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39 Cards in this Set
- Front
- Back
What level of triglycerides can cause life-threatening pancreatitis?
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TG levels greater than 1000 mg/dL
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T or F: Treating high levels of LDL is particular has been shown to reduce the risk of future CAD events.
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T
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What causes hyperlipidemia?
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While some lipid abnormalities are caused by known inborn erros of lipid metabolism, the majority of lipid disorders arise from a combination of dietary factors, lack of exercise and some degree of genetic susceptibility. Coexisting conditions and medications may also affect lipid levels.
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What are some secondary causes of hyperlipidemia?
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1. Poorly controlled diabetes
2. Hypothyroidism 3. Obstructive liver disease 4. Nephrotic syndrome 5. Chronic renal failure 6. Smoking 7. Drugs: corticosteroids, anabolic steroids, progestins, protease inhibitors |
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What drugs can cause hyperlipidemia?
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1. corticosteroids
2. anabolic steroids 3. progestins 4. protease inhibitors |
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Whom should I test for hyperlipidemia?
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1. Anyone with known cardiovascular disease
2. The NCEP currently recommends screening every 5 years in adults older than age 20 3. A reasonable approach would be to begin screening at age 35, and earlier only if the patient has significant cardiovascular risk factors or a family history of hyperlipidemia. |
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What is in a complete lipid panel?
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A complete lipid panel provides direct measurement of total cholesterol (TC), HDL, and TG and is measured after a 12-hour fast, usually in the morning before breakfast.
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How do you calculate LDL?
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LDL is calculated based on the formula ...
LDL = TC - HDL - (TG/5) |
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What are the cardiovascular risk factors ,per NCEP Guidelines (besides elevated LDL cholesterol)?
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1. Age (men over 45 or women over 55)
2. Cigarette smoking 3. Diabetes mellitus 4. Family history of premature CAD: CAD event in a 1st degree male relative over 55 and a 1st degree female relative over 65 5. HDL less than 40 mg/dL 6. HTN (greater than 140/90 or on medication) Note: HDL greater than 60 counts as a negative risk factor |
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What test should I use for hyperlipidemia for screening purposes?
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Measure nonfasting levels of TC and HDL for convenience and decreased expense. If the TC is greater than or equal to 200 mg/dL or the HDL is less than 40 mg/dL, a complete fasting lipid panel is indicated.
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For any patient in whom treatment is possible or currently under way, what test should you get?
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A fasting lipid panel.
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When looking for causes of pancreatitis, what test should you get?
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An isolated TG level may be useful.
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If patient's TG level is greater than 400, the LDL cannot be accurately calculated. This is problematic since treatment guidelines are generally based on LDL levels. What can you do?
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To circumvent this problem, you can assume the TG to be 400. This provides a conservative (high) estimate of your LDL (LDL = TC - HDL - 400/5), because a TG level higher than 400 would actually subtract more from the LDL figure.
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What does the NCEP stand for?
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National Cholesterol Education Program
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NCEP Guidelines for the Treatment of Hypercholesterolemia:
If you have 0-1 risk factors, what is the threshold LDL for starting drug therapy? What is the goal LDL (by diet or drugs)? |
Threshold LDL: greater or equal to 190 mg/dL
Goal LDL: less than 160 mg/dL |
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NCEP Guidelines for the Treatment of Hypercholesterolemia:
If you have 2+ risk factors (and 10 year risk of less than 10%), what is the threshold LDL for starting drug therapy? What is the goal LDL (by diet or drugs)? |
Threshold LDL: greater or equal to 160 mg/dL
Goal LDL: less than 130 mg/dL |
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NCEP Guidelines for the Treatment of Hypercholesterolemia:
If you have 2+ risk factors (and 10 year risk of 10%-20%), what is the threshold LDL for starting drug therapy? What is the goal LDL (by diet or drugs)? |
Threshold LDL: greater or equal to 130 mg/dL
Goal LDL: less than 130 mg/dL |
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If you have CAD, other atherosclerotic disease, diabetes mellitus or 10-year risk greater than 20%, what is the threshold LDL for starting drug therapy? What is the goal LDL (by diet or drugs)?
