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Flashcards in Dyslipidemia 1 Deck (33)
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1

The density of plasma lipoproteins is determined by their relative content of which 2 things?

  • Protein
  • Lipid

2

3

  • Carries most of the triglyceride
  • Carries 60 - 70% of total serum cholesterol

  • VLDL
  • LDL

4

  • % of HDL?
  • % of VLDL?

  • HDL: 20 - 30%
  • VLDL: 10 - 15%

5

  • In what organ is cholesterol made in?
  • How many steps involved in production?
  • Made from what?

  • Liver
  • 25
  • Acetyl CoA (breadown product of FFA)

6

Is cholesterol synthesized by the liver during morning or night time?

Predominantly at night

7

What substance is associated w/ the rate limiting step in synthesis of cholesterol by the liver?

HMG-CoA reductase

8

  • HMG-CoA reductase converts HMG-CoA to ____ during the rate limiting step. 
  • What is controlled during this step?

  • mevalonate
  • Negative feedback is controlled (high levels of LDL)

9

  • What type of drug is an HMG-CoA reductase?
  • What can happen if dosage is too high?

Statin. * IF we lower cholesterol too much, if can affect our sex hormones. 

10

Why do we treat dyslipidemia?? What are the 2 major associated complications of dyslipidemia?

  • Acute pancreatits (due to hyperlipidemia)
  • Atherosclerosis leading to ASCVD (leading cause of death for both genders)

11

What are the 5 risk factors of Dyslipidemia?

"FLASH"

  • F: Family hx of premature CHD of 1st degree family (Men <55 & Women <65)
  • L: Low HDL cholesterol (<40), if >60 counts as neg risk factor
  • A: Age (Men >45 & Women >55)
  • S: Cigarette Smoking
  • H: HTN leading to CKD

12

What is a major secondary cause of lipoprotein abnormalities?

DRUGS (Rx drugs)

13

Tx of Dyslipidemia

  • There is no RCT evidence to support what?
  • There is extensive evidence for what?

  • No evidence to support titrating cholesterol lowering drug therapy to achieve target LDL/non-HDL
  • Appropriate intensity of statin to reduce ASCVD

14

  • Moderate intensity statin reduce LDL by what %?
  • High intensity statin reduce LDL by what %?

  • Moderate: 30 - 50%
  • High: 50% or greater

15

What are names of "Non-Statin Therapies" recommended by 2017 ACC?

  • Alirocumab and Evolocumab
  • Ezetimibe

16

  • Patients w/ high risk for ASCVD (risk = 7.5 or 10%) should receive Statin therapy for which type of prevention?
  • Patients w/ known ASCVD should receive Statin therapy for which type of prevention?
  •  

  • Primary Prevention
  • Secondary Prevention

17

Which 3 meds SHOULD NOT be routinely prescribed for primary or secondary prevention of ASCVD bc/ although they lower cholesterol, they don't alter pt oriented outcomes?

  • Niacin
  • Fibrates
  • Omega 3 fatty acids

18

What medication should be considered as an alternative for patients w/ acute coronary syndrome (ACS) who do not tolerate high intensity statin therapy?

Moderate Intensity Statin PLUS Ezetimibe

19

In all individuals, what should you emphasize?

Heart-healthy lifestyle across the life course

20

In patients w/ clinical ASCVD, reduce LDL cholesterol w/ what med?

High intensity statin

21

In patients with very high risk ASCVD, use an LDL threshold of ___mg/dL to consider addition of what med to pre-existing statin therapy?

  • 70
  • Non-statins 

22

  • In patients with severe primary hypercholesterolemia (LDL > ____ mg/dL) WITHOUT calculating 10 yr risk, begin what med?
  • If LDL remained >100, what should you add?
  • If LDL on both of these meds is still >100, add what next?

  • 190
  • High intensity statin therapy 
  • Ezetimibe
  • PCSK9 inhibitor

23

In patients 40 - 75 yrs w/ DM and LDL > ___mg/dL, what med do you start?

Moderate intensity statin therapy WITHOUT calculating 10 yr risk

24

In adults 40 - 75 yrs evaluated for primary ASCVD prevention, give what med?

None yet, first have clinician / patient risk discussion before starting statin therapy

25

In adults 40 - 75 yrs without DM and LDL >___mg/dL, with a 10 yr risk >7.5%, what med do you start?

  • 70
  • Moderate intensity statin

26

In adults 40 - 75 yrs without DM and 10 yr risk of 7.5 - 19.9%, what med?

Statin therapy

27

In adults 40 - 75 yrs without DM and LDL levels >___mg/dL to ___mg/dL, w/ a 10 yr risk of >7.5% to 19.9%, if decision about statin therapy is uncertain, consider measuring what?

  • 70 to 189
  • CAC

28

Assess adherence and percentage response to LDL lowering meds and lifestyle changes w/ repeat lipid measurement ___ weeks after statin initiation or dose adjustment. 

4 to 12 weeks

29

Risk <5%

  • "Low risk"
  • Emphasize lifestyle changes to reduce risk

30

Risk 5 - <7.5%

  • Borderline risk
  • Discuss moderate statin