Management of Hyperlipidemia

Question 1

Xanthomas

Answer 1

Soft, yellow skin plaques or nodules that contain deposits of lipoproteins inside histiocytes

Especially likely to be found on skin of patients with hyperlipidemia

Question 2

Step 1: Check Lipid PanelATP III Guidelines

Answer 2

Healthy adults, no risk factors – every 5 yrs starting at age 20

Obtain a fasting (9 to 12 hour) serum lipid profile consisting of total cholesterol, LDL, HDL and triglycerides

Follow up in 6 weeks

Question 3

Lipid Panel Goals

Answer 3

Total Cholesterol < 200
LDL  < 100
HDL 
		> 40 in men
		> 50 in women
		> 60 is considered cardio protective
Triglycerides < 150 is normal

Question 4

MOA of Statin Medications

Answer 4

Blocks the conversion of HMG-CoA to mevalonate, which is the rate limiting step in the production of cholesterol in the liver
Leads to an increase in the number of LDL receptors in the liver
HDL increases

Question 5

What are main side effects of Statins?

Answer 5

Hepatotoxicity
Myalgias
Myopathy
Myositis
GI Upset
Headache
Asymptomatic elevation in LFTs
-  They should be checked at baseline, at 6-12 weeks after starting or titrating, and every 6 months after

Question 6

Statins CI

Answer 6

Pregnant women
Patient with active / chronic liver disease
Patient with unexplained elevated aminotransferase levels (ALT’s)
CAUTION in patient who consume large amounts of alcohol or a history of liver disease

Question 7

Bile Acid Resins

Answer 7

Safe in pregnancy and pediatrics
Use is often limited by side effects
Nausea, bloating, cramping
Increase in liver enzymes
Colesevalam is better – less likely to cause GI effects

Question 8

Niacin CI

Answer 8

Absolute CI:
        -    Hepatic dysfunction
	-   Severe gout
Relative Contraindications:
-  Peptic ulcer disease
-  Gout - can elevate uric acid levels 
-  Diabetes - can worsen glucose control

Question 9

Cholesterol Absorption Inhibitors: Ezetimibe (Zetia)

Answer 9

Appears to act at the brush border of the small intestine
Inhibits the absorption of cholesterol leading to a decrease in the delivery of intestinal cholesterol to the liver
This mechanism is complementary to that of the STATINS