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Clin Med 2 > Hyperlipidemia > Flashcards

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
Q

adverse effects of nicotinic acid

A

flushing
pruritis
liver damage monitor LFTs
safety concern when used with statin

26
Q

contraindications of nicotinic acid

A

absolute: active liver disease
relative: hyperuricemia, hyperglycemia, unstable angina
not used during pregnancy

27
Q

purpose of fibric acid derivatives (gemfibrozil, fenofibrate, bezafibrate)

A

lower triglycerides up to 50%
raising HDL up to 25%
useful with elevated triglycerides
not used in pregnancy

28
Q

adverse effects of fibric acid derivatives

A

gallstones
hepatitis
myositis

29
Q

contras of fibric acid derivatives

A

absolute: severe hepatic or renal disease, preexisiting gallstones, taking simvastatin
relative: other statin use, concurrent warfarin use

30
Q

ezetimibe mechanism

A

blocks intestinal absorption of dietary and biliary cholesterol via transporter

31
Q

ezetimibe contraindications

A

use with a statin in active liver disease pregnancy

32
Q

PCSK9 inhibitor important notes

A

can reduce LDL levels as much as 70%
expensive
requires injections

33
Q

4 statin benefit groups

A
  1. Individuals with ASCVD (secondary prevention)
    acute coronary syndromes, history of MI, symptomatic peripheral artery disease, stroke or TIA

Primary prevention:

  1. individuals with LDL greater than or equal to 190
  2. individuals with diabetes aged 40-75 years with LDL greater than or equal to 70
  3. individuals without ASCVD or diabetes with LDL 70-189 and estimated 10 year ASCVD risk greater than or equal to 7.5%

Clin Med 2 (6 decks)

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