Dyslipidemia

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Author:
alvo2234
ID:
199037
Filename:
Dyslipidemia
Updated:
2013-02-09 15:40:42
Tags:
PT II
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Description:
dyslipidemia
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  1. what is primary prevention
    • patients at risk but no CV event
    • treat less aggressively
  2. when should adults get lipoprotein profile screening
    every 5 years
  3. what are secondary causes of dyslipidemia
    • DM
    • hypothyroidism
    • nephrotic synrome
    • obstructive liver disease
    • drug induced (thiazides, BBs, OC, iotretinoin)
  4. organizations who created dyslipidemia guidelines
    • adult treatment panel
    • national cholesterol education program (NCEP)
    • National Heart Lung and Blood Institute
  5. when were the ATP III guidelines published and updated
    • published 2001
    • updated 2004
  6. optimal LDL
    <100
  7. near optimal LDL
    100-129
  8. borderline high
    130-159
  9. high LDL
    160-189
  10. very high LDL
    <=190
  11. optimal, borderline high, high, very high TG level
    • <150
    • 150-199
    • 200-499
    • >=500
  12. causes of low HDL
    • elevated triglycerides
    • obesity
    • physical inactivity
    • type 2 DM
    • smoking
    • beta blockers, anabolic steroids, progestational agents
  13. desirable TC
    <200
  14. borderline high TC
    200-239
  15. High TC
    >=240
  16. what can elevated TGs be treated with
    fibrates, niacin, omega-3 fatty acids
  17. what disease can lead to TGs >500
    acute pancreatitis
  18. How do you treat elevated TGs (from diet)
    treat with very low-fat diets (<15% of daily calories)
  19. name the positive risk factors for
    • cigarette smoke
    • HTN
    • low HDL
    • age (male >45 female >55)
    • FH of premature CHD
    • -CHD in male < 55
    • -CHD in female < 65
  20. CHD risk equivalents
    • DM
    • symptomatic carotid artery disease
    • peripheral arterial disease
    • abdominal aortic aneurysm
    • 10 yr risk of CHD > 20%
  21. what is the underlying risk factor for metabolic syndrome
    insulin resistance
  22. LDL goals for 0-1 risk factors
    <160
  23. LDL goal for 2 or more risk factors
    <130
  24. CHD/risk equivalent
    <100
  25. target to treat is whos principle?
    NCEP principle
  26. according to the NCEP principle what percentage reduction in LDL levels are used to establish an initial dose
    30-40%
  27. if LDL < 70 is not achievable, aim to decrease LDL by how much? (according to the NCEP)
    >50%
  28. in a tailored treatment approach how do you treat patients with a moderate risk
    • moderate dose statin (simvastatin 40)
    • -reduction of 35-45%
  29. according to the tailored treatment approach how do you treat high risk patients?
    • with high dose statins (lipitor 40mg)
    • -55-60% reduction
  30. what type of therapy should be initiated in patients with acute coronary syndrome?
    high dose statin therapy
  31. what type of therapy should be used in primary prevention of cardiovascular events in high risk patients?
    statin therapy
  32. therapeutic drug classes that do not change patient-oriented outcomes
    ezetimibe, bile acid binding resins, niacin, fibrates
  33. doses for rosuvastatin
    5, 10, 20, 40
  34. doses for simvastatin
    10, 20, 40, 80
  35. doses for atorvastatin
    10, 20, 40, 80
  36. doses for pravastatin
    10, 20, 40, 80
  37. doses for pitavastatin
    1, 2, 4
  38. doses for fluvastatin
    20, 40
  39. doses for lovastatin
    10, 20, 40
  40. lipid effects of statins
    • LDL 20-60
    • HDL 5-15
    • TG 7-40
  41. statin most effective when given at night
    lovastatin w/ evening meals
  42. which statin can be used in HIV pts
    • Pravastatin
    • Crestor
    • Lipitor (low doses)
  43. side effects of statins
    • HA
    • diarrhea
    • GI upset
    • myopathy
    • rhabdomyolysis
  44. what do we monitor in pts taking statins
    lipids, LFTs, CPK at baseline
  45. drug interactions with statins
    • macrolides
    • anti fungals
    • amiodarone
    • warfarin
    • gemfibrozil
    • niacin
    • protease inhibitors
  46. how long until therapeutic effects seen in pts taking statins
    • 2-4 wks
    • optimal effects in 6 wks
  47. which drug class is teratogenic
    statins
  48. HPS
    • -heart protection study
    • -used simva 40
    • -concluded statin therapy efficacious in pts with DM (even without CHD and with low LDL lvs)
  49. PROSPER trials
    • prospective study of pravastatin in the elderly at risk
    • pravastatin 40mg
    • decreased non fatal MI and CHD death and fatal and non fatal stroke
  50. ASCOT-LLA
    • -anglo-scandinavian cardiac outcomes trial-lipid lowering arm
    • -atorvastatin 10
    • -treated pts with HTN and >=3 CV risk factors
    • -stopped early bc of compelling evidence supporting the fact that there was a decrease in total CV events by 21% in pts treated with lipitor
  51. JUPITER
    • -Justification for the Use of statins in Prevention: an Intervention Trial Evaluation Rosuvastatin
    • -no prior CAD or DM with LDL less than 130 and high C-reactive protein
    • -rosuvastatin
    • -significantly reduced levels of MI, stroke revascularization, angina, and combined endpoint including death
  52. lipid effects of fibrates
    • LDL- no effect
    • HDL- 10-15
    • TG- 20-50
  53. side effects of fibrates
    • myopathy
    • GI upset
    • gallstones
  54. what to do with an interaction with fibrates and OA
    adjust the dose of OA
  55. Fibrates place in therapy
    TGs (effective in DM pts)
  56. if you add a fibrate to a statin what must you adjust in the pts regimen
    you must decrease the statin dose in half
  57. ACCORD lipid therapy
    • -action to control cardiovascular risk in diabetes
    • -type 2 pts
    • -adding a fenofibrate did not appear to reduce risk of fatal CV events, non fatal MI and non-fatal stroke as compared to statin therapy
  58. lipid effects from bile acid sequestrants
    • LDL 10-30
    • HDL 3-5
    • TG - no effect
  59. side effects of Bile acid sequestrants
    • constipation
    • bloating
    • abdominal pain
    • gallstones
    • myopathy
    • decreased absorption of many medications and fat soluble vitamins
  60. clinical pearls of Bile Acid Sequestrants
    • must take with food and liquid for decrease GI side effects
    • fruits, fiberl and a stool softener may help with constipation
  61. Bile Acid sequestrants place in therapy
    • reduces coronary events
    • effective added to statin therapy
  62. Bile acid sequestrants may increase TGs in pts with?
    TG >300
  63. Best Bile Acid Sequestrant in class
    welchol


































