Hyperlipidemia

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Author:
giddyupp
ID:
50534
Filename:
Hyperlipidemia
Updated:
2011-01-13 11:37:14
Tags:
Hyperlipidemia PHPR522
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Description:
Hyperlipidemia
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  1. What is the step-wise process for treating hyperlipidemia?
    • 1. determine lipoprotein levels
    • 2. identify CHD or CHD risk equivalent
    • 3. determine presence of major risk factors other than LDL
    • 4. if 2+ risk factors w/out CHD or equivalent, assess 10-yr CHD risk
    • 5. determine risk category: establish LDL goal, determine need for TLC or drug tx
    • 6. initiate therapeutic lifestyle changes
    • 7. consider adding drug tx
    • 8. identify metabolic sndrome and treat, if present, after 3 mo TLC
    • 9. treat elevated TG
    • 9a. treat low HDL
  2. How do you calculate non-HDL level?
    TC - HDL = non-HDL
  3. What is the non-HDL goal?
    30 mg/dl above LDL goal
  4. When is non-HDL used?
    when TG between 200 - 499 and LDL goal has been reached
  5. What do you do if TG > 500?
    treat TG first to prevent pancreatitis, then treat LDL
  6. When should TG levels be checked?
    on a 12h fast
  7. List the order of potency of statins from highest to lowest.
    • Pitavastatin
    • Rosuvastatin
    • Atorvastatin
    • Simvastatin
    • Lovastatin
    • Pravastatin
    • Fluvastatin
  8. What is the goal for total cholesterol?
    < 200
  9. What is the goal for LDL?
    < 160
  10. What is the goal for HDL?
    • > 40
    • > 50 for diabetic females
  11. What is the goal for TG?
    < 150
  12. What is considered clinical CHD?
    • MI
    • unstable angina
    • chronic stable angina
  13. What are CHD equivalents?
    • symptomatic carotid artery disease
    • peripheral artery disease
    • diabetes
    • FR > 20%
    • abdominal aortic aneurysm
  14. What are the major risk factors other than LDL for CAD?
    • cigarette smoking in past month
    • HTN (even if controlled by meds)
    • low HDL
    • 45 yo or more male
    • 55 yo or more female
    • premature menopause w/o HRT
    • family hx of premature CAD (AMI or sudden death 55 or less in males, 65 or less in females)
  15. If pt has CAD or CAD risk equivalent, what is the goal LDL?
    <100
  16. If pt has 2+ CAD risk factors, what is the LDL goal?
    < 130
  17. If pt has 0-1 CAD risk factor, what is the LDL goal?
    < 160
  18. What are the risk factors for metabolic syndrome?
    • > 40 in waist in males
    • > 35 in waist in females
    • TG 150 or more
    • HDL < 40
    • BP 130/85 or higher
    • fasting glucose 110 or higher
  19. What is first-line tx for high TC and LDL?
    • statin
    • niacin
    • BAR
    • ezetimibe
  20. What is first-line tx for high TC, LDL, and TG?
    • Niacin if TG > 400
    • Statin if TG < 400
  21. What is first-line tx for high TC, LDL, and TG with low HDL?
    • niacin (nondiabetic)
    • statin (diabetic)
  22. What is first-line tx for high TG?
    • fibric acid (better tolerated than niacin)
    • niacin
    • lovaza
    • statin (if < 400)
  23. What is first-line tx for high TG with low HDL?
    • fibric acid (better tolerated than niacin)
    • niacin
  24. What is first-line tx for low HDL?
    • fibric acid (better tolerated than niacin)
    • niacin
  25. What are the names of the bile acid resins (BAR)?
    • cholestyramine 4g QD-BID
    • colestipol 1-2g BID
    • colesevelam 3 625mg tabs BID
  26. What are the effects of BAR on lipids?
    • decrease LDL
    • increase HDL
    • increase TG
  27. What are the side effects of BAR?
    • nausea
    • constipation
    • bloating
    • flatulance
  28. What are the DI of BAR?
    can form complexes with other drugs, decreasing their absorption
  29. What is the place in tx for BAR?
    adjunct to statins when further LDL lowering is needed
  30. What are the names of niacin products?
    • immediate release (niacor) 250mg BID
    • intermediate release (niaspan) 500mg QHS
    • sustained release (nicobid) 250mg BID
  31. At what point is there no added benefit by increasing niacin doses?
    above 2g
  32. What are the effects on lipids of niacin?
    • decrease LDL
    • decrease TG
    • increase HDL
  33. What are the SE of niacin?
    • flushing
    • NVD
    • dyspepsia
    • hyperuricemia
    • hyperglycemia
    • myopathy
    • hepatotoxicity
  34. What should be monitored for niacin?
    • AST/ALT baseline, 8-12 wks after dose changes, then q 6mo
    • fasting plasma glucose baseline, then periodically (more if diabetic)
    • uric acid (if gout present)
    • CPK baseline, then if myopathy suspected
  35. What are the names of the fibric acids?
    • fenofibrate 145mg QD
    • micronized fenofibrate 200mg QD
    • fenofibric acid 135mg QD
    • gemfibrozil 600mg BID
  36. What are the effects of fibric acids on lipids?
    • decrease TG
    • increase HDL
    • minimal effect on LDL
  37. What are the SE of fibric acids?
    • N,D
    • Myopathy (gemfibrozil worst)
    • gall stones
    • hepatotoxicity
    • neutropenia
  38. What should be monitored for fibric acids?
    • AST/ALT baseline, 8-12 wks, then q 6mo
    • CPK baseline, then if suspect myopathy
    • renal fx baseline and periodically
    • CBC
  39. What is the place in tx for fibric acids?
    first line for high TG and/or low HDL
  40. What are the names of the statins?
    • pitavastatin 2mg
    • rosuvastatin 5mg
    • atorvastatin 10mg
    • simvastatin 20mg
    • lovastatin 40mg
    • pravastatin 40mg
    • fluvastatin 60mg
  41. What is the effect on lipids of statins?
    • decrease LDL
    • decrease TG (only rosuvastatin, atorvastatin, simvastatin)
    • increase HDL
  42. What are the SE of statins?
    • myopathy
    • hepatitis
    • insomnia
    • vivid dreams
    • difficulty concentrating
    • proteinuria/hematuria
  43. What should be monitored for statins?
    • AST/ALT baseline, 12 wks, then q 6mo
    • CPK baseline then if suspect myopathy
    • renal fx baseline
  44. What is the effect on lipids of ezetimibe?
    • decrease LDL
    • decrease TG (minimal)
    • increase HDL (minimal)
  45. What are the SE of ezetimibe?
    • Diarrhea
    • abdominal pain
    • increased transaminases (in combo with statins)
  46. What are the DI of ezetimibe?
    fibric acids (increased risk of gall stones)
  47. What should be monitored for ezetimibe?
    AST/ALT (if on a statin too)
  48. What is the place in tx for ezetimibe?
    • adjunct to statins for decreasing LDL
    • familial hypercholesterolemia
  49. What is the effect on lipids of Omega-3s?
    decrease TG
  50. What are the SE of Omega-3s?
    • fishy burp (take w/food to improve)
    • dyspepsia
    • taste perversion
  51. What is the place in tx for Omega-3s?
    • tx of TG>500
    • adjunct to statins to lower TG

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