Lipidology Flashcards
Type I (Chylomicrons)
Contain TGAs
Defect dec’d familial LPL, CII
Skin lesions: eruptive xanthomas
Type II (LDL)
Contains: LDL
Defect - dec’d LDL rct’s
Skin lesions: Tendon, xanthomas
Type III (IDL)
Contains: LDL+TGAs
Defect Abnormal APoE
Skin lesions: Palmar/Tuberous Xanthomas
Type IV (VLDL)
Contains: TGAs
Defect dec’d familial LPL, CII
Skin Lesions: Eruptive Xanthomas
Type V (VLDL+Chylomicrons)
Contains: TGAs
Defect dec’d familial LPL, CII
Skin Lesions: Eruptive Xanthomas
Statins
Primary LDL tx, dec’s LDL, inc’s TGA, inc’d HDL
S/E - inc’d LFTs, CPK, wt gain
Glucose intolerance
Fibric Acid derivatives
Primary TGA tx
Inc’d /N LDL, dec’d TGA, inc’d HDL
S/E Gallstone, hepatoma
Bile Acid derivatives
Secondary LDL tx
dec’d LDL, TGAs, inc’d HDL
S/E Bloating, constipation, nausea
Nicotinic Acid
Primary HDL, secondary LDL
dec’d LDL, very dec’d TGA, very inc’d HDL
S/E Abd pain, nausesa, flushing, dry skin
Ezetimibe
TGA tx, seconary LDL
dec’d LDL, dec’d TGA
Apo protien E def
Type III
Def of LDL rct’s
Type IIa
Tendon xanthomas
Type IIa
Pancreatitis
Type I, IV, V
Pt with LDL 140, TGA 600 -0 fhx hypertriglyceridemia
Fibrinc acid derivative (gemfibrozil, fenofibrate)
Which reduces TG of 500 in pt with BMI 30
Losing wegith 5-10%
Defect - C II def - eruptive xanthoma
Tx: Gemfibrozil
Palmar Xanthoma
Most likely defect Apo E
Chol guidelines
No CAD, 0-1 risk factor LDL <130
CAD equivalent risk factors
DM, Vascular dz, multiple risk factors with 10 year framingham >20%
Treatment
First line = diet Goo fats, < 200mg chol 15% calories from protienes excercise 1hr/day, 5 days/ week smoking cessagion
Reynolds vs Framingham
Reyolds include high sensitivety CRP
Parental h/o MI
Accounts for gender…
Pt wants alternative med for prevention of CAD
Omega 3 fatty acid
40yo no risk factors for CAD with LDL 175
first diet/excercise
Pt with DM likely has…
inc’d LDL, inc’d TGA, dec’d HDL
Primary target for therapy in DM pt
LDL
62yo F with HTN and DM2 requests advice of CAD risk reduction BP 152/92, A1c 7.6, chol 268, LDL 180, HDL 42
Statin for LDL <100
What is initial drug for DM pt with LDL 160, TGA 250, HDL 45
Statin
57yo F with MI, quits smoking, changes diet, started on zocor 20 LDL 180 to 140, TGA 350 to 250, HDL 48 wtd?
inc to zocor 40
Pt over age 50, LDL 140, CRP more than 2mg - what will dec mortality?
Statin
Pt on zocor - 8 wks later with genralized myalgias, CPK 75, AST/ALT 30/40 dz?
statin induced myalgia
Best management - switch to pravastatin
67yo M c/o pain/wk legs, difficulty getting up from seated postion, stpped taking lipitor 3 mo ago after CPK elevated - - repeat CPK 1925 - not much change - mulscel bx necrotizing fibers no inflamm, no vaculole - dx?
Statin induced myopathy 2/2 to HMGCR
Hyperlipidemia in pregnancy
Colesevelam (welchol)
Lipitor 40-> 80 - AST/ALT up but not 2x ULN, LDL now 80 , HDL now 59, wtd?
continue current dose
40yo M strong fhx prem MI LDL 130, HDL 28, TGA 175 what is elevated?
Lp(a) (dec’d HDL)
tx: Niacin
Prevention of flushing aw Niacin
ASA 30min prior
55yo M strong fhx premature coronary dz LDL 180, HDL 29, TGA 375 - started on zocor 40 - LDL now 120, HDL 35, TGA 245 wtd?
continue zocor, add niacin
Pt on zocor with Wk CPK 850
d/c zocor
Pt for regular checkup LDL 150 TG 160, HDL 80 wtd?
No need for meds
