I'm currently in pharmacy school and we were taught that increasing levels of uric acid causes gout. Niacin may cause increased levels of uric acid. So I believe that is why Niacin is not recommended for those with gout.
thank you baby jesus for this video. These are just amazing review. Thanks Paul for taking the time to do these for the benefit of others in the medical community.
Thank you very much for you efforts! .. I wished if you included the new monoclonal antibodies "PCSK9 inhibitors" i heared that they started to appear in usmle questions.
Monday, October 3, 2022. Cardiology: Hypercholesterolemia (High Cholesterol and/or Triglycerides, LDL, and/or VHDL Levels). Association with 1) Atherosclerosis, 2) Coronary Artery Disease, 3) Myocardial Infarction, and 4) Death; Dx: Cholesterol Level Blood Test (Lipid/Cholesterol Panel) with Two Separate Lipid Panel Abnormalities; Screening Recommendations are q 5 Years from 20 Years of Age onward. Aetiology: 1) Diet (High Consumption of Meats and Eggs, otherwise Animal Products) and 2) Genetics (Familial Hypercholesterolemia [FHC] an Autosomal Dominant and Recessive Inheritance; SSx: Xanthoma Skin Lesions with FHx of Premature CAD); Tx: 1) Low-Fat Diet and/or 2) Medical Treatment with Antilipidemic Agents (Most Common Treatment is HMG CoA Reductase Inhibitors, Statins); Risk Factors (RFs) using the Framingham Cardiac Risk Study Criteria: 1) Nicotine From Smoking Tobacco ("Smoking"); 2) Hypertension (Treated or Untreated), 3) Low High-Density LIpoprotein (HDL) Levels indicating Low Exercise And/or Sedentary Lifestyle Possibly; 4) Family History of Premature CAD (Male < 55Y and Female < 65 y); and 5) Age (Male >45 and Female > 55); Other Risk Factors Possible are 1) Coronary Artery Disease (CAD), 2) Peripheral Artery Disease (PAD), 3) Abdominal Aortic Aneurysm (AAA), and 4) Diabetes Mellitus (DM); Pharmacology of Antihyperlipidemics and Drug Classes: 1) HMG CoA Reductase Inhibitors (Association of an Increased Survival) commonly known as Statins (Atorvastatin Most Common Prescribed Medication in the History of Pharmacology) is known to Lower Biosynthesis of Cholesterol and primarily Lowering LDL. Statins are First Line Treatment for Dyslipidemia/Hypercholesterolemia. Pregnancy (Teratogenic) and Liver Disease (Increase Liver Enzymes) Contraindication/Niacin and Fibrate Concomitant (Rhabdomyolysis And/or Myalgia). When Warfarin is Relevant INR Monitoring is Indicated to check For ADRs and may warrant Warfarin Dosage Adjustments; 2) Fibrates (Primarily for Lowering Triglycerides due to Increasing of Lipoprotein Lipase), 3) Niacin (Niacinamide or Vitamin B 3 for HDL Increases) are known to cause 1) Flushing, 2) Pruritus, 3) Gout Aggravation and are CI in 1) Liver Disease and 2) Severe Peptic Ulcer Disease (sPUD). Niacin is ideal for Refractory Low Level of HDL; 4) Bile Acid Sequestrants for Lowering Low-Density Lipoprotein (LDL Level and the Most Concerning Lipid). The Mechanism of Action (MOA) is Bile Acid Reuptake (Reabsorption) in the Small Intestine. Side Effects (SEs) are 1) Flatulence/Bloating, 2) Dyspepsia/GI Upset, and 3) Steatorrhea (Foul Stools); and 5) Ezetemibe is Indicated for increasing the Cellular Absorption of Cholesterol when combined with a Statin (MOA: Intestinal Lumen Cholesterol Transporter Antagonism) and is touted as an Effective Cholesterol Reduction Adjuvant (Coupled with a Statin) and Producing few if any Side Effects or ADRs. This Agent is CI in Patients with Severe Hypertriglyceridemia; All Dyslipidemia Agents are Contraindicated in Pregnancy (Exercise and Low Fat Diet is otherwise the Alternative or First LIne Treatment of Dyslipidemia/Hypercholesterolemia in a Gestating Female). Goodness, such a Bonanza these Pharmaceutics have been and the glaring and absurd Irony of The American Craze for Fat only to have a High Morbidity/Mortality for-Purchase as an Economic Model. MD Paul Bolin, es geht sehr gut zu lernen und Lehren mit Ihnen. Ich hoffe es ahnlich fur Dich es. Heil!
Thank you so much doctor. I just have one comment on high LDL causes, is HYPO or HYPER thyroid cause it? bcz I read that hyperlipidemia(high LDL) is classic feature of HYPOthyroidism. Thanks again.
thank you very much for your videos. my question is "what if a patient on diet and exercise for high LDL, but not high enough to start meds, couldn't achieve the desired LDL level. do we start drug therapy?"
Advise the patient for good dietary habits and exercise and re assess after 4 8 weeks But if results are not with in normal limits BUT are not up to the limits for drug therapy you should wait for 6 months, It after 6 months results are not under limits then you can start drugs. Regards
I'm currently in pharmacy school and we were taught that increasing levels of uric acid causes gout. Niacin may cause increased levels of uric acid. So I believe that is why Niacin is not recommended for those with gout.
thank you baby jesus for this video. These are just amazing review. Thanks Paul for taking the time to do these for the benefit of others in the medical community.
Thank you very much for you efforts! .. I wished if you included the new monoclonal antibodies "PCSK9 inhibitors" i heared that they started to appear in usmle questions.
