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what's the difference between hyperlipidemia and dyslipidemia?
- hyper = elevated cholesterol
- dys = messed up cholesterol (not normal)
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what are secondary causes of dyslipidemia and how do they affect TC, TG, LDL, HDL?
- DM; inc TC, TG, LDL and dec HDL
- alcoholism inc TG and HDL
- Obstructive Liver Dz; inc TC, abnormal LDL
- Sedentary Lifestyle; dec HDL
- obesity; inc TG, dec HDL
- hypothyroidism; inc LDL, possibly inc TG
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What are the dgs that induce hyperlipidemia?
- diuretics (thiazides, loops)
- beta-blockers
- alpha agonists and antagonists
- OCs
- glucocorticoids
- ethanol
- isotretinoin
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what was the paradigm shift in new treatment guidelines for dyslipidemia?
- tx to reduce atherosclerotic cv dz
- statin benefit groups
- out with the old (tx to goal = tx to target, lower is best, tx level of risk, tx lifetime risk)
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what is ASCVD?
- MI
- Stable and unstable
- PAD/revascularization
- TIA/Stroke
- cornoary revascularization
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What are lifestyle modifications?
- inc intake of fruits, veggies and whole grains
- reduce calories from sat fat
- reduce percent of calories from trans fat
- engage in aerobic activity (40 mins, 3 times/wk)
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What are the 4 benefit groups?
- 1. cholesterol >190,
- 2. secondary prevention (ascvd)
- 3. diabetes with cholesterol 70 - 189 and 40-75 yo
- 4. 10 yr risk >7.5%, no diabetes
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what is the tx for group 1?
- </= 75 = high intensity
- >75 = mod
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what is the tx for group 2?
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What is the tx for group 3?
- ASCVD risk <7.5% = mod
- ASCVD risk >/= = high
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what is the tx for group 4?
mod-high for >/= 7.5%
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what are the two exceptions to guideline tx recommendations?
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what are the high intensity statins?
- atorvastatin 40 - 80mg
- rosuvastatin 20mg
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what are the absolute CI to statins?
- active or chronic liver dz
- pregnancy
- lactation
(relative = concomitant use of certain drugs)
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What are the drug interactions with HMG-CoA RI?
- 3A4 - atorvastatin, flu, lov, sim
- 2C9 - flu, ros
- glucoronidation - pravastatin
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What is the cholesterol absorption inhibitor and its side effect??
- zetia
- well tolerated
- sever diarrhea, myalgias, rhabdo, hepatitis - more likely with combo therapy
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CI to Zetia?
mod - severe hepatic insufficiency
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What are the fibric acid derivatives?
- lopid (gemfibrozil)
- tricor/trilipix (fenofibrate)
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what are the CIs to fibric acid?
- hepatic or sever renal dysfxn
- primary biliary cirrhosis
- gallbladder dz
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what are the side effects of fibric acid?
- rash
- diarrhea, nausea, ab pain - inc risk of gallstones
- dec hgb/hct
- myopathy
- elevated lfts
- DO NOT GIVE GEMFIBROZIL AND STATINS TOGETHER
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What are the CIs to niacin?
- absolute - hepatic dysfxn
- relative - DM, peptic ulcer, gout
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what are the CIs to bile acid sequestrants?
- absolute - TG > 400, complete biliary obstruction
- relative - TG > 200
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what are the bile acid sequestrants?
- colestid (colestipol)
- questran (cholestyramine)
- welchol (colesevelam)
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what are the education points of bile acid sequestrants?
take before meals
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