Hyperlipidemia Flashcards
Hyperlipidemia vs hypercholesterolemia
hyperlipidemia=high levels of LDL or triglycerides
hypercholesterolemia=high levels of cholesterol
secondary dyslipidemia (levels are either high or low) lab work up
UA (looking for metabolic syndrome), TSH, LFTs, A1C, FBS
HDL over what is a negative risk factor for CHD
60
Are triglycerides an independent risk factor for CHD?
no
Premature arches cornealis
a deposit of phospholipid and cholesterol in the peripheral cornea. hazy white, grey, or blue opaque ring
Lipemia retinalis
abnormal appearance of the retinal arteries and veins caused by increased triglycerides
normal triglyceride level
<150
desirable total cholesterol level
<200
Optimal LDL level
<100
when do you do a follow up appointment after a statin is started?
6-8 weeks
Bile Sequestrants and Fibrates work best on what?
triglycerides
Fibrate examples
Gemfibrozil (Lopid), Fenofibrate, Clofibrate
Gemfibrozil (Lopid), Fenofibrate, Clofibrate are examples are what
Fibrates
What medications do you need to be careful with when giving a fibrate?
coumadin and oral hypoglycemic agents for DM
If CK levels are elevated and patient is experiencing muscle weakness, what 3 things could you do?
Change to something different OR
Change to different Statin OR
Start Statin at a lower dose
What is the ASCVD risk factor for a diabetic, CKD or other people with 2 or more risk factors?
high
is ASCVD screening the same for women and men?
yes
If an older adult (65 years or older) has a risk factor of 0-1 how often should you screen for dyslipidemia?
annually
when do you start evaluating young adults for dyslipidemia and how often
at 20 years old and every 5 years
middle aged adults (45-65) with no ASCVD risk factors should be screened for dyslipidemia how often?
every 1-2 years
Simon Broome Register Diagnostic Criteria
Dutch Lipid Clinic Network Diagnostic Criteria
U.S. MEDPED
3 clinical diagnostic tools used for Familial Hypercholesterolemia diagnosis
What criteria does this fit?
Premature ASCVD, fasting LDL-C >190 mg/dL, the presence of tendon xanthomas, full corneal arcus in individuals <40 years of age, or a family history of high cholesterol and/or premature ASCVD1
Factors that lead to an FH diagnosis include
what does alcohol affect?
triglycerides
a very high triglyceride level and low HDL signals what?
insulin resistance
a low HDL
<40
An increased total cholesterol and LDL levels could be caused by what secondary causes?
- Hypothyroid
- Nephrosis (protein in urine)
- Dysgammaglobulinemia (systemic lupus erythematosus, multiple myeloma)
- Progestin or anabolic steroid treatment,
- Diseases of the liver due to abnormal lipoproteins
- Protease inhibitors for treatment of HIV infection
AN increase in triglycerides and VLDL could be caused by what secondary causes?
- Chronic renal failure
- T2DM
- Obesity
- Excessive alcohol intake
- Hypothyroidism
- Antihypertensive medications (thiazide diuretics and b-adrenergic blocking agents)
- Corticosteroid therapy
- Orally administered estrogens, oral contraceptives, pregnancy
- Protease inhibitors for treatment of HIV infection
PCSK9 inhibition example
Repatho
No ASCVD risk factors is what risk and what should their LDL be?
low; <130
2 or fewer ASCVD risk factors and a calculated 10-year risk of less than 10% is what risk and what should LDL be?
moderate, <100
leading cause of mortality in women?
ASCVD
Can physical activity be broken up throughout the day in 10 minute sessions?
yes
what constitutes as physical activity?
brisk walking, riding a stationary bike, water aerobics, cleaning/scrubbing, mowing the lawn, and sporting activities
(Need to lose at least 200cal/day
recommended diet
reduced calorie diet with fruits, veggies, grains, fish and lean meats
when are omega 3 fish oils good to use? and what are examples?
triglycerides >500, Vascepa and Lovaza
Question, Welchol, Cholestyramine are example of?
bile sequestrants
what are bile sequestrants good for? and what bad thing might they increase?
lowering LDL and increasing HDL, may increase TG
bile acid sequestrants side effects
constipation, diarrhea, bloating
bile acid sequestrants action
bind to bile acids (which contains cholesterol) in the intestine and prevent their reabsorption into the body
when are PCSK9 inhibitors used?
in combo with Statins or with a person who can’t tolerate a statin
cholesterol absorption inhibitor example
Zetia (Ezetimibe)
Zetia (Ezetimibe) is an example of what?
Cholesterol absorption inhibitor
rosuvastatin is also called?
Crestor
Simvastatin is also called?
zocor
Statins have a potential drug interaction with which drugs?
CYP450 3A4 inhibitors, cyclosporine, warfarin, and protease inhibitors (HIV meds)
what disease is at increase risk for developing while on statins?
diabetes
pravastatin is also called
pravachol
Atorvastatin is also called?
Lipitor
Alirocumab and Evolocumab are examples of what?
PCSK9 inhibitors
PCSK9 inhibitors adverse reactions
influenza, nasopharyngitis
PCSK9 inhibitors are given how often?
SQ q 2 weeks
If GFR is <15 what should you do with vibrate medication?
stop it
If GFR is 15-60 what should you do with vibrate medication?
cut dose in half
Fibrates can improve what diabetic problem?
diabetic retinopathy
Fibrates can increase what? what are they mainly good for?
can increase LDL, good for TG and HDL
Fibrates adverse reactions
GI symptoms, possible cholelithiasis
Fibrates can interact with what other medications?
anticoagulants
Bile Acid Sequestrants may reduce the absorption of what?
folic acid and fat-soluble vitamins such as vitamins A, D, and K
Vascepa and Lovaza is an example of what
omega 3 fatty acid
Omega 3 fatty acid drug interactions
coagulation meds. They will prolong bleeding time, also increase ALT
when a patient is on a stable lipid lowering medication how often should you check lipids?
every 6 to 12 months
what should be measured before and 3 months after starting niacin or a fibrate?
liver enzymes
When are Creatine kinase levels drawn
when a patient experiences myalgias or muscle weakness
when do you check lipids when starting a new cholesterol med?
6-8 weeks
