGNANCY

22
Q

adverse effects of resins

A

constipation
gas
may affect warfarin or vitamin absorption
can INCREASE triglycerides

23
Q

contras of resins

A

absolute: Triaglycerides > 400
relative: Triglycerides >200

24
Q

Nicotinic acid (Niacin) uses

A

reduces production of LDL
increases HDL
may reduce triglycerides

25
adverse effects of nicotinic acid
flushing pruritis liver damage monitor LFTs safety concern when used with statin
26
contraindications of nicotinic acid
absolute: active liver disease relative: hyperuricemia, hyperglycemia, unstable angina not used during pregnancy
27
purpose of fibric acid derivatives (gemfibrozil, fenofibrate, bezafibrate)
lower triglycerides up to 50% raising HDL up to 25% useful with elevated triglycerides not used in pregnancy
28
adverse effects of fibric acid derivatives
gallstones hepatitis myositis
29
contras of fibric acid derivatives
absolute: severe hepatic or renal disease, preexisiting gallstones, taking simvastatin relative: other statin use, concurrent warfarin use
30
ezetimibe mechanism
blocks intestinal absorption of dietary and biliary cholesterol via transporter
31
ezetimibe contraindications
use with a statin in active liver disease pregnancy
32
PCSK9 inhibitor important notes
can reduce LDL levels as much as 70% expensive requires injections
33
4 statin benefit groups
1. Individuals with ASCVD (secondary prevention) acute coronary syndromes, history of MI, symptomatic peripheral artery disease, stroke or TIA Primary prevention: 2. individuals with LDL greater than or equal to 190 3. individuals with diabetes aged 40-75 years with LDL greater than or equal to 70 4. individuals without ASCVD or diabetes with LDL 70-189 and estimated 10 year ASCVD risk greater than or equal to 7.5%