S1M3 Hyperlipoproteinemias

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S1M3 Hyperlipoproteinemias
2011-04-08 21:47:30
S1M3 Hyperlipoproteinemias

S1M3 Hyperlipoproteinemias
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  1. Type I hyperlipoproteinemia (familial hyperchylomicronemia) is a defect in?
    • defect in LPL
    • Deficiency in apo C-II (can't clear chylomicrons well)
  2. Type I hyperlipoproteinemia (familial hyperchylomicronemia) has what symptoms?
    • increase chylomicrons
    • turbid retinal vessels
    • LOW LDL and HDL
    • treat with low fat high carb diet
  3. Type IIa (familial hypercholesterolemia) is a defect of what?
    4 CLASSES of LDL receptor
  4. Type IIa (familial hypercholesterolemia) symptoms?
    • reduced LDL clearance results in high LDL
    • Coronary Heart Disease (CAD)
  5. Type III (familial dys-beta lipoproteinemia) is a defect of what?
    • apo E2 homozygotes
    • E2 is non functional apo protein, so being a homozygote you can't clear VLDL or IDL
  6. Type III (familial dys-beta lipoproteinemia) symptoms?
    • Hypertriglyceridemia
    • Hypercholesterolemia
    • CAD/Plaques

  7. Your patient has Xanthomas! What inherited hyperlipoproteinemia do you think of immediately?
    Type III!
  8. Type IV (familial hypertriglyceridemia) has what characteristics?
    • elevated VLDL....Think Type IV = VLDL elevated
    • associated with glucose = hyperinsulinemia
  9. Your patient has hyperinsulinemia. What inherited hyperlipoproteinemia does he have?
    Type IV (familial hypertriglyceridemia)
  10. Type IV hyperlipoproteinemia ...?
    • Elevated VLDL production.
    • Insulin resistance
    • obestiy (fat people!)
    • diabetes
    • EtOH consumption
  11. Type V (familial) hyperlipoproteinemia associated with what?
    • elevated VLDL...again think V = VLDL issues
    • elevated chylomicrons
  12. Type V (familial) hyperlipoproteinemia symptoms
    • hypertriglyceride
    • hypercholesterol
    • decreased LDL/HDL
  13. Which hyperlipoproteinemia is good for your health? Which lipoprotein is it an increase in?
    • Familial hyperalpha-lipoproteinemia
    • Increased HDL
  14. Type IIb (familial combined hyperlipidemia) what is unique about it?
    • Most common!
    • Increased LDL
    • Delayed clearance of VLDL
  15. What clinically do you see with people with Type V (familial) hyperlipoproteinemia
    • hypertriglycerides
    • hypercholesterol
    • decreased LDL HDL
    • Elevated VLDL, Chylomicrons
  16. What do you see clinically with patients with type IIb (familial combined hyperlipidemia)?
    • increased LDL
    • delayed clearance of VLDL
    • High risk of CAD
  17. Your young patient has xanthelasmas on her eyelids. What is in high amounts and what inherited hyperlipoproteinemia does she probably have?
    • Probably has Type IIa (hypercholesterolemia)
    • She has reduced LDL clearance, so she has a lot of cholesterol and get's xanthelasmas
  18. Your patient has Arcus senilis (peripheral corneal opacity). What inherited lipoproteinemia does she have?
    • Type IIa familial hypercholesterolemia
    • reduced LDL clearance (which is high in cholesterol)
  19. You patient presents with a tendon xanthoma of his achilles tendon. What inherited hyperlipoproteinemia does he have?
    • Type IIa (familial hypercholesterolemia)
    • due to defects in 4 classes of LDL receptors...reduced LDL clearance...which are high in cholesterol.
  20. Your nice patient is embarassed because she has eruptive xanthomas on her elbow and everytime one breaks open it's distgusting. What inherited lipoproteinemia does she have?
    • Type I (hyperchylomicronemia)....
    • Eruptive xanthomas are characteristic of hypertriacyglyceridaemia!

  21. How do you treat type I hyperlipidemia?
    low fat, Gemfibrozil
  22. How do you treat type IIa hyperlipidemia?
    • Statin
    • Resin
  23. How do you treat type IIb hyperlipidemia?
    • Statin
    • Niacin
  24. How do you treat type II hyperlipidemia?
    • Statin
    • Niacin
    • Gemfibrozil
  25. How do you treat type IV hyperlipidemia?
    • Niacin
    • Gemfibrozil
  26. How do you treat type V hyperlipidemia
    • Niacin
    • Gemfibrozil
    • Low Fat Diet
  27. What do your statins do? List all three.
    Statins inhibit HMG-CoA Reductase (the ultimate rate limiting step of cholesterol synthesis)

    MLS = Mevastatin, Lovastatin, Simvastatin
  28. What do you use Gemfibrozil for?
    PTs with hypertriglyceridemia (so high chylo or VLDL)

    So for Type I, III, IV, V

    Know these!
  29. What are Resins used for?
    • hypercholesterolemia (lowers cholesterol)
    • binds BILE ACIDS in intestines
  30. What does Niacin do? What hyperlipoproteinemia is it used for?
    • Niacin inhibits release of FREE FA's from adipose
    • decreases VLDL/LDL
    • Treats Type IIB
  31. Niacin is great treatment for what?
    Type IIb

    (high LDL, reduced VLDL clearance)
  32. Your patient has palmar xanthomas what's wrong?
    probably Type III, homozygous for apo E2 (defective E2)
  33. Type IIb
    • increased LDL/ delayed clearance of VLDL
    • so hypertriacylglycerides, hypercholesterolemia