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Clin Med Exam 1 (Shelby) > Hyperlipidemia > Flashcards

Hyperlipidemia Flashcards

(90 cards)

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1
Q

What type of statin is used for patients in group 4

A

Moderate or high intensity

Group 4 - LDL 70-189 + greater than 7.5% 10 year risk

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3
Q

Desirable level for triglycerides

A

Less than 150

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4
Q

How is exercise helpful in patients with hyperlipidemia

A

Increase HDL

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6
Q

Where would you find Tuberous Xanthoma

A

Knees, elbows, tendons

Yellow-orange nodules

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7
Q

Your patient falls into group 1 for determining need for a statin. What else do you need to determine before deciding between high and moderate intensity statin?

A

Older than 75 years old = moderate intensity

75 years old or younger = high intensity

(Group 1 = clinical ASCVD)

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8
Q

What “Cautions” should you consider before putting your patient on bile acid sequestrants

A

Triglycerides greater than 200 (less than 400, which is a contraindication)

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10
Q

What type of patients fall into “group 2” of determining need for a statin

A

LDL-C > 190

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11
Q

What type of diet should a patient go on if they have hyperlipidemia

A

DASH diet

Increase plant protein, decrease animal protein, low sodium, low fat dairy, fruits and veggies

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13
Q

Where would you find Eruptive Xanthoma

A

Extensor surfaces, buttocks

Red-yellow papules with abrupt onset

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16
Q

What do you need before you can prescribe a statin?

What do you do after you prescribe a statin?

A

Before: Baseline lipid AND LFT

After: test again 6-8 weeks later, then every 6-12 months

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19
Q

What type of protein should a patient eat if they are trying to adhere to the DASH diet? What type should they avoid?

A

Lots of plant protein

Minimal animal protein

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21
Q

What type of lipoprotein carrier is used in the reverse pathway

A

HDL

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22
Q

What “cautions” should you consider before putting your patient on fibrates

A

Interactions with other statins (other than simvastatin which is not a caution, it is a contraindication)
Interaction with warfarin

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24
Q

How do statins work? What two things do they do

A
  1. Stabilize vulnerable plaques

2. Reduce underlying inflammation

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25
Q

What are some non-medications that can help manage hyperlipidemia

A

Fish oil

Red yeast rice

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27
Q

Circulating lipids are carried on

A

Lipoproteins

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28
Q

What other blood test value can be useful as an “Additional consideration” for prescribing a statin

A

HS-CRP > 2 mg/dL

Protein the liver makes when there is inflammation

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29
Q

LDL carries _______ from the ___________ to the __________

A

LDL carries cholesterol from the liver to the cells

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30
Q

What do Cholesterol Absorption Inhibitors (Ezetamibe) do?

A

Lowers LDL

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31
Q

What would you find on a lipid panel of someone with Famililal hypercholesterolemia?

A

Increased LDL

As opposed to familial combined hyperlipidemia, which is a wide variety of lipid abnormalities

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32
Q

What type of patient falls into “group 4” of determining need for a statin

A

LDL-C 70-189

+

More than 7.5% 10 year risk

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36
Q

Your patient has hyperlipidemia and needs to go on a medication. She is also PREGGO. What medications are NOT OK to give her

A

Statins
Nicotinic acid (Niacin)
Cholesterol Absorption Inhibitos (Ezetamibe)

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38
Q

What would you find on the lipid panel of someone with Polygenic hypercholesterolemia

