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Endocrine > Lipid Management > Flashcards

Lipid Management Flashcards

1
Q

what are xanthomas?

A

soft yellow skin plaques or noduels that contain depoosits of lipoproteins inside histiocytes.

-most commonly found around eyes and on the achilies tendon

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2
Q

Metabolic Syndrome

-what is this?

A

3 criteria must be met in order to have metabolic syndrome:
-abdominal obesity ( greater than 40 in men, greater than 35 in women)

  • high triglyceride level (150 or greater)
  • Low HDL ( less than 40 for men, less than 50 for women)
  • HTN (greater than 130/85)
  • Impaired fasting glucose level (greater than 100)
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3
Q

If triglycerides are up in the 700-800s what are we thinking?

What are soem things that lower HDL?

How does HTN damage endothelial lining of blood vessels?

A
  • think genetic disorder OR pancreatitis
  • smoking and DM that lower HDL
  • HTN creates a stressful environment for plaques
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4
Q

Hyperlipidemia

-5 major steps for treatment recommendations

A
  1. fasting lipid profile
  2. ID CHD risk equivalents
  3. ID major CHD risk factors other than LDL
  4. Calculate 10year risk of CHD
  5. Determine risk category using Framingham scoring for persons without known CHD or atherosclerotic disease or diabetes.
    * for persons with 0-1 risk factor you do not need to calculate.
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5
Q

What is a risk equivolent? Risk factor?

A

Equivolent: means the same as already having an event. ex: DM, Abdominal aortic Aneurysm, Peripheral arterial disease,

Risk factor: factors that put you at risk of having an actual event.

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6
Q

Lipid Panel Goals

A

Total Cholesterol less than 200

LDL less then 100

HDL

  • greater than 40 men
  • greater than 50 women
  • greater than 60 cardio protective

Triglycerides less than 150 is normal

  • first get LDL to goal then start on HDL and Triglycerides
  • if smoker and/or DM you need to make sure these two things are under control before you start meds to lower HDL. If not HDL will never come up.
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7
Q

Major Risk Factors for hyperlipidemia?

A
  • Smoking
  • HTN 140/90
  • Low HDL
  • family hx of premature CHD
  • age men greater than 45 and women 55.
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8
Q

Risk category:
-CHD
-2 or more risk factors
0-1 risk factors

-what are the goal LDL, LDL level to initiate lifestyles changes, LDL leve to consider drug therapy for the above?

A

CHD:

  • goal= less than 100
  • lifestyle changes = greater than 100
  • medication = greater than 130

2 RF:

  • goal = less than 130
  • lifestyle = greater than 130
  • meds = less than 130-160

1 RF:

  • goal = less than 160
  • lifestyle = greater than 160
  • meds = greater than 190
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9
Q

Very high risk patients we want LDL to be below?

A

70

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10
Q

What is an appropriate LDL to HDL ratio?

A

1: 4

* higher ratio = higher risk of heart disease

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11
Q

Therapuetic Lifestyle changes in lowering LDL

A
  • dietary changes
  • weight management
  • increase physical exercise (little effect on LDL but increased HDL)
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12
Q

Statins

  • aka
  • what are they used for?
  • most common 3
  • moa
A
  • aka: HMG-CoA reductase inhibitors
  • lowering LDL cholesterol and triglycerides and increase HDL.

Common:

  • Crestor (rosuvastatin)
  • Lipitor (atorvastatin)
  • Zocor (simvastatin)* most commonly used, generic

MOA:

  • block conversion of HMG-CoA which is the rate limiting step in production of cholesterol.
  • increases LDL receptors in liver
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13
Q

Main SE of Statins?

CI?

A
  • hepatoxicity
  • myalgias
  • myopathy (muscle breakdown)
  • Myositis (muscle inflamm)
  • GI upset
  • HA
  • elevated LFT
  • SE are agent specific not always class specific.

