Brainscape's Knowledge GenomeTM

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


See full index

Clin Med II > L2: Hyperlipidemia > Flashcards

L2: Hyperlipidemia Flashcards

1
Q

What do chylomicrons do?

A

Carry dietary lipids from intestine to liver, skeletal muscle, and adipose tissue

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

What do VLDL’s do?

A

Carry newly synthesized triglycerides from liver to adipose tissue

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

What do IDL’s do?

A

Intermediate between VLDL and LDL; not usually detectable in blood

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

What do LDL’s do?

A

Carry cholesterol from liver to body’s cells

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

What do HDL’s do?

A

Collect cholesterol from body’s tissue and return it to liver (the good cholesterol)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the 2 forms of exogenous lipid metabolism?

A
  • Diet

- Chylomicrons

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

What are the 2 forms of endogenous lipid metabolism/

A
  • Liver (produces fats)

- VLDL, LDL, IDL

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

What is the 1 form of reverse cholesterol transport lipid metabolism?

A

HDL

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

What are the 3 types of inherited lipid disorders?

A
  • Familial hypercholesterolemia
  • Polygenic hypercholesterolemia
  • Familial combined hyperlipidemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the gene requirements for familial hypercholesterolemia?

A

Monogenic disorder:

  • Heterozygotes (2x normal value of LDL)
  • Homozygotes (8x normal value of LDL)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which inherited hyperlipidemias are polygenic?

A
  • Polygenic hypercholesterolemia

- Familial combined hyperlipidemia

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

Of the 3 inherited disorders, which is most common?

A

Familial combined hyperlipidemia

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

What is FCH different from PH or FH?

A

PH and FH have increased levels of LDL while FCH has a wide variety of lipid abnormalities.

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

How do you treat the inherited hyperlipidemias (in general)?

A

Statins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the types of secondary hyperlipidemias? (8)

A
  • Diabetes
  • Excessive alcohol
  • Smoking
  • Obesity
  • Hypothyroidism
  • Chronic renal disease
  • Medications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When should children with a family hx of hyperlipidemia be screened?

A

Between ages 9-11 and again at 17-21 years old or earlier if high suspicion

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

What are the modifiable risk factors for CHD (coronary heart disease)?

A
  • HTN (BP >/= 140/90 or on antihypertensive)
  • DM
  • Tobacco use
  • Obesity
  • Hyperlipidemia or HDL <40
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What HDL level is considered a risk factor? What HDL level is considered a negative risk factor?

A

Risk factor: HDL <40

Negative risk factor: HDL >/= 60

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

What is the primary form of testing for hyperlipidemia? Describe the process.

A

Fasting lipid panel

  • Consists of total cholesterol, triglycerides, LDL, and HDL
  • Total cholesterol = HDL + LDL + (triglycerides/5)
  • 12 hour fast (mostly for the triglycerides)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What can cause falsely low levels when taking a fasting lipid panel?

A

Acute coronary syndrome (cholesterol/LDL/HDL levels can drop 24-48 hours after acute MI and persist for 60 days)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the desirable, borderline, and high risk levels for cholesterol on a lipid profile?

A

Desirable: <200
Borderline: 200-239
High risk: 240

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the desirable, borderline, and high risk levels for triglycerides on a lipid profile?

A

Desirable: <150
Borderline: 150-199
High risk: 200-499

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

What is the desirable, borderline, and high risk levels for HDL on a lipid profile?

A

Desirable: 60
Borderline: 35-45
High risk: <35

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the desirable, borderline, and high risk levels for LDL on a lipid profile?

A

Desirable: 60-130
Borderline: 130-159
High risk: 160-189

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are 4 possible exam findings you may see in a patient with hyperlipidemia?

A
  • Plane xanthomas
  • Tuberous xanthoma
  • Eruptive xanthoma
  • Corneal arcus

***But remember PE may be completely normal

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

What are plane xanthomas? Which disorders would this finding indicate?

A
  • Cholesterol filled, soft, yellow plaques that appear in various places
  • Can indicate familial or secondary causes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are cholesterol filled, soft, yellow plaques that appear in various places?

A

Plane xanthomas

28
Q

What are tuberous xanthomas? Which disorders would this finding indicate?

A
  • Yellow-orange nodules often located over knees and elbows (can also be in the tendons = tendinous xanthoma)
  • Associated with familial hypercholesterolemia
29
Q

What are yellow-orange nodules often located over knees and elbows?

A

Tuberous xanthomas

30
Q

What are crops of red-yellow papules with abrupt onset, most commonly located on the extensor surfaces and buttocks?

A

Eruptive xanthomas

31
Q

What are eruptive xanthomas? Which disorders would this finding indicate?

A
  • May indicated familiar HLD

- Caused by elevated triglycerides often >1500mg/dL

32
Q

What level of triglycerides can cause eruptive xanthomas?

A

> 1500mg/dL

33
Q

What is a corneal arcus?

A

White or grey ring around cornea (can be common in pts over 40 WITHOUT elevated lipids)

34
Q

What is the DASH diet?

A
  • Dietary Approaches to Stop Hypertension*
  • Rich in fruits and veggies
  • Moderate in low-fat dairy products
  • Low in animal protein
  • Contains many plant sources of protein (legumes and nuts)
  • Low sodium
35
Q

What is a form of treatment that can actually increase HDL levels?

