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Clin Med 2 - CARDS > Lipid Disorders - waldron > Flashcards

Lipid Disorders - waldron Flashcards

1
Q

what are the subclasses of lipids

A

fatty acids
triglycerides
cholesterol
phospholipids

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2
Q

what is the importance of lipids

A

storing energy
signaling
structural components of cell membranes
provide insulation
source of fat-soluble vitamins (A,D, E, K)
protection

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3
Q

what does cholesterol in circulation originate from

A

either endogenous of exogenous pathway

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4
Q

what must lipids attach to to be soluble

A

lipoproteins

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5
Q

what is atherosclerosis

A

chronic inflammatory disease characterized by buildup of lipids in/on artery walls

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6
Q

what is the underlying process responsible for the majority of cardiovascular events

A

atherosclerosis

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7
Q

what make a atherosclerotic plaque vulnerable

A

thinning of the fibrous cap

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8
Q

what occurs with plaque rupture

A

formation of thrombus

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9
Q

what is the framingham heart study

A

identified risk factors:
blood cholesterol levels as predictive
C-reactive proteins as predictive in higher risk patients
equivocal on homocysteine as a predictor

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10
Q

what are non-modifiable risk factors of atherosclerosis

A

age
sex
family history

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11
Q

what are modifiable risk factors for atherosclerosis

A

smoking
High BP
High blood cholesterol levels
inflammatory and hyper-coagulable states
DM
overweight/obesity
sedentary lifestyle
high stress
unhealthy diet

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12
Q

what are considerations for risk calculations for atherosclerosis

A

age
sex
race
cholesterol levels
BP
Meds
Diabetes status
smoking status

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13
Q

over what percentage is considered high risk for ASCVD

A

> 20%

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14
Q

what are risk enhancers for ASCVD

A

family hx of early onset ASCVD
continually elevated LDL
chronic kidney disease
metabolic syndrome
preeclampsia or premature menopause
inflammatory disease (RA, psoriasis, HIV/AIDS)
south asian ancestry
continually elevated triglycerides
elevated biomarkers

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15
Q

what are the types of lipid disorders

A

Primary (familial/hereditary) hyperlipidemia
secondary (acquired) hyperlipidemia: hypercholesterolemia and hypertriglyceridemia

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16
Q

what are the typically causes of hypercholesterolemia/hyperlipidemia

A

high fat diets
sedentary lifestyle
obesity
DM
Genetic causesL: familial hypercholesterolemia

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17
Q

what is familiar hypercholesterolemia

A

genetic disorder
causes significant elevation of LDL-C levels
leads to early cardiovascular disease (CVD)

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18
Q

What is the friedewald equation

A

Total cholesterol = LDL + HDL + (TG x 20%)

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19
Q

what can affect total cholesterol

A

can vary due to stress, minor illness

20
Q

what is LDL (low-density lipoprotein)

A

primary measure for cardiovascular disease risk assessment and treatment guidance
made up mostly of cholesterol
high levels increases risk for heart disease and stroke

21
Q

what is HDL (high-density lipoproteins)

A

inversely associated with adverse cardiac outcomes
absorbed cholesterol and takes it back to the liver

22
Q

what are triglycerides

A

store unused calories and provide body with energy

23
Q

What are the different LDL particles and what do each contain more or less of

A

Small LDL particles - less cholesterol
Large LDL particles - more cholesterol

24
Q

What is ApoB

A

primary apolipoprotein attached to atherogenic particles
involved in metabolism and transport of lipids
high # indicative for increased risk for Heart dx

25
Q

what is lipoprotein A

A

genetically determined
increased may indicate increased risk for MI, stroke or aortic stenosis in the future

26
Q

what are cholesterol treatments

A

dietary changes
weight loss
aerobic exercise
tobacco cessation
pharmacotherapy: statins, bile acid sequestrants, fibrates

27
Q

what are the considerations when choosing treatment options

A

overall cardiovascular disease risk factor
cost of treatment
patient preferences

28
Q

what is considered first line therapy for lipids

A

statins

29
Q

what are statin intolerance

A

muscle symptoms
rhabdomyolysis
ALT rise >3x normal
serious liver disease

30
Q

what is personal hx that increases risk for statin intolerance

A

age (>80)
sex (f)
ethnicity (asian)
neuromuscular, kidney, or liver conditions
hypothyroidism
new intensive exercise

31
Q

what should be monitored when using long term statin

A

check lipid panel
LFTs
CK level

32
Q

how do BAS work

A

sequestering bile acid in the GI tract, prevents being absorbed into bloodstream
- liver removes cholesterol from blood to make more bile acid, thus reducing cholesterol levels

33
Q

what is the primary indication for fish oils

A

hypertriglyceridemia

34
Q

what is the use of fibrates

A

reduces liver production of VLDL and speeds up removal of TG from blood
consider with high triglycerides

35
Q

what is Ezetimbie (zetia)

A

hyperlipidemia medication that inhibits absorption of cholesterol from small intestine
decreases amount of cholesterol normally available to liver cells
reduces CV events, reduces LDL-c

36
Q

what is Niacin

A

hyperlipidemia medication that reduces TC, LCL-C, TG and increases HDL-C

37
Q

What are PCSK9 Inhibitors

A

monoclonal antibodies that block PCSK9 protein from working - LDL receptors increase and LDL-c decreases
may be used with or separate from statin medications

38
Q

what can high triglycerides be a sign of

A

type 2 diabetes or prediabetes
metabolic syndrome
hypothyroidism
certain rare genetic conditions that affect how the body converts fat to energy

39
Q

what medications can have a side effect of high triglycerides

A

diuretics
estrogen and progestin
retinoids
steroids
BB
some immunosuppressants
some HIV meds

40
Q

what are the initial management choices for triglycerides

A

healthy lifestyle
exercise
avoid sugar/refined carbs
lose weight
choose healthier fats
limit alchohol intake

41
Q

what is the medication management for triglycerides

A

statins
fibrates
fish oil
niacin

42
Q

what are metabolic syndromes associated wtih

A

insulin resistance
prothrombotic and pro-inflammatory states
risk of DM, MI and CVA

43
Q

what are risk factors for metabolic syndrome

A

obesity
sedentary lifestyle
family hx
hyperlipidemia
HTN

44
Q

how often should screenings be done for metabolic syndromes

A

repeat every 3 years

45
Q

how are metabolic syndromes diagnosed

A

impaired glucose metabolism
lipid profile
insulin resistance

46
Q

what is the management of metabolic syndrome

A

key is to prevent progression of diabetes
weight reduction/loss
aerobic exercise
decreased caloric intake
pharmacologic tx for glucose control and cardiac risk management

Clin Med 2 - CARDS (11 decks)

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