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OU Module Cardio Spring 2018 > Therapeutics of Dyslipidemia > Flashcards

Therapeutics of Dyslipidemia Flashcards

1
Q

What is the goal for treating primary prevention of ASCVD?

A

reducing risk of initial CV event

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2
Q

What is the goal for treating secondary prevention of ASCVD?

A

patient has had at least one CV event; goal is to reduce risk of repeated event

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3
Q

risk of very high triglycerides

A

pancreatitis

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4
Q

therapeutic lifestyle changes that can improve dyslipidemia

A
  • Heart-healthy lifestyle and habits recommended for all
  • Reduced intake of saturated fats and cholesterol
  • Weight reduction
  • Increased physical activity
  • Smoking cessation – lowers ASCVD risk
  • Substitute unhealthy foods
  • Low fat, low cholesterol diet
  • Achieve ideal body weight
  • Dietary options to reduce LDL
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5
Q

What are the dietary options to reduce LDL?

A
  • Fiber: 10-15g/d of psyllium seed reduced total and LDL cholesterol by 5-20%; MOA: binds cholesterol in the gut and reduces hepatic production and clearance
  • Plant sterols and plant stanols: 2-3 g/day lowers LDL by 6-15%
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6
Q

How long should a patient be on TLC’s before going to drug therapy?

A

3 months unless patient is at very high risk

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7
Q

What are the the 4 statin benefit groups (as defined by the 2013 ACC/AHA Guideline)?

A
  • Secondary prevention in patients with clinical ASCVD
  • Primary prevention in patients with LDL > 190
  • Primary prevention in patients with diabetes, 40-75 years of age, and LDL 70-189
  • Primary prevention in patients without diabetes, 40-75 years of age, LDL 70-189, and 10-year ASCVD risk of > 7.5%
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8
Q

Therapy for Secondary prevention in patients with clinical ASCVD

A
  • High intensity statin if < 75 yrs and no safety concerns

- Moderate intensity statin if > 75 years and safety concerns

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9
Q

Therapy for Primary prevention in patients with LDL > 190

A
  • High intensity statin if > 21 years

- Target 50% LDL reduction, add non-statin LDL lowering drug if needed

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10
Q

Therapy Primary prevention in patients with diabetes, 40-75 years of age, and LDL 70-189

A
  • Moderate intensity statin

- Consider high intensity if 10-year ASCVD risk > 7.5%

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11
Q

Therapy Primary prevention in patients without diabetes, 40-75 years of age, LDL 70-189, and 10-year ASCVD risk of > 7.5%

A
  • Moderate or high intensity statin if 10-year ASCVD risk > 7.5%
  • Consider moderate intensity statin if 10-year ASCVD risk 5-7.5%
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12
Q

When would the goals be for LDL < 70 mg/dL and non-HDL < 100 mg/dL?

A

if it’s secondary prevention in patients with clinical ASCVD comorbidities:

  • DM
  • recent ASCVD event
  • poorly controlled ASCVD risk factors
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13
Q

When would the goals be for LDL <100 mg/dL and non-HDL < 130 mg/dL?

A
  • Secondary prevention in patients with clinical ASCVD without comorbidities
  • Primary prevention in patients with LDL ≥ 190
  • Primary prevention in patients with diabetes, 40-75 years of age, and LDL 70-189
  • Primary prevention in patients without diabetes, 40-75 years of age, LDL 70-189, and 10-year ASCVD risk of ≥ 7.5%
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14
Q

What do you do if patient is experiencing myopathy?

A
  • Check CK, SCr, and myoglobinuria

- Take patient off statin; if ADR resolves, re-challenge with lower dose or lower class (usually pravastatin)

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15
Q

symptoms of hepatotoxicity

A
  • fatigue
  • loss of appetite
  • abdominal pain
  • dark urine
  • yellow of skin
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16
Q

What do you do if patient is experiencing hepatotoxicity?

A
  • immediately take patient off medication

- measure LFT’s (AST/ALT) immediately

17
Q

What do you do for patients who are intolerant to statins?

A
  • Optimize diet and exercise + a non statin agent
  • Preferred agents: Ezetimibe (low intensity) or PCKS9 inhibitors (high intensity)
  • Non-preferred: bile acid sequestrants (if TG < 300)
18
Q

If patient does not fall under the 4 statin benefit groups, why would patient need to be treated?

A
  • have ASCVD risk
  • hypertriglyceridemia (TG ≥ 500 mg/dL)
  • patients with low HDL (HDL < 40 mg/dL is a risk factor for CHD)
19
Q

How do you treat patients that have ASCVD risk but does not fall under the 4 statin benefit groups?

A
  • First line: statin therapy with intensity tailored based on patient factors
  • Second line: Ezetimibe (low intensity) or PCKS9 inhibitors (high intensity), or non-preferred: bile acid sequestrants (if TG < 300)
20
Q

How do you treat patients that have hypertriglyceridemia (TG ≥ 500 mg/dL) but does not fall under the 4 statin benefit groups?

A
  • TLC’s

- Drug therapy: high potency statin, niacin, fibrates, omega-3 fatty acids

21
Q

How do you treat patients that have low HDL (HDL < 40 mg/dL) but does not fall under the 4 statin benefit groups?

A
  • TLC’s

- Drug therapy: niacin, fibrates

22
Q

Dyslipidemia therapy with pregnancy

A
  • Discontinue therapy for the duration of the pregnancy

- Statins are category X

23
Q

Dyslipidemia therapy with children

A
  • Therapy not recommended until patient is at least 8
  • TLC’s s
  • Drug therapy: Bile acid sequestrants and statins
24
Q

Collect

A
  • Patient characteristics
  • Patients medical and family history
  • Current medications and prior lipid-lowering medication use
  • Socioeconomic factors
  • Lifestyle assessment
  • Symptoms indicative of ischemic injury
  • Objective data: vitals, FLP, liver and renal function, glucose
25
Q

Assess

A
  • Rule out secondary causes
  • Assess groups with special considerations such as pregnancy, children
  • Dyslipidemia-related complications (e.g., MI, stroke)
  • 10-year atherosclerotic cardiovascular disease (ASCVD) risk assessment
  • Current medications that may contribute to dyslipidemia
  • LDL-C reduction based on statin benefit group, if applicable to patient
  • Appropriateness and effectiveness of current lipid-lowering therapy (if any)
26
Q

Plan

A
  • Tailored therapeutic lifestyle changes
  • Lipid-lowering medication regimen
  • Monitoring plan to assess efficacy and safety: Every 6-12 weeks after drug initiation or titration; Every 6-12 month intervals once at goal
  • Patient education
  • Self-monitoring of weight, exercise, diet, drug adherence/AE
  • Referrals to other providers when appropriate for coordination of care
27
Q

Implement

A
  • Provide patient education regarding all elements of treatment plan, including self-management training
  • Use motivational interviewing and coaching strategies to maximize adherence
  • Schedule follow-up and timeframe to achieve goals of therapy
28
Q

Monitor and Evaluate

A
  • Determine response to lipid-lowering therapy
    weight-loss goals (weight, BMI)
  • Presence of medication-induced adverse effects
  • Occurrence of CV events
  • If secondary prevention, ASCVD symptoms may improve over months to years
  • If xanthomas present, lesions should regress with therapy
  • Patient adherence to treatment plan using multiple sources of information

OU Module Cardio Spring 2018 (16 decks)

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