A

Increased LDL

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41
Q

High risk value for total cholesterol

A

240

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42
What releases cholesterol when it dies and forms deposits
Foam cells
43
Familial combined hyperlipidemia involves how many genes? Is it common or rare?
Many genes | 1-2% of the population, relatively common
44
Where would you find plane xanthoma?
“Various places” | Soft, yellow plaques
45
Your patient falls into group 3 for determining a need for a statin. What else do you need to determine before deciding between moderate and high intensity statin?
10 year risk assessment Greater than 7.5% = high intensity Less than 7.5% = moderate intensity (Group 3 = diabetes + LDL 70-189)
51
Borderline value for HDL
35-45
52
High risk value for LDL
160-189
53
Name that physical finding: white-gray ring around the cornea
Corneal Arcus
54
What type of lipoprotein carrier is used in the endogenous pathway
VLDL, IDL, LDL
55
What type of patient falls into “group 3” for determining need for a statin
Has diabetes + LDL-C 70-189
56
Name that physical finding: soft, yellow plaque
Plane xanthoma
58
Your patient has Tuberous Xanthoma. What could be the cause?
Familial Hypercholesterolemia | Tuberous Xanthoma = yellow-orange nodle on knees elbows and tendons
59
What are the contraindications of Nicotinic Acid (Niacin)
Active liver disease | Pregnant
60
What creates a “Cap” around cholesterol deposits
Collagen
61
What “cautions” should you consider before putting your patient on nictonic acid (Niacin)
Hyperuricemia Hyperglycemia Unstable angina Interactions with other statins
63
What are the three pathways in which ciculating lipids can be carried on lipoproteins
1. Exogenous 2. Endogenous 3. Reverse
64
Desirable level for LDL
60-130
65
Which medication(s) lower triglycerides
Fibrates | Statins (also lowers LDL)
66
What do PCSK9 inhibitors do?
Lowers LDL
69
Borderline value for total cholesterol
200-239
70
Name that physical finding: yellow-orange nodule
Tuberous Xanthoma
71
Which medication CAN be combined with statins
Bile Acid Sequestrants | Cholesterol Absorption Inhibitors (Ezetamibe)
72
Lipid panels are done fasted. Which measurement on the lipid panel is most affected by meals?
Triglycerides
73
Statins are the only proven medication to decrease incidence of:
Major vascular events and coronary mortality
74
Your patient falls into group 2 of determining need for a statin. What do you do next
Give them a high intensity statin | Group 2 = LDL-C > 190
75
What are the contraindications for Fibrates
Renal disease Gall stones Taking Simvastatin
77
What type of patient education about taking statins should you give your patient?
Take a bedtime because cholesterol is produced at night
78
Your patient has eruptive Xanthoma. What could be the cause?
Familial Hyperlipidemia OR triglycerides greater than 1500 1500!!! (Eruptive Xanthoma is red-yellow papules with abrupt onset on extensor surfaces and buttocks)
79
Why are PCSK9’s not often used to lower LDL
Expensive | Injection only
80
Having an HDL less that _____ is a modifiable risk factor for CHD
40 mg/dL
81
High risk value for triglycerides
200-499
83
What type of patients fall into “group 1” when determining need for a statin
Clinical ASCVD | Acute coronary syndrome, MI, angina, stroke/TIA
85
Chylomicrons carry _________ from the ________ to the ________
Chylomicrons carry dietary lipids from the intestine to the liver, adipose, muscle
87
Your patient has Plane Xanthoma... what could be the cause?
Familial OR secondary hyperlipidemia ... basically anything. This is not very specific Plane xanthoma = soft yellow papule in various places
89
If your patient is on Simvastatin, what medication is a HUGE NO NO to give them
Fibrates
92
Which medication has the side effect of INCREASING triglycerides (NOT GOOD)
Bile acid sequestrants
93
Name that physical finding: red-yellow papules with an abrupt onset
Eruptive Xanthoma
94
What are the contraindications of Cholesterol Absorption Inhibitors (Ezetamibe)
Active Liver Disease | Pregnant
97
HDL carries ____________ from the ___________ to the __________
HDL carries collected cholesterol from the tissues to the liver
98
Which medication has the side effect of gallstones
Fibrates
100
What are the contraindications of Bile Acid Sequestrants
Triglycerides over 400
101
What enzyme do statins inhibit? What is the result of this inhibition?
HMG-CoA reductase Decreases cholesterol production, liver enzyme increase production of LDL receptors, LDL enters liver and digested
102
Which is more common, inherited hyperlipidemia or secondary hyperlipidemia
Inherited is more common
103
High risk value for HDL
Less than 35
105
What “cautions” should you consider before putting a patient on a statin
Chronic liver disease Chronic kidney disease CYP3A4 drug interactions
110
Which medication has the side effect of rhabdomyalisis
Statins
111
What do Bile Acid Sequestrants do?
Lower LDL
114
What can produce a falsely low cholesterol level
Acutely ill - up to 60 days
115
What can happen if a collagen cap surrounding a cholesterol deposit ruptures
A thrombus can form, potential infarct
116
Which medication has the side effect of flushing
Nicotinic Acid (Niacin)
117
What are the side effects of Bile Acid Sequestrants
Increases triglycerides!!!! | GI symptoms
118
What are the contraindications for statins
Active liver disease | Pregnant
120
Total cholesterol equation =
HDL + LDL + ( Triglycerides/5 )
123
Desierable value for total cholesterol
Less than 200
124
LDL diffused through the endothelium at a rate __________
Dependent on concentration in the blood
125
Which medication increases HDL and lowers LDL
Nicotinic Acid (Niacin)
126
Your patient has corneal Acrus. What could be the cause?
If they are under 40, hyperlipidemia
133
What are foam cells
Macrophages that have absorbed LDL
137
Borderline value for triglycerides
150-199
138
Having an HDL greater than ______ is a NEGATIVE modifiable risk factor for CHD
60 mg/dL
139
When should you screen adolescents for hyperlipidemia
1. 9-11 years old 2. Again 17-21 years old * and if you have high suspicion
140
Borderline value for LDL
130-159
141
What would you find on a lipid panel of someone with Familial Combined Hyperlipidemia?
Wide variety of lipid abnormalities | As opposed to familial hypercholesterolemia, which is only increased LDL
142
Desirable level for HDL
60
155
VLDL carries _______ from the ________ to the ________
VLDL carries new triglycerides from the liver to the adipose
160
What type of lipoprotein carrier is used in the exogenous pathway
Chylomicron
163
Familial hypercholesterolemia involves how many genes? | Is it common or rare?
1 gene | Rare

Clin Med Exam 1 (Shelby) (10 decks)

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