Monday, October 3, 2022. Cardiology: Hypercholesterolemia (High Cholesterol and/or Triglycerides, LDL, and/or VHDL Levels). Association with 1) Atherosclerosis, 2) Coronary Artery Disease, 3) Myocardial Infarction, and 4) Death; Dx: Cholesterol Level Blood Test (Lipid/Cholesterol Panel) with Two Separate Lipid Panel Abnormalities; Screening Recommendations are q 5 Years from 20 Years of Age onward. Aetiology: 1) Diet (High Consumption of Meats and Eggs, otherwise Animal Products) and 2) Genetics (Familial Hypercholesterolemia [FHC] an Autosomal Dominant and Recessive Inheritance; SSx: Xanthoma Skin Lesions with FHx of Premature CAD); Tx: 1) Low-Fat Diet and/or 2) Medical Treatment with Antilipidemic Agents (Most Common Treatment is HMG CoA Reductase Inhibitors, Statins); Risk Factors (RFs) using the Framingham Cardiac Risk Study Criteria: 1) Nicotine From Smoking Tobacco ("Smoking"); 2) Hypertension (Treated or Untreated), 3) Low High-Density LIpoprotein (HDL) Levels indicating Low Exercise And/or Sedentary Lifestyle Possibly; 4) Family History of Premature CAD (Male < 55Y and Female < 65 y); and 5) Age (Male >45 and Female > 55); Other Risk Factors Possible are 1) Coronary Artery Disease (CAD), 2) Peripheral Artery Disease (PAD), 3) Abdominal Aortic Aneurysm (AAA), and 4) Diabetes Mellitus (DM); Pharmacology of Antihyperlipidemics and Drug Classes: 1) HMG CoA Reductase Inhibitors (Association of an Increased Survival) commonly known as Statins (Atorvastatin Most Common Prescribed Medication in the History of Pharmacology) is known to Lower Biosynthesis of Cholesterol and primarily Lowering LDL. Statins are First Line Treatment for Dyslipidemia/Hypercholesterolemia. Pregnancy (Teratogenic) and Liver Disease (Increase Liver Enzymes) Contraindication/Niacin and Fibrate Concomitant (Rhabdomyolysis And/or Myalgia). When Warfarin is Relevant INR Monitoring is Indicated to check For ADRs and may warrant Warfarin Dosage Adjustments; 2) Fibrates (Primarily for Lowering Triglycerides due to Increasing of Lipoprotein Lipase), 3) Niacin (Niacinamide or Vitamin B 3 for HDL Increases) are known to cause 1) Flushing, 2) Pruritus, 3) Gout Aggravation and are CI in 1) Liver Disease and 2) Severe Peptic Ulcer Disease (sPUD). Niacin is ideal for Refractory Low Level of HDL; 4) Bile Acid Sequestrants for Lowering Low-Density Lipoprotein (LDL Level and the Most Concerning Lipid). The Mechanism of Action (MOA) is Bile Acid Reuptake (Reabsorption) in the Small Intestine. Side Effects (SEs) are 1) Flatulence/Bloating, 2) Dyspepsia/GI Upset, and 3) Steatorrhea (Foul Stools); and 5) Ezetemibe is Indicated for increasing the Cellular Absorption of Cholesterol when combined with a Statin (MOA: Intestinal Lumen Cholesterol Transporter Antagonism) and is touted as an Effective Cholesterol Reduction Adjuvant (Coupled with a Statin) and Producing few if any Side Effects or ADRs. This Agent is CI in Patients with Severe Hypertriglyceridemia; All Dyslipidemia Agents are Contraindicated in Pregnancy (Exercise and Low Fat Diet is otherwise the Alternative or First LIne Treatment of Dyslipidemia/Hypercholesterolemia in a Gestating Female). Goodness, such a Bonanza these Pharmaceutics have been and the glaring and absurd Irony of The American Craze for Fat only to have a High Morbidity/Mortality for-Purchase as an Economic Model. MD Paul Bolin, es geht sehr gut zu lernen und Lehren mit Ihnen. Ich hoffe es ahnlich fur Dich es. Heil!
Actually kids are tested beginning on there 12 year old visit. Adults are tested yearly at their annual wellness exam.
Thank you so much doctor. I just have one comment on high LDL causes, is HYPO or HYPER thyroid cause it? bcz I read that hyperlipidemia(high LDL) is classic feature of HYPOthyroidism. Thanks again.
Perfect Explanation👏🏻👏🏻
God bless you.
Hyperthyroidism surely causes many symptoms and risks, but LDL is typically lower in hyperthyroidism than euthyroid.
Very nice!
Excellent lecture
thank you for your efforts
Thank you. Great lectures.
Great presentation. Engaging.
god bless you and your efforts
Screening start at age 35 for men and 45 for women with no risk
Thank you .
Thank you this was an awesome video!
You did not mention about
Non HDl / chol ratio which is important.
What us normal range. And when to start therapy
U r my hero
2 videos today, oh yeah.
thank you very much for your videos. my question is "what if a patient on diet and exercise for high LDL, but not high enough to start meds, couldn't achieve the desired LDL level. do we start drug therapy?"
Advise the patient for good dietary habits and exercise and re assess after 4 8 weeks
But if results are not with in normal limits BUT are not up to the limits for drug therapy you should wait for 6 months,
It after 6 months results are not under limits then you can start drugs.
Regards
HIGH LDL, in HYPERTHYROIDISM,? isnt it wrong ? it should be HYPOTHYROIDISM
i think its due to the high metabolism and activity of the liver that makes it produce MORE cholesterol
I think you are right. High LDL in Hashimoto.
What if a patient cannot tolerate statins? What can be an alternative?
Question stems for review for Step1 and Step2
5.38 hypothyroidism?