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UF COM ClinDx Unit 4 > L8 - Hyperlipidemia > Flashcards

L8 - Hyperlipidemia Flashcards

1
Q

What are the different types of lipoproteins? Are they “good” or bad”?

A

HDL = good

LDL = Bad

Triglyceride rich proteins (VLDL, IDL & Chylomicrons) = probably bad

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2
Q

What lipoproteins are measured individually in a lipid panel?

A

HDL
LDL
Triglycerides (VLDL, IDL & Chylomicrons)
Total Cholesterol (HDL + LDL + triglycerides/5)

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3
Q

What lipoproteins are not measured individually in a lipid panel?

A

VLDL, IDL & Chylomicrons are listed collectively as triglycerides

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4
Q

What is the relationship between total cholesterol & heart disease risk on a population basis?

A

Directly proportional in men & women of all ages

However on individual basis total cholesterol is misleading

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5
Q

Lowering cholesterol helps lower cardiac risk in who?

A

Almost everyone

He joked about putting statins in the water

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6
Q

What non-cardiac presentations can results from hypercholesterolemia?

A

Xanthomata = high levels of cholesterol leads to the deposition of cholesterol in nodular plaques on the skin, retina or tendons

Secondary consideration to cardiac issues

Generally related with really high cholesterol seen in familial conditions, but can also have benign forms with normal lipid panel

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7
Q

What is the relationship between total cholesterol & heart disease risk when looking at an individual?

A

Poor association

Can have high HDL lead to an inaccurate high total cholesterol reading when low LDL is present

Can have a low HDL level lead to an inaccurate normal total cholesterol when high LDL is present

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8
Q

Patient presents with high triglycerides, low HDL & high LDL. What do you focus on first?

A

LDL

Then can focus on either triglycerides or HDL (no diffinitive research suggesting which one should be treated second) after LDL is in desired range

Exception = if triglycerides are over 500, need to get those under 500 before LDL can be accurately measured

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9
Q

What is the relationship between LDL & heart disease risk when looking at an individual?

A

Strong directly proportional

More accurate than total cholesterol

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10
Q

What are the different ranges of LDL?

A

Optimal <70 can be beneficial

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11
Q

What is treatment goal for somebody with prior Coronary Heart Disease?

A

<100

Same as CHD equivalent

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12
Q

What is the treatment goal for somebody with 2 or more risk factors for CHD & no previous history of CHD?

A

<130

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13
Q

What is the treatment goal for somebody with 1 or less risk factors for CHD and no previous history of CHD?

A

<160

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14
Q

How do statins work?

A

HMG CoA reductase inhibitor –> blocks step of cholesterol synthesis in the liver

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15
Q

How do bile sequestrants work?

A

Interrupt entero-hepatic circulation –> excrete more bile –> need to make more bile –> use up cholesterol making new bile

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16
Q

What drug should not be used when trying to get triglycerides lowered?

A

Bile sequestrants, cuz may actually increase triglycerides

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17
Q

If trying to lower LDL, what drug do you use?

A

Use statin, but if patient can’t tolerate statin use bile acid sequestrant (less effective & more side effects)

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18
Q

Side effects related to statins? What to do if see these in a patient?

A

Myopathy

Increased LFTs (Liver function test = bilirubin, INR, PT, albumin)

If severe side effects –> switch to bile acid sequestrant

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19
Q

Side effects related to bile acid sequestrants?

A

GI problems = bloating, gas, diarrhea …

+ can raise triglycerides

Common. Part of reason why statins are first line

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20
Q

Types of bile acid sequestrants mentioned in lecture?

A

Cholestipol

Cholestyramine

Both start with Chol

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21
Q

What drug is best for raising HDL?

A

Niacin

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22
Q

What is another name for Niacin?

A

Nicotinic Acid

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23
Q

Actions of Niacin? Side effects?

A

Mainly raises HDL & lower triglycerides

Flushing (more severe form of blushing seen not just on the face). Common = why don’t use this drug if just targeting triglycerides

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24
Q

Action of Fibric Acid derivatives?

A

Mainly lowers triglycerides, but also helps HDL & LDL a bit

25
Q

What Fibric Acid derivatives were mentioned?

A

Gemfibrozil

Fenofibrate

Both have fib in the middle

26
Q

Side effects of Fibric Acid derivatives?

A

Myopathy

Y shouldn’t be used in conjunction with statin

27
Q

Why should a fibric acid derivative not be used at the same time as a statin?

A

Both drugs can cause side effect of myopathy –> potentiated effect –> rhabdomyolysis

28
Q

What is the effect of therapuetic lifestyle changes (TLC) on LDL?

A

20-30%, good so should be part of every treatment regimen but not great so usually not enough on its own

29
Q

What is the relationship of statin dose on LDL level? Why is this important?

A

Dose dependent response = as increase does lower LDL

If not at goal can up dose and get better results

30
Q

What is the difference between different statins and when are they used?

