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Clin Med Cardio Exam 2 > Dyslipidemias > Flashcards

Dyslipidemias Flashcards

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1
Q

Thickened and hardened lesions of the medium and large muscular and elastic arteries that are lipid rich

A

Atherosclerosis

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2
Q

Carries lipid to the arteries (must be oxidized)

A

LDL

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3
Q

Removes lipid from the arteries

A

HDL

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4
Q

What is the major source of endogenously derived cholesterol?

A

Liver and intestines

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5
Q

Where do you exogenously derive cholesterol?

A

Diet

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6
Q

What is the rate limiting step in the liver for cholesterol biosynthesis?

A

Converting HMG CoA to mevalonic acid by HMG CoA reductase

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7
Q

If you increase your intake of dietary cholesterol, what happens?

A

Down regulation of LDL receptors leads to subsequent elevation of serum LDL cholesterol

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8
Q

What can lead to the uptake of lipoproteins?

A

Vascular injury (smoking, HTN, DM)

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9
Q

Elevation of ____ can directly lead to vascular injury resulting in premature atherosclerosis

A

LDL (oxidized)

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10
Q

What is necessary for LDL to damage endothelial cells?

A

Oxidation

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11
Q

The relation between serum HDL and atherosclerosis is ____

A

Inverse

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12
Q

If your patient has normal LDL, but has low HDL, does this put them at risk for CHD?

A

Yes!

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13
Q

Clinical findings of hyperlipidemia

A 
Often asymptomatic 
Atherosclerosis
Eruptive xanthomas
Tendinous xanthomas
Xanthelasma
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14
Q

Most cases of adult dyslipidemia are ____

A

Multifactoral - diet, lifestyle, genes

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15
Q

Which diseases put you at risk for dyslipidemias?

A

DM, renal failure, hypothyroidism

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16
Q

What causes familial hypercholesterolemia?

A

LDL recepter defect (heterozygous)

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17
Q

What is the goal of treatment in secondary prevention of CHD?

A

To prevent recurrent coronary events and decrease coronary and total mortality (Prevention from progressing)

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18
Q

Patients with known CHD have a known incidence of ____X risk of MI

A

5-7

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19
Q

What are the 4 key groups for statin therapy?

A
  1. ASCVD history
  2. Primary elevation of LDL greater than or equal to 190mg/dL
  3. 45-70 y.o. with diabetes, and LDL from 70-189 w/o ASCVD
  4. 45-70 y.o. without clinical ASCVD or diabetes with LDL 70-189 with 10 year ASCVD risk of 7.5 or higher
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20
Q

Are there goals based on specific LDL values?

A

No! No evidence to support

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21
Q

Which therapies are HIGH intensity daily doses that lower LDL cholesterol? How much do they lower it by?

A

Atorvastatin, Rousuvastatin

50%

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22
Q

Which therapies are MODERATE intensity daily doses that lower LDL cholesterol? How much do they lower it by?

A

Simvastatin, Pravastatin, Lovastatin

30%

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23
Q

Who should receive high intensity statins?

A

All patients with ASCVD unless they are not a candidate and patients with LDL greater than 190 mg/dL

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24
Q

Diabetics with a 10 year ASCVD risk greater than 7.5 should receive??