CI:

  • pregnancy
  • liver disease
  • CAUTION in those who consume large amounts of alcohol or hx liver disease
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14
Q

CHeck ____ if patient complains of myalgias while on statin?

When you suspect myopathy how do you manage statin use?

Meds that increase statin myopathy?

When to stop statins based on LFTs?

Which statin do you need to check kidney function?

A 
Creatinine phosphokinase (CPK) 
released with muscle damage

-change statin and rechallenge. if rhabdo occurs stop statin use and begin IV fluids to prevent renal failure.

Med:

  • gemfibrozil
  • clarithromycin
  • amiodarone

Stop Statin if LFT greater than 3 times baseline

Check kidney function with crestor.

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15
Q

When to take statins?

Which statin is most effective in raising HDL? Lowering dTGs?

A

evening or bedtime , majority of cholesterol production occurs during sleep.

HDL raise: Rosuvastatin (Crestor)
TG lower: Atorvastatin (lipitor) and Rosuvastatin (Crestor)

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16
Q

Bile Acid Resins

  • used for what?
  • how do they work?
  • monotherapy?
A
  • decrease cholesterol absorption through exogenous pathway, decreases the return of cholesterol to the liver whereby the liver responds by increasing LDL receptors, which in turn decreases the amount of LDL in blood.
  • bind bile acids in intestines forming an insoluble complex that is excreted in the feces.
  • used as adjunct therapy
17
Q

Bile Acid Resins

  • SE
  • which med has lease SE?
  • what are two other meds?
A
  • nausea, bloating, cramping
  • increased liver enzymes

-colesevalam

2 others:

  • cholestyramine (Questran)
  • Colestipol (Colstid)
18
Q

Niacin

  • what does this do?
  • efficacy?
  • SE
A
  • raises HDL and lowers LDL and TG
  • one of most effective agents but most pts cannot tolerate the high doses
  • SE:
  • -pruritis
  • -flushing
  • -HA ( take aspirin 30mins prior)
  • –hepatotoxicity
  • -ortho hypotension
  • -GI side effects
19
Q 
Cholesterol Absorption Inhibitors 
-medication name?
-MOA
-monotherapy?
-SE
-
A

Ezetimibe (Zetia)

  • moa:
  • act on brush border enzymes of small intestines, inhibits absorption of cholesterol to liver.

-usually not going to be single therapy, use in combo with statins.

SE:
-HA, diarrhea, Abd pain

20
Q

Fibric Acid Derivatives

  • Drug names
  • what does this do?
  • SE
A

Drugs:

  • Gemfibrozil (lopid)* may cause rhabdo
  • Fenofibrate (Tricor, Trilipix)
  • principal effect is TG lowering, but it also rasies HDL and lowers LDL
  • SE
  • GI upset
  • Myopathy
  • Jaundice
  • increases effects of warfarin
  • gallstones
  • hepatotoxicityoo
21
Q

Hypertriglyceridemia

-tx

A

tx:
- Borderline (150-199mg/dL) calorie restriction and excercise
- High (greater than 200) diet and meds
- TG greater than 500 increased risk of pancreatitis

22
Q

Fish Oil

  • what does this do?
  • medication names
A
  • lowers TG conc.

- meds: Lovaza for TG greater than 500.

23
Q

Match the Drug class with its medications.

  • Bile Acid Sequesterants
  • Nicotinic Acid
  • HMG CoA reductase Inhib.
  • Fibric Acid Derivatives
  • Cholesterol absorption Inhib.
A

Bile:

  • cholestyramine (Questran)
  • Colestipol (Colstid)
  • Colesevelam

Nicotinic Acid:
-Niacin

HMG CoA:

  • Crestor (rosuvastatin)
  • Lipitor (atorvastatin)
  • Zocor (simvastatin)

Fibric Acid:

  • Gemfibrozil
  • Fenofibrate

Cholesterol:
Ezetimibe (Zetia)

24
Q

What non-specific inflamm marker correlates pretty well with LDL

A

CRP (C-reactive Protein)

Endocrine (10 decks)

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