37 - Dyslipidemias Flashcards Preview

PEBC > 37 - Dyslipidemias > Flashcards

Flashcards in 37 - Dyslipidemias Deck (37):
1

Who and how often should we screen for dyslipidemias?

-those with fam Hx
-those over 40
-women who are postmenopausal

screen every 3 years

2

What is the Fridewald equation?

LDL-C = Total-C - (HDL-C + TG/2.2)

*cannot be used if TG > 4.52

3

Is fasting before test required?

no longer required unless TG > 4.5

4

What are some optional targets after reaching LDL-C goals?

non-HDL-C < 2.6 mmol/L

apolipoprotein B < 0.8 g/L

5

What are very high TGs (>10 mmol/L) are risk factor for?

pancreatitis

6

Non-pharms

-diet (aimed at decreasing blood levels of lipids and weight if needed)
-For primary prevention, try diet x 3 months
-For secondary prevention or high risk patients, initiate cholesterol-lowering med at the same time as dietary changes
-eat sterol enriched foods (margarine, fruit juice)
-other lifestyle mods to reduce risk of CVD (smoking cessation, stress management, weight loss, physical activity)

7

What is 1st line?

Statins bc they have established CV benefit

8

s/e of statins

-muscle-related symptoms
-concern with new onset DM
-anecdotal reports of memory loss

9

cholesterol absorption inhibitor: example?

ezetimibe

10

What is Ezetimibe (cholesterol absorption inhibitor) indicated for?

monotherapy or in combo with statins

11

Ezetimibe is better tolerated than ____

resins (ex. cholestyramine)

12

Does ezetimibe improve CV outcomes

no - not been proven to

13

Give examples of fibrates

-gemfibrozil
-bezafibrate
-fenofibrate

14

How do fibrates work?

-lower TG
-raise HDL-C

may benefit patients with diabetic dyslipidemias

*effect of fibrates on LDL-C is variable

15

Which fibrates lower LDL-C more consistently and can be combined with a statin?

-Benzafibrate
-Fenofibrate

16

Give an example of a microsomal triglyceride transfer protein inhibitor

Lopitamide

17

What is lopitamide indicated for?

as adjunctive Tx in adult homozygous familial hypercholesterolemia

18

What can Lopitamide cause?

hepatic toxicity, therefore need to monitor hepatic transaminases

19

What is nicotinic acid (niacin)?
What does it do?

a B vitamin that at high doses lowers TG and LDL-C and raises HDL-C more than any other lipid-lowering agent

*also lowers lipoprotein (a)

20

What types of forms of niacin is more hepatotoxic?

slow-release forms more hepatotoxic than IR forms

21

What are examples of PCSK9 inhibitors?

alirocumab and evolocumab

22

What do PCSK9 inhibitors do?

-they are SC injection
-result in substantial LDL-C reduction beyond that achieved with statins alone

23

Give 3 examples of Bile acid sequestering resins

-Cholestyramine
-Colesevelam
-Colestipol

24

Resins help improve ___ outcomes when used alone

CV

25

What are the main drawbacks to using resins?

-GI distress
-concomitant drug malabsorption

26

T or F: Resins are appropriate for children, pregnancy and breastfeeding

true

27

Ezetimibe can be used in kids ___ and older

10

28

Non-Rx Agents:
How much psyllium do you need to lower LDL-C?

daily consumption of 10 g psyllium can decrease LDL-C by 7%

29

Non-Rx Agents:
Is omega-3 FA recommended?

it is recommended (1 g/day) but no evidence to improve CV outcomes

30

Non-Rx Agents:
Patients taking 2-4 g of O3FA decrease TG by ____%

25-30%

31

Non-Rx Agents:
If they take >3g/day of O3FA they need to do so under Dr.'s supervision as this can increase risk of ____

bleeds

32

Pregnancy:
d/c all lipid-lowering agents except _____

resins

33

Pregnancy:
If resins are tolerable, what should you initiate?

a lipid-soluble vitamin supplement

34

Pregnancy:
Is it a big deal to stop all lipid-lowering agents for duration of therapy?

No - interrupting lipid-lowering Tx during childbearing potential has little impact on overall risk

35

Breastfeeding:
Which drugs are recommended?

NONE

don't use these drugs while breastfeeding, begin lipid-lowering agent again after breastfeeding completed

36

Doubling the dose of a statin will further reduce the LDL-C level by only ___%

6%

37

Appears to be safe to target LDL-C levels to _____ in individuals with overt CHD and multiple risk factors

1.3 mmol/L

Decks in PEBC Class (130):