A

Exercise!

36
Q

What is the recommendation for exercise in a pt with hyperlipidemia?

A

3-4 session/week (40 min, mod-vigorous exercise)

37
Q

What is another name for statins?

A

HMG Co-A Reductase Inhibitors

38
Q

What is the MOA for statins? (describe the process)

A
  • Inhibit HMG Co-A Reductase (part of RLS in cholesterol synthesis in liver)
  • Less cholesterol produced and blood cholesterol levels decrease
  • Liver enzymes detect low cholesterol = increased LDL and VLDL receptors at liver = cholesterol digestion
39
Q

What are the adverse effects of using statins? (4)

A
  • Liver toxicity
  • Mild GI complaints
  • Myalgias, myositis, myopathy
  • Rhabdomyolysis
40
Q

When should statins be taken (time of day)?

A

Bedtime (that is when most cholesterol is synthesized)

41
Q

What are the contraindications for statins? (List absolute and cautionary situations)

A

Absolute: Active liver disease, Pregnancy
Use with caution: Concomitant use of CYP3A4 inhibitors and various drugs (drug interactions!), chronic kidney/liver disease

42
Q

How do you monitor statin therapy?

A
  1. Baseline lipid panel, liver function test, and creatine kinase labs
  2. While pt takes meds and makes life style changes, repeat lipid panel every 4-12 weeks after initiation or dose adjustment
  3. Repeat every 3-12 months as needed
43
Q

What are the 3 things you should do if pt has a poor response or intolerance to statin therapy?

A
  1. Reinforce adherence to medication and lifestyle changes
  2. Exclude secondary causes of hyperlipidemia
  3. Investigate statin intolerance
44
Q

How should you treat an individual who is at high risk for atherosclerotic cardiovascular disease and who is already taking max tolerated statin but has an insufficient response?

A

Consideration for addition of a non-statin LDL lowering agent to their therapy

45
Q

Which medications should NOT be given during pregnancy?

A
  • Statins
  • Nicotinic Acid (Niacin)
  • Fibric acid derivatives
  • Ezetimibe
46
Q

Which medications are safe to use during pregnancy?

A

-Bile acid sequestrants (resins)

47
Q

What is the primary purpose of statin use?

A

Lowers LDL

48
Q

What 3 primary things should you be cautious of when prescribing statins?

A
  • Liver toxicity
  • Myopathy
  • Drug interactions
49
Q

What should you do if myositis (rhabdomyolysis) is suspected with statin therapy?

A

Discontinue statin and check CK level

50
Q

What is the primary purpose of fibrate use?

A

Decrease triglycerides (most useful with hypertriglyceridemia)

51
Q

What are the absolute and relative contraindications with fibrates?

A

Absolute: Severe hepatic or renal disease, pre existing gall stones, taking simvastatin
Relative: Other statin use (myopathy risk), concurrent warfarin use
***INCREASED RISK OF TOXICITIES WHEN USED WITH STATINS

52
Q

What is the primary purpose of niacin use?

A

Raise HDL, Lower LDL

53
Q

What are the absolute and relative contraindications with nicotinic acid (niacin) use?

A

Absolute: Active liver disease (check LFTs)
Relative: Hyperuricemia, hyperglycemia, unstable angina

54
Q

What is the primary side effect of fibrate use and how do you help prevent this?

A

Flushing; titrate slowly

55
Q

What is the primary purpose of bile acid sequestrants (resins)?

A

Lower LDL

56
Q

Which drug acts synergistically with statins?

A

Bile acid sequestrants (resins)

57
Q

What are the absolute and relative contraindications for resins?

A

CAN INCREASE TRIGLYCERIDES
Absolute: TGs > 400 mg/dL
Relative: TGs > 200 mg/dL

58
Q

What is the primary side effect associated with resins?

A

GI side effects

59
Q

What is the primary purpose of Ezetimibe?

A

Decreases LDL, Statin add-on

60
Q

What is are the contraindications associated with Ezetimibe use?

A

Use with a statin in active liver disease, pregnancy

61
Q

What is the primary purpose of PCSK9 inhibitors?

A

Decreases LDL

62
Q

How should PCSK9 inhibitors be used?

A

Adjunctive w/ statins or if statins not tolerated

63
Q

Which medication is expensive and requires injections?

A

PCSK9 inhibitors

64
Q

Which medications can be used in adjunct with statins?

A
  • Resins
  • Ezetimibe
  • PCSK9 inhibitors
65
Q

Which medications should NOT be used in adjunct with statins?

A
  • Nicotinic acid (Niacin)

- Fibrates

66
Q

According to 2018 guidelines, what are the primary goals for tx of hyperlipidemia?

A
  • Reduce ASCVD events in secondary and primary prevention
  • Focus on ASCVD risk reduction rather than target lipid levels
  • Risk reduction = decrease in LDL level
67
Q

Which 4 groups would benefit from statin therapy? Specify which is secondary and primary prevention)

A
  1. Individuals with clinical ASCVD (secondary prevention)
  2. Individuals with LDL >/= 190 mg/dL
  3. Individuals with diabetes aged 40-75 yo with LDL >/= 70 mg/dL
  4. Individuals without ASCVD or DM but with LDL levels at 70-189 mg/dL and estimated 10-year ASCVD risk >/= 7.5% (estimated via pooled cohort equations)

Clin Med II (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions