thera 3 lipids

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coal
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268079
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thera 3 lipids
Updated:
2014-03-26 18:59:22
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thera lipids
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thera 3 lipids
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thera 3 lipids
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  1. total cholesterol calculation
    TC = LDL + HDL + TG/5
  2. secondary causes of dyslipidemia
    • HOODAS
    • Hypothyroidism
    • Obesity
    • Obstructive Liver Disease
    • Diabetes Mellitus
    • Alcoholism
    • Sedentary lifestyle
  3. drugs that can induce hyperlipidemia
    • diuretics
    • beta blockers
    • alpha agonist & antagonist
    • OC's
    • glucocorticoids
    • ethanol
    • isotretinoin
  4. what defines ASCVD
    • history of MI
    • stable or unstable angina
    • coronary revascularization
    • stroke or TIA of atherosclerotic origin
    • PAD or revascularization
  5. 4 statin benefit groups
    • 1. adults with clinical ASCVD who are candidates
    •   age < 75 yrs = high intensity statin
    •   age > 75 yrs or not a candidate for high   intensity statin

    2.adults with primary LDL-C > 190 mg/dL: familial hypercholesterolemia = high intensity

    • 3. primary prevention diabetes
    •   adults aged 40-75 yrs with DM and LDL-C 70-189 mg/dL.
    • ASCVD risk < 7.5% = moderate intensity
    • ASCVD risk > 7.5 % = high-intensity
  6. high intensity statin therapy
    • atorvastatin 40-80 mg
    • rosuvastatin 20 mg (40mg)
    • lower LDL-C by > 50%
  7. moderate-intensity statin therapy
    • atorvastatin 10 mg (20mg)
    • rosuvastatin (5mg) 10 mg
    • simvastatin 20-40 mg
    • pravastatin 40 mg (80mg)
    • fluvastatin 80 mg
    • pitavastatin 2-4 mg

    lower LDL-C by 30-50%
  8. 3 lifestyle modifications to help lower LDL
    1. diet rich in vegetables, fruits, and whole grains

    2. reduced percent of calories from saturated fat (5-6%)

    3. reduce percent of calories from trans fat
  9. absolute contraindications to statins
    • chronic liver disease
    • pregnancy
    • lactatino
  10. side effects of statins
    • myopathy
    • rhadomyolysis
    • HA
    • constipation
    • elevated LFT's
  11. some adverse effects associated with long term use of statins
    • increase risk of DM = increased monitoring
    • cognitive impairment
  12. 2 drugs that need dose reductions when taken with simvastatin
    • gemfibrozil
    • amlodipine
  13. difference between myalgia and rhabdomyolysis
    rhabdo has elevated CK (10 x ULN)
  14. statins metabolized by CYP 3A4
    • simvastatin (Zocor)
    • atorvastatin (Lipitor)
    • lovastatin (mevacor)
  15. statins metabolized by CYP 3A4 & 2C9
    • fluvastatin (lescol)
    • rosuvastatin (Crestor)
  16. statins in order of most potent to least potent
    • rosuvastatin (crestor)
    • atorvastatin (Lipitor)
    • simvastatin (Zocor)
    • lovastatin (mevacor)
    • fluvastatin (lescol)
    • pravastatin (pravachol)
    • pitavastatin (livalo)
  17. zetia (ezetimibe) MOA
    inhibits intestinal absorption of dietary and biliary cholesterol by blocking transport at the brush border of the small intestine
  18. CI for zetia (ezetimibe)
    moderate to severe hepatic insufficiency
  19. CI to fibric acid derivatives
    • hepatic or severe renal dysfunction
    • primary biliary cirrhosis
    • gallbladder disease
  20. 2 fibric acid derivatives
    • lopid - gemfibrozil
    • tricor - trilipipix (fenofibrate)
  21. absolute CI for niacin
    hepatic dysfunction
  22. relative CI of niacin
    • diabetes
    • peptic ulcer disease
    • gout
  23. 2 main side effects of niacin
    • flushing
    • hyperglycemia
  24. 3 bile acid sequestrants
    • colestid - colestipol
    • questran - cholestyramine
    • welchol - colesevelam
  25. absolute CI to bile acid sequestrants
    • TG > 400
    • complete biliary obstruction
  26. relative CI to bile acid sequestrants
    TG > 200
  27. drug summary of fibric acid derivatives
    most effective agents to reduce TG
  28. drug summary of nicotinic acid
    • potent HDL increaser
    • watch for drug-disease interactions
    • tolerability limits using higher doses
  29. drug summary for bile acid sequestrants
    • preferred in liver disease
    • not useful if > 20% reduction in LDL needed
    • tolerability limits use, do not use w/elevated TG

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