    welchol
  64. dosing for welchol
    3 tablets BID or 6 tablets once
  65. cholestyramine dosing/class
    • bile acid sequestrant
    • 4g 1-2 times per day
  66. cholesterol absorption inhibitor has no effect on
    TGs
  67. cholesterol absorption inhibitor lipid effects
    • LDL 15-20
    • HDL 3
    • no effect on TGs
  68. side effects for zetia
    • headache
    • rash
  69. TLC
    • reduce intake of sat fats by <7%
    • reduce intake of dietary cholesterol <200
    • moderate increase in polyunsat fats
    • dietary fiber 10-25 g per day
    • exercise
    • smoking cessation
  70. what is the OTC niacin formulation and dosage strengths
    IR 50, 100 (dietary supplement)
  71. Niacin lipid effects
    • LDL 2-25
    • HDL 15-35
    • TG 20-50
  72. best drug for raising HDL
    Niacin 15-35
  73. side effects of niacin
    • flusing
    • HA
    • GI upset (take with food)
    • hyperglycemia
    • hyperuricemia
    • hepatotoxicity
  74. niacin is contraindicated in
    liver disease and gout
  75. clinical pearls for niacin
    • take with food to avoid GI upset
    • take ASA for flushing (so min prior)
    • take at bedtime with food
    • avoid hot beverages, food, showers around time of administration
  76. Niacin works best for
    raising HDL 15-35%
  77. AIM-HIGH
    • -atherothrombosis intervention in metabolic syndrome with low HDL/high triglycerides: impact on global health
    • -found no incremental benefit from the addition of niacin to statin therapy
  78. Omega 3 fatty acids lipid effect
    TGs 30-50
  79. side effects of lovaza
    • fishy taste
    • GI upset
    • flu-like symptoms
  80. Omega-3 place in therapy
    • pts with TG >=500
    • 4g per day in 1 or 2 doses
  81. ORIGIN
    • -outcome reduction with an initial glargine intervention
    • -1g of n-3 fatty acids
    • -did not reduce the rage of CV events in pts at high risk for CV events

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