A

High intensity statins

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25
Diabetics with a 10 year ASCVD risk lower than 7.5 should receive?
Moderate intensity statins
26
Patients 40-75 years with a 10 year ASCVD risk greater than 7.5 should receive?
Moderate to high intensity statins
27
What is the NNT that you need to treat with Atorvastatin to prevent one MI, one stroke, etc.
25
28
How do you prevent atherosclerosis?
LOWER LDL!!
29
How do you treat an individual who is younger than 40?
Use clinical judgement - cause other cholesterol lowering agents may be considered in addition to statins
30
What is the optimal value of total cholesterol? HDL?
170mg/dL total 50g/dL HDL
31
Does having high triglycerides put you at an increased risk for CAD/CHD?
Not necessarily - more risk when LDL is high or HDL is low
32
How are VLDL and HDL related?
Inversely
33
What do high triglycerides put you at risk for?
Pancreatitis
34
Should you treat hypertriglyceridemia?
Yes, but lowering LDL is more important!
35
Hypertriglyceridemia is very sensitive to ??
Diet, weight reduction, and exercise
36
If your patients triglycerides are greater than 200mg/dL, should you treat them?
Yes! Also consider Rx if HDL is very low!
37
How do you treat hypertriglyceridemia?
Fabric acid agents or niacin
38
Why is HDL good?
It is cardioprotective and directly protective
39
What does HDL do?
Facilitates removal of cholesterol in tissues
40
What non-pharmacologic treatments can increase HDL?
Weight loss, regular exercise, smoking cessation, estrogen therapy in post menopausal women (avoid where possible), decrease alcohol intake
41
What meds can increase HDL?
Fibric acid and niacin -- drugs used to treat hypertriglyceridemia
42
Do drugs that raise HDL reduce CV events and endpoints?
NO!
43
Why do drugs that raise HDL not help with endpoints?
It is raising the cholesterol HDL carries, but not the particles or proteins within the HDL molecule
44
What is the most important part of the HDL molecule that makes it anti-atherogenic?
The particles
45
The ideal diet is less than ____% fat, ____% saturated fat ____mg/day cholesterol
should be less than 30% fat, 7% saturated fat, and less than 200mg/day cholesterol
46
How should you replace fats in the diet?
Carbohydrates or monosaturated fatty acids
47
MOA of statins?
HMG CoA reductase inhibitors
48
Inhibit rate limiting step in cholesterol synthesis in liver; up regulate synthesis of LDL receptors - further reduction LDL cholesterol; LDL and TC lowered by 30-55%
Statins
49
What is the most commonly reported adverse effect of statins
Statin myopathy
50
What is the most common statin myopathy?
Myalgias CK will most likely be normal
51
What is a rare but life threatening type of statin myopathy? What will be increased with this condition?
Myositis with rhabdomyolysis CK will be increased 10X upper limit of normal If present, DC drug!
52
If your patient complains of a statin myopathy, what should you do?
1. Stop/hold drug immediately 2. Get CK 3. If CK is not elevated or mildly elevated then you just decrease the dose of statin
53
What increases the risk of statin myopathy?
Increased with drugs that inhibit statin metabolism
54
What is a major endocrine issue with statin therapy?
Can cause chemical diabetes
55
Who is at risk for chemical diabetes?
1. HTN 2. Obesity 3. FBG greater than 100 4. TG greater than 150
56
Does the decrease of CV events while taking statins outweigh the risk of chemical diabetes?
Yes!
57
What are some added benefits of statins?
1. Plaque stabilization 2. Anti-inflammatory effects 3. Reduce CRP levels 4. Protection of vessels subject to invasive coronary interventions
58
What is more effective at lowering LDL levels and decreasing CV events than doubling the dose of a statin?
Adding Ezetimibe plus a low/moderate dose of statin
59
When ezetimibe is added to a statin, how much additional LDL is lowered?
25%! Holy shet
60
For patients with heterozygous familial hypercholesterolemia or patients with ASCVD already taking max doses of statin
Alirocumab
61
Bind bile in the intestine and stimulate conversion of cholesterol to bile acids in the liver; up regulate LDL receptors- result is decrease in LDL cholesterol
Bile acid sequestrants
62
Decreases VLDL synthesis and release, lowers triglycerides to a lesser degree than LDL cholesterol, and RAISES HDL
Nicotinic acid
63
What is important when dosing nicotinic acid to avoid side effects of flushing/itching and GI symptoms?
Start with a very low dose and work upwards
64
What is the primary effect of fabric acid derivtatives like gemfibrozil and fenofibrate?
Lower triglycerides; mild reduction of LDL-C
65
Outline the guidelines for drug therapy for elevated LDL and total cholesterol
1. Statin 2. If unable to use statin use nonstatin (ezetimibe, cholestyramine, etc.) 3. Add other agents to a statin on a case by case basis
66
Outline the guidelines for drug therapy for elevated triglycerides and hypercholesterolemia
1. Lifestyle change is very very important! 2. If diet and exercise don't work consider Rx: gemfibrozil, fenofibrate, or niacin 3. If LDL remains above goal, add statin
67
What enzyme binds to LDL receptors on hepatocytes, promoting receptor degradation, preventing LDL-C clearance from blood and is associated with familial hypercholesterolemia
PCSK9
68
What type of drug is Alirocumab
PCSK9 inhibitor
69
What is the problem with bile acid sequestriants?
Lots of GI side effects
70
What does VLDL carry?
Triglycerides
71
When will you see eruptive xanthomas? (Red papules on buttock)
Very high triglycerides (VLDL)
72
When will you see tendinous xanthomas (nodules on tendons)?
Very high LDL
73
What is the best way to reduce mortality and morbidity from coronary heart disease?
Diet and drug induced reductions of LDL
74
Which drugs inhibit statin metabolism?
Niacin, fibrates, bile acid sequestrants, ketoconazole, erythromycin, clarithromycin, cyclosporins

Clin Med Cardio Exam 2 (6 decks)

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