A

Differing effectiveness

Crestor = most effective, but more expensive and individuality means some can’t handle it

31
Q

What is secondary CHD prevention?

A

Lower cholesterol in somebody who has already had CHD so they don’t get another episode

<100 goal

32
Q

If the patient is on a statin but still very far from goal, what should you do?

A

Raise dose, but in a stepwise fashion

Don’t jump up multiple dosages at once cuz more likely to get side effects

33
Q

Follow up schedule for somebody that has an LDL >30 more than desired treatment goal at dianosis?

A

Start TLC & drug –> follow up in 6 weeks

Continue seeing every 6 weeks and up dose until get to treatment goal

34
Q

What is the difference in HDL between sexes?

A

Pre-menopasual women have higher HDL cuz estrogen increases HDL (may have high total cholesterol but that isn’t bad)

35
Q

What are CHD risk factors?

A

Smoking

HDL 45 men, >55 women)

1st degree relative with CHD (60, “eliminates” a risk factor

36
Q

If LDL is less than 30 away from treatment goal on diagnosis, what should you do?

A

Start with just TLC

Follow up in 6 weeks. Give another 6 weeks if still not at goal

If still not at goal by third visit use drug

If no motivation for TLC just jump to meds

37
Q

What are CHD equivalents?

A

Any CHD (stent, MI, angina …)

Carotid Stenosis

Peripheral Artery disease

Aortic aneurysm

Renal artery stenosis

Diabetes

*Familial hyperlipidemia is sort of an equivalent

38
Q

How to proceed in a patient with CHD equivalent?

A

Suggested TLC + drug

For diabetes, must use drug + TLC (evidence shows it is helpful even if LDL is lower than treatment goal. Same for patients with previous CHD)

39
Q

What is primary CHD prevention?

A

Trying to prevent first CHD in somebody with CHD equivalent

<100

40
Q

If see somebody who is really young or has really healthy lifestyle with high LDL, what should you suspect?

A

Familial/genetic

Didn’t fast before test –> inaccurate

41
Q

If see somebody with an LDL >160 what should you suspect?

A

Familial/genetic

Didn’t fast before test –> inaccurate

42
Q

How is treating a genetic or familial cause different?

A

More aggressive

Drug & TLC from the start

43
Q

What is the treatment goal for somebody with familial/genetic hyperlipidemia?

A

Treat as CHD equivalent –> <100

44
Q

Secondary causes of Hyperlipidemia?

A 
Diabetes
Obesity
Smoking
Renal Failure
Liver Disease
Hypothyroidism
Meds (progestins, estrogen, HIV drugs, steroids & corticosteroids)
45
Q

High LDL with no apparent secondary cause. What should you consider?

A

Think familial

46
Q

Patient has LDL >190. What do you do?

A

If familial, drug + TLC

If non-familial (just crazy bad lifestyle), just TLC

47
Q

How is LDL measured?

A

Too expensive to measure directly

Measure other stuff & calculate with equation

If triglycerides over 500 equation doesn’t work. Can send out for direct measurement but takes too long & is expensive

48
Q

What does LDL undetermined mean?

A

Triglycerides are over 500 so can’t calculate LDL

49
Q

When would you focus on triglycerides before LDLs?

A

If triglycerides are > 500, need to treat it until < than 500 so can accurately measure LDL

Once <500 can treat LDL

50
Q

Why is having a triglyceride >500 bad?

A

Pancreatitis is a concern

Can’t measure LDL accurately

51
Q

How does triglyceride level correlate with CHD risk factor?

A

Directly proportional, but no proof that it is cause and effect. Could just be that people with high triglycerides tend to have other risk factors

52
Q

What is treatment goal for somebody with CHD equivalent?

A

< 100

Same as prior CHD

53
Q

What the action of bile sequesterants?

A

Main action is to lower LDL, but also help raise HDL. It is the only drug that actually may rise Triglycerides.

54
Q

Which hyperlipedemia drug has a significant effect on 2 different classes of lipoproteins?

A

Niacin raises HDL & lowers triglyceride

55
Q

43 yo female smoker with HTN and HDL of 43. Father had MI at 62. Treatment goal?

A

2 risk factors –> <130

Dad is not risk factor (he is too old)

56
Q

40 yo female non-smoker with well controlled HTN on medication. Father had MI at 62. HDL is 67. Treatment goal?

A

1 for HTN, but - 1 for high HDL –> 0 RF

Goal <160

Dad is not risk factor (he is too old)

57
Q

Treatment goal for diabetic 45 yo woman with HDL of 65 & no HTN. Non-smoker with no family history of CHD?

A

Diabetic = equivalent –> ignore other risk factors

<130

58
Q

What type of hyperlipidemia can lead to pancreatitis?

A

Triglycerides > 500

UF COM ClinDx Unit 4 (10 decks)

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