Lipid mgmt

Question 1

what is FH

Answer 1

defective LDL receptor

Question 2

how common in FH

Answer 2

heterozygote 1:500

homo 1:100000

Question 3

3 signs if FH

Answer 3

1. tendonous xanthoma
2. xanthelasma
3. arcus cornea

Question 4

what is structure of lipoproteins from least to most dense

Answer 4

chylomicron
VLDL
LDL
HDL

Question 5

what normally happens to VLDL

Answer 5

1. fatty acids pulled off by LPL on cells to make LDL
2. LDL-r on liver reabsorbs the LDL
3. liver secretes VLDL

Question 6

what is problem with LDL

Answer 6

atherosclerotic plaques
CV risk factor
** redcution in LDL leads to meaningful drop in CV risk

Question 7

how does statin work

Answer 7

1. reduces HMG coA in liver
2. don’t make cholersterol
3. low chol. causes the liver to produce lots of LDL-r
4. pulls in more LDL

Question 8

how to determine when to start statins

Answer 8

look at framingham risk cats

Question 9

what is rule of 67

Answer 9

each statin dose doubling reduces risk by 6%

Question 10

what to add if statin isn’t enough

Answer 10

ezetimibe

Question 11

what is MOA of ezetimibe

Answer 11

1. blocks absorbtions of cholesterol in the intestine

2. less chol. circulating means upreg. LDL-r in liver

Question 12

what is addition of ezitimibe equivalent to

Answer 12

3 doubleing of statins (18%)

Question 13

**what are normal, elevated and extreme levels of triglycerides

Answer 13

normal 10

Question 14

complications of moderate and extreme elevatiokns

Answer 14

moderate - CHD

extreme - pancreatitis

Question 15

mgmt of extreme hypertriglyceridemia

Answer 15

acute : NPO, fluids, low fat diet

chronic : diet, fibrates

Question 16

2 Sx of hypertriglyceridemia

Answer 16

1. lipemia retinalis

2. eruptive xanthoma

Question 17

what is patho of hypertri

Answer 17

defective LPL so get build up - target of fibrates

Question 18

what is not assessed in framingham (2) and how to deal with

Answer 18

1. family Hx - if have - double score

2. metabolic Sndrome

Question 19

even in moderate riskm what is target

Answer 19

lower LDL

Question 20

what is alternate target

Answer 20

non- HDL or apoB

Question 21

mgmt if mixed dylipidemia

Answer 21

1. statin is first line

2. offer adjunct if statin doesn’t work

Question 22

what is TC formula

Answer 22

TC = VLDL (TG/2.2) + LDL + HDL

Question 23

4 non statin therapies

Answer 23

1. ezitimibe
2. fibrates
3. bile acid sequestrants
4. niacin