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Cardiology II
Lipid Disorders
45
Medical
Graduate
11/04/2009

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Cards

Term
TG > 1000 can cause what skin condition?
Definition
eruptive xanthomas - red-yellow papules esp. on the buttocks
Term
TG >2000 can cause what physical finding?
Definition
lipemia retinalis - cream colored vessels in the fundus
Term
High LDL can cause what physical finding?
Definition
tendinous xanthomas
Term
What is familial hypercholesterolemia?
Definition
defective or absent cell-surface LDL receptors (8X normal LDL)- usu req. liver transplant in childhood
Term
What is familial hyperchylomicronemia?
Definition
TG >4000, recurrent pancreatitis and hepatosplenomegaly, eruptive xanthomas and lipemia retinalis
Term
DMs tend to have what type of lipid abnormality?
Definition
Hypertriglyceridemia d/t elevated insulin levels
Term
What carries lipids from the intestines to the cells and the liver?
Definition
Chylomicrons
Term
What vitamin supplementation is used to tx dyslipidemia?
Definition
Niacin (nicotinic acid)- reduces LDL, raises HDL (best), and lowers TG
Term
What side effects of niacin often cause poor compliance?
Definition
skin flushing and itching
Term
What other dietary supplement is used to tx dyslipidemia?
Definition
Omega-3 - lower TG
Term
Unlesss TG are the concern, which meds are rec. to start with when treating hyperlipidemia?
Definition
statins
Term
How do statins work?
Definition
Work in the liver to inhibit cholesterol production
Term
What are the major side effects of statins?
Definition
muscle aches, elevated LFTs and abd pain
Term
The long-term use of which drugs reduce the metabolism of statins?
Definition
erythromycin, cyclosporine, and azole antifungals
Term
How do bile acid-binding resins work?
Definition
bind bile acid in the intestines requiring the body use internal cholesterol for new bile (reduces LDL by 15-25%)
Term
Why are many people unable to tolerate bile acid binding resins?
Definition
GI side effects, also blocks absorption of fat soluble vitamins and other meds
Term
Which meds block intestinal absorption of cholesterol (dietary and biliary)?
Definition
Ezetimbe (Zetia)
Term
Lowering TG is the major effect of which meds?
Definition
Fibric acid derivatives
Term
What are the side effects of fibric acid derivatives?
Definition
hepatitis, cholelithiasis, and myositis
Term
What are the only cholesterol lowering meds safe for use during pregnancy?
Definition
bile acid-binding resins (statins category X)
Term
Name the 9 steps in ATP III.
Definition
1) Det. lipid levels 2) Identify any CHD risk equivalents 3) Major risk factors other than LDL 4) If 2+ risk factors - assess CHD risk 5) Det. risk category 6) Therapeutic lifestyle changes 7) Drug tx if indicated 8) Identify and tx metabolic syndrome 9) Tx TG
Term
When should you obtain a lipid panel?
Definition
after a 9-12 hr fast
Term
What are the ATP III levels of LDL cholesterol?
Definition
optimal - <100, near/above optimal - 100-129, borderline high - 130-159, high - 160-189, very high > or = 190
Term
What are the levels for total cholesterol?
Definition
Desirable - <200, borderline high - 200-239, high - > or = 240
Term
What are the levels for HDL cholesterol?
Definition
Low <40, high > or = 60
Term
4 CHD risk equivalents?
Definition
1) Clinical CHD 2) Sx CAD 3) PAD 4) AAA
Term
5 major risk factors other than LDL that modify LDL goals?
Definition
1) Smoking 2) HTN 3) HDL <40 4) Famhx of premature CHD 5) Men >45 and women >55 yo
Term
What is considered a negative risk factor whose prescence removes one risk factor from the total count?
Definition
HDL >60
Term
What is the LDL goal for CHD or CHD risk equivalents (10 yr risk >20%)? What LDL level would you start TLC? Drug tx?
Definition
<100, >100, >130
Term
What is the LDL goal for 2+ risk factors (10yr risk <20%)? What LDL level would you start TLC? Drug tx?
Definition
<130, >130, >130 if risk 10-20% or >160 if risk <10%
Term
What is the LDL goal for 0-1 risk factor? What LDL level would you start TLC? Drug tx?
Definition
<160, >160, >190
Term
What is the TLC diet comprised of?
Definition
Sat fat <7% of kcals, chol <200/day, increase soluble fiber to 10-25gm/day and plant stanols/sterols to 2gm/day
Term
What are the 2 other non-dietary components of TLC?
Definition
weight management and increased physical activity
Term
What class of drugs are Cholestyramine, Colestipol, and Colesevalim?
Definition
Bile acid sequestrants
Term
What is the common name for HMG Co-A reductase inhibitors?
Definition
statins
Term
What are absolute contraindications for using statins?
Definition
active or chronic liver disease
Term
What are absolute contraindications for using bile acid sequestrants?
Definition
dysbetalipoproteinemia (TG >400)
Term
Besides skin flushing, what are some major side effects of nicotinic acid?
Definition
hyperglycemia, hyperuricemia (gout), Upper GI distress, hepatotoxicity
Term
What are absolute contraindications for using nicotinic acid?
Definition
chronic liver dz and severe gout
Term
What are relative contraindications for using nicotinic acids?
Definition
DM, hyperuricemia, PUD
Term
What class of drugs are Gemfribrozil, Fenofibrate, and Clofibrate?
Definition
fibric acids
Term
What are absolute contraindications for using fibric acids?
Definition
severe renal or hepatic dz
Term
What are 5 categories that make up metabolic syndrome?
Definition
1) Abd obesity - men >40in waist and women >35in 2) TG >150 3) HDL - men <40 and women <50 4) BP >130/>85 5) FSBS >110
Term
5 tx for metabolic syndrome?
Definition
1) Wt loss 2) Exercise 3) Tx HTN 4) Asprin for CHD pts 5) Tx TG and/or low HDL
Term
What are the ATP III levels for TG?
Definition
Normal - <150, Borderline high 150-199, high 200-499, very high >500
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