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Threshold LDL: Greater or equal to 130 mg/dL
Goal LDL: less than 100 mg/dL |
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How do you calculate the 10-year risk of CAD events?
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It can be calculated using a point system or computerized risk model. One example of a risk calculator is based on the Framingham study, and is available at the National Heart, Lung and Blood Institue website.
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For a person with mild hyperlipidemia, what can you do before starting medications?
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Try a 6 to 12 week trial of lifestyle modification, with or without referral to a dietitian.
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T or F: Diet, exercise, weight loss and alcohol restriction are first line therapy for hypertriglyceridemia.
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T
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What is first line therapy in patients with known CAD and elevated LDL?
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The "statins", aka HMG CoA reductase inhibitors. Treatment is focused on reducing LDL level, which is most efficienty accomplished by statins.
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What are some side effects of statins?
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Side effects of statins include rare myopathy and generally insignificant liver enzyme elevations.
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For patients without known CAD who have high LDL and low HDL levels, which is an alternative to statins?
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Niacin is a low-cost alternative to statins.
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What about the flushing and headached associated with taking niacin?
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These symptoms can be attenuated by pretreatment with aspirin and slow upward dose titration. Older extended-release niacin preparations were associated with hepatotoxicicty, but newer preparations appear to be safer.
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For patients who have very elevated TG, or low HDL levels in the absence of elevated LDL, what drugs should you use?
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A fibric acid derivative such as gemfibrozil may be indicated.
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Is hormone replacement therapy a reasonable alternative for treatment of hyperlipidemia in postmenopausal women?
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No, estrogen with or without progestin should not be used for the treatment of hyperlipidemia, although it may be indicated for other reasons.
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What are side effects of the statins?
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1. myopathy
2. elevated liver enzymes 3. GI distress 4. Headache 5. Insomnia |
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What are the side effects of nicotinic acid (niacin)?
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1. flushing, headache, tachycardia and pruritus
2. hyperuricemia 3. hyperglycemia 4. hepatotoxicity |
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What are the side effects of fibric acids (gemfibrozil, clofibrate)
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1. myopathy, small increased risk with statins, huge increase in risk with cyclosporine, erthromycin and ketoconazole
2. gallstones 3. hepatotoxicity 4. GI malignancy 5. nausea |
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What are the side effects of bile-acid sequestrants?
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1. decreased absorption of many other medications
2. GI distress, constipation |
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What is the effect of statins on LDL, TG and HDL?
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LDL: Lowers a lot!
TG: Lowers a little HDL: Raises a little |
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What is the effect of niacin on LDL, TG and HDL?
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LDL: Lowers a little
TG: Lowers a lot! HDL: Raises a little |
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What is the effect of fibrates on LDL, TG and HDL?
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LDL: Lowers a little
TG: Lowers a lot HDL: Raises a lot! |
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What is the effect of bile-acid sequestrants on LDL, TG and HDL?
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LDL: Lowers a little
TG: Raises a little (bad) HDL: no change |
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How much omega-3 fatty acids should you recommend?
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Increasing dietary omega-3 fatty acids by consuming fish and fish oil (30 gm/day or two fish meals weekly) has been shown to reduce total cholesterol, triglycerides, raise HDL and lower mortality.
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What other foods have been shown to lower cholesterol levels?
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soluble dietary fiber, found in legumes, oat bran, fruit and psyllium.
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How much alcohol consumption is beneficial in raising HDL levels and reducing incidence of CAD.
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Less than 1oz/day = 2 oz whiskey = 8 oz wine = 24 oz of beer) is recommended.
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What are the well-established effective ways to prevent CAD events (other than medications and diet counseling)?
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Assess and treat any cardiovascular risk factors. Counsel patients to quit smoking, and aggressively treat hypertension and diabetes mellitus.
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