Hyperlipidemia

Question 1

2 main lipids in blood?

Answer 1

Cholesterol

Triglycerides

Question 2

Chylomicrons are?

Answer 2

lipoproteins w/ high TAG content

creamy layer

Question 3

Source of Chylomicrons?

Answer 3

dietary fat

Question 4

Chylomicron travel route?

Answer 4

portal vein ->
liver ->
thoracic duct ->
circulation

Question 5

Chylomicron purpose?

Answer 5

transfer food energy into mm and fat cells

Question 6

VLDL manufactured where?

Answer 6

Liver from stores of fat and carbs

Question 7

VLDL made mostly of?

Answer 7

triglycerides

Question 8

VLDL metabolized down to?

Answer 8

LDL

Question 9

LDL purpose?

Answer 9

deliver cholesterol for cell membranes and to make bile acid in the liver

Question 10

↑ in LDL leads to?

Answer 10

atherosclerosis in arterial endothelium

Question 11

3 ways to ↓ LDL?

Answer 11

1) ↓ cholesterol synth
(HMG-CoA reductase inhibitors - Statins)

2) ↓ cholesterol reabsorption
(plant sterols - omega3, red yeast rice; -ezetimibe)

3) ↑ cholesterol excretion
(bile acid sequestrants)

Question 12

HDL made where?

Answer 12

liver and intestines

Question 13

HDL made of?

Answer 13

apoproteins and cholesterol

Question 14

HDL do what?

Answer 14

reverse cholesterol transport by moving chol into lipoprotiens or directly into live

Question 15

3 ways to ↑ HDL?

Answer 15

1) exercise
2) estrogen
3) alcohol

Question 16

5 things that ↓ HDL?

Answer 16

1) hypertriglyceridemia
2) smoking
3) anabolic steroids
4) genes
5) fat and lazy

Question 17

3 systems that maintain cholesterol balance?

Answer 17

1) extrahepatic organs
2) liver
3) intestines

Question 18

Acute illness can give what false result on cholesterol tests?

Answer 18

falsely low

Question 19

Total cholesterol levels?

Answer 19

< 200 = good
200-239 = borderline
>=240 = high

Question 20

Triglyceride levels?

Answer 20

=500 = very high

Question 21

LDL levels?

Answer 21

=190 = very high

Question 22

HDL levels?

Answer 22

=60 = high

Question 23

Goal LDL for pt’s w/ CAD or DM?

Answer 23

<70

Question 24

Hypertriglyceridemia is risk factor esp when accompanied by?

Answer 24

low HDL

Question 25

Triglycerides >1000 risk for?

Answer 25

pancreatitis

Question 26

Familial Hypertriglyceridemia definition?

Answer 26

cell-surface LDL receptors absent or defective: homozygotes 8x normal LDL heterozgotes 2x normal LDL

Question 27

Familial Hypertriglyceridemia causes?

Answer 27

unregulated synth of LDL | early CHD

Question 28

Xanthelasma is?

Answer 28

cholesterol-filled plaques on skin (U) medial eyelids soft, yellow

Question 29

Eruptive Xanthomas are?

Answer 29

red-yellow papules on skin | w/ trigly >1000

Question 30

Tuberous Xanthoma are?

Answer 30

yellow-orange nodules <= 2cm | (U) knees, elbows

Question 31

Lipemia Retinalis is?

Answer 31

cream colored blood vessel in fundus | w/ trigly >2000

Question 32

Coronary Heart Disease (CHD) definition?

Answer 32

narrowing of coronary bv, | leading cause of death M and F

Question 33

CHD Non-modifiable risk factors?

Answer 33

FH: M 45, F 55

Question 34

CHD modifiable risk factors?

Answer 34

HYPERLIPIDEMIA HTN w/ BP >=140/90 HDL <40 fat and lazy

Question 35

What is a negative risk factor for CHD?

Answer 35

HDL >=60

Question 36

Coronary thombosis result of?

Answer 36

vulnerable plaques w/i wall of coronary arteries

Question 37

Vulnerable plaques filled w/?

Answer 37

lipid core lipid-laden macrophage foam cells inflammatory cells

Question 38

Role of lipid-laden macrophage foam cells in vulnerable plaques?

Answer 38

make tissue factor that stim rapid coag when in contact w/ blood

Question 39

Statins use to tx CAD why?

Answer 39

cholesterol-lowering drugs: stabilize vulnerable plaques ↓ underlying inflammation ↓ major vascular events

Question 40

Hyperlipidemia tx?

Answer 40

diet exercise meds

Question 41

Major way to ↑ HDL?

Answer 41

exercise

Question 42

HMG-CoA Reductase Inhibitors work how?

Answer 42

competitive inhibition of HMG-CoA Reductase | cholesterol synth

Question 43

Statins are first line tx for?

Answer 43

↑ LDL | (P) 2º benefit is some ↓ in trigly

Question 44

Lipitor LDL reduction %age and does range?

Answer 44

38-54% LDL ↓ | 10-80 mg

Question 45

Lipitor side-effects?

Answer 45

``` Myalgias Elevated LFTs (liver fxn) ```

Question 46

What test monitors myalgias w/ Lipitor?

Answer 46

serum creatine kinase (↑ levels = must ∆ drug)

Question 47

Alway obtain baseline for what when starting Lipitor? Retest?

Answer 47

liver fxn (LFT) 3 month post start of tx

Question 48

Alternate to statins if pt can't tolerate them?

Answer 48

ezetimibe bile acid requestrants niacin

Question 49

Fibrates used to tx CAD, mechanism?

Answer 49

LOWER TRIGLYCERIDES: stim lipoprotein lipase ↓ VLDL secretion stim fatty acid oxydation

Question 50

Fibrates may also affect?

Answer 50

↑ HDL slightly | ↓ LDL slightly

Question 51

Fibrates best first-line med for whom?

Answer 51

diabetics w/ hypertriglyceridemia

Question 52

Fibrate drug names?

Answer 52

Lopid Tricor Trilipix

Question 53

``` Nicotinic Acid (niacin/vit B3) used to treat CAD, mechanism? ```

Answer 53

MODERATE ↑ HDL ↓ prodxn of VLDL some ↓ LDL, trigly

Question 54

Nicotinic Acid side effect?

Answer 54

cutaneous flushing | result of ↑ prostaglandin D2

Question 55

Bile Acid Sequesterants used to tx CAD, mechanism?

Answer 55

forms complex w/ bile acids -> releases chloride ions -> prevents reuptake of bile salts -> bile salt-bound LDL lost in feces

Question 56

Bile Acid Sequesterants results in?

Answer 56

↓ LDL | *may ↑ trigly by 10%

Question 57

Bile Acid Sequesterant drug names?

Answer 57

Questrant | Colestid

Question 58

Bile Acid Sequesterant side-effects?

Answer 58

constipation flatulence dyspepsia (indigestion)

Question 59

Cholesterol Absorption Inhibitor tx for CAD, mechanism?

Answer 59

↓ absorb of cholesterol at small intestine -> ↓ delivery to liver -> ↓ chol for liver to use -> ↑ clearance of cholesterol from blood

Question 60

Cholesterol Absorption Inhibitor results in?

Answer 60

↓ LDL

Question 61

Cholesterol Absorption Inhibitor drug name?

Answer 61

Zetia (ezetimibe)

Question 62

Omega-3 FA tx for CAD, results in?

Answer 62

↓ trigly

Question 63

Omega-3 FA drug name?

Answer 63

Omacor | Lovaza