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Flashcards in Foundations-Hyperlipidemia Deck (70):
1

List the two types of lipids

1. Cholesterol
2.Triglycerides

2

Role of cholesterol

helps form steroid hormones & bile acids

3

Role of Triglycerides

helps transfer energy from food to cells

4

How are lipids transported

Lipoproteins

5

How are lipoproteins classified?

1. Low density= more triglycerides
2. High density= more apoproteins (contains proteins)

6

Define Primary Prevention

Pt's without evidence ASCVD

7

Define Secondary Prevention

-Known ASCVD
-Goal is to prevent 2nd CV event

8

How is cholesterol carried? Equation...

Total cholesterol= HDL + VLDL + LDL

9

What do most clinical laboratories MEASURE?

-Total cholesterol
-Triglycerides
-HDL

10

How do you calculate VLDL cholesterol?

Triglycerides/5

11

Friedewalk equation

LDL-Chol= (total cholesterol)- (HDL-Chol)- (Tg/5)

12

What is a normal triglyceride level

<150

13

What is the first step in plaque formation?

Oxidation of LDL
-Pro-inflammatory, thrombotic

14

What symptom would you expect to see with obstructive atherosclerotic plaque?

Exertional angina

15

What does the ACC/AHA CVD risk score include that the "hard" coronary framingham risk score doesn't?

-Race (AA or other)
-DBP
-Diabetes

16

What is the optimal LDL cholesterol level?

<100

17

What is high LDL cholesterol level?

160-189

18

What is very high LDL cholesterol level?

> or equal to 190

19

What is the LDL goal for those with CAD?

<70

20

What is the desirable cholesterol level?

<200

21

What is high cholesterol level?

> or equal to 240

22

What is low HDL for men?

<40

23

What is low HDL for women?

<50

24

What is high HDL?

> or equal to 60

25

How long do you have to fast for to check lipoprotein levels?

9-12 hrs

26

What are the major risk factors (other than LDL)-->Step 3 in ATP III guidelines

-Smoking
-HTN
-HDL <40
-Family hx of premature coronary dx
-Men>45
-Women >55

27

What is the LDL Goal for pt's with a 10-year risk > or equal to 20%

<100
<70- optional

28

At what LDL level do you initiate TLC for pt's with a 10-year risk > or equal to 20%

> or equal 100

29

At what LDL level do you consider drug therapy for pt's with a 10-year risk > or equal to 20%

> or equal 130

30

What is the LDL Goal for pt's with a 10-year risk < or equal to 20% WITH 2+ risk factors

<130
<100- optional

31

At what LDL level do you initiate TLC for pt's with a 10-year risk < or equal to 20% WITH 2+ risk factors

> or equal 130

32

At what LDL level do you consider drug therapy for pt's with a 10-year risk < or equal to 20% WITH 2+ risk factors

10 yr risk 10-20%= > or equal 130
10 yr risk <10%= > or equal 160

33

What is the LDL goal for 0-1 risk factor?

<160

34

What LDL level do you initiate TLC for 0-1 risk factors

> or equal 160

35

What LDL level do you consider drug therapy for 0-1 risk factors

>190

36

How much can maximizing TLC reduce LDL?

25-30%

37

List the Metabolic Syndrome Risk factors

1. Abdominal obesity
-Waist circumference >40 men
-Waist circumference >35 women
2. Triglycerides >150
3. Low HDL
4. Increased BP- >or equal 130/85
5. Impaired fasting glucose >100 mg

*3 or more=metabolic syndrome

38

What is a high triglyceride range?

200-499

39

What is a very high triglyceride level?

> or equal 500

40

If triglycerides are > or equal 500, why should you first lower triglycerides?

to prevent pancreatitis

41

What is the ACC/AHA 2013 screening age recommendation

> or equal 21 yrs

42

List the 4 major groups of ppl who should be treated with STATINs

1. Anyone w/ ASCVD
2. Extremely elevated LDL, >190
3. 40-75 y.o w/ DM w/ LDL 70-189
4. 40-75 w/ 10 year risk > or equal 7.5% per new risk calculator

43

How much does high intensity treatment reduce LDL?

50%

44

List the two statins recommended for high intensity treatment

1. Atorvastatin 40 or 80 mg
2. Rosuvastatin 20 or 40 mg

45

How much does moderate intensity treatment reduce LDL?

30-50%

46

List the three statins recommended for moderate intensity tx

1. Atorvastatin 10-20 mg
2. Simvastatin 20-40 mg
3. Pravastatin 40 mg

47

ALL TLC combined can decrease your LDL by how much?

30%

48

What are the overall benefits of statins?

Reduces:
-Fatal and non-fatal MI
-Incidence of CVA
-ALL causes of mortality

49

Why are statins best dosed at night?

Cholesterol is synthesized at night

50

What enzyme do statins inhibit?

HMG-COA reductase inhibitors

51

How much do statins decrease LDL?

20-55+%

52

Contraindications to statins

1. Pregnancy/breastfeeding
2. Active liver dz
3. unexplained elevated LFTs

53

Major side effects of statins

RHIMM:
Rhabdo
Hepatotoxicity
Increased diabetes risk
Myalgia
Myopathy

54

What is the MOA of statins?

inhibit the rate-limiting enzyme in the formation of cholesterol

55

What is the MOA of cholesterol absorption inhibitor

Decreases absorption of cholesterol in small intestine, upregulates LDL receptors on peripheral cells

56

List an example of a cholesterol absorption inhibitor?

ezetimibe

57

How much do cholesterol absorption inhibitors decrease LDL?

15-20%

58

Contraindications to cholesterol inhibitor absorption inhibitors?

-Do not use with fibrates

59

What is the MOA of fibric acid derivatives?

Reduced synthesis and increased breakdown of VLDL particles

60

List examples of f fibric acid derivatives

gemfibrozil, fenofibrate

61

What is the drug of choice for TG >500

gemfibrozil, fenofibrate

62

How much do fibric acid derivatives decrease TG?

40%

63

Contraindications to fibric acid derivatives

Not recommended with statin use

64

What drug would you prescribe for moderately high LDL and very low HDL?

Niacin

65

What is considered the only safe lipid-lowering medication in pregnancy?

Bile-Acid binding resins

66

List examples of bile-acid binding resins

cholestyramine, colesevelam, colestipol

67

MOA of PCSK9 inhibitors

Blocks PCSK9 effects of degrading LDL receptors= more receptors that are continually active so MORE LDL is bound

68

How much does PCSK9 inhibitors lower LDL

50-60%

69

What genetic disorder has absent or dysfunctional LDL receptors?

Familial hypercholesterolemia

70

What genetic disorder has a lipoprotein lipase abnormality and causes severe hypertriglyceridemia?

Familial hyperchylomicronemia