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Nurs 5229 Clinical Pharmacotherapeutics > cholesterol > Flashcards

cholesterol Flashcards

1
Q

is the leading cause of death of men and women

A

ASCVD (athloclerotic cardiovascular disease)

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2
Q

Risk of developing ASCVD is directly r/t

A

increases levels of blood cholesterol, in the form of LDL

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3
Q

Lower LDL, slow

A

slow progression of atherosclerosis, reduce risk for serious ASCVD

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4
Q

Very-low-density lipoproteins (VLDLs)

Triglycerides – levels above

A

500mg/dL – increase risk of pancreatitis.

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5
Q

Low-density lipoproteins (LDLs) (bad)

A

Cholesterol primary core lipid

Greatest contributor to coronary heart disease

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6
Q

For each 1% reduction in LDL

A

1% reduction in the risk for a major CV event.

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7
Q

High-density lipoproteins (HDLs) (good)

A

Cholesterol primary core lipid

Carry cholesterol from peripheral tissues back to the liver

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8
Q

HDL promotes

A

cholesterol removal – high HDL levels protect again ASCVD.

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9
Q

Risk Factors for ASCVD

A 
Smoking
High blood pressure
Abnormal cholesterol
Diabetes
ASCVD risk status uncertain – a coronary artery calcium test (40 to 75 y.o.)
Risk-enhancing factors (40 to 75 y.o.)
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10
Q

Primary hypercholesterolemia

A

(LDL-C, 160–189 mg/dL [4.1–4.8 mmol/L); non–HDL-C 190–219 mg/dL [4.9–5.6 mmol/L])*

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11
Q

Metabolic syndrome

A

(increased waist circumference, elevated triglycerides [>175 mg/dL], elevated blood pressure, elevated glucose, and low HDL-C [<40 mg/dL in men; <50 in women mg/dL] are factors; tally of 3 makes the diagnosis)

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12
Q

CKD

A

eGFR 15–59 mL/min/1.73 m2 with or without albuminuria; not treated with dialysis or kidney transplantation

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13
Q

Chronic inflammatory conditions

A

such as psoriasis, RA, or HIV/AIDS

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14
Q

History of premature menopause

A

before age 40 y) and history of pregnancy-associated conditions that increase later ASCVD risk such as preeclampsia

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15
Q

High-risk race/ethnicities

A

e.g., South Asian ancestry

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16
Q

Lipid/biomarkers

A

Associated with increased ASCVD risk
Persistently* elevated, primary hypertriglyceridemia (≥175 mg/dL);
If measured:

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17
Q

Elevated high-sensitivity C-reactive protein

A

(≥2.0 mg/L)

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18
Q

Elevated Lp(a):

A

A relative indication for its measurement is family history of premature ASCVD. An Lp(a) ≥50 mg/dL or ≥125 nmol/L constitutes a risk-enhancing factor especially at higher levels of Lp(a).

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19
Q

Elevated apoB

A

≥130 mg/dL: A relative indication for its measurement would be triglyceride ≥200 mg/dL. A level ≥130 mg/dL corresponds to an LDL-C >160 mg/dL and constitutes a risk-enhancing factor

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20
Q

ABI

A

<0.9

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21
Q

Adults > 20 y.o. without ASCVD/not on therapy – measure

A

LDL-C fasting or non-fasting plasma lipid profile (document)

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22
Q

If initial non-fasting lipid panel with triglycerides >

A

400mg/dL , repeat fasting lipid panel

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23
Q

3 Regimens Statins

A

High intensity, which typically lowers LDL-C by 50% or more
Moderate intensity, which lowers LDL-C by 30% to 49%
Low intensity, which lowers LDL-C by 30% or less

24
Q

patients who have extreamly high (190 or higher) LDL are at risk

A

for lifetime risk of cardiac events

25
Q

40 to 75 with diabetes

A

modtere to high risk. Remonded moderate intensity regimine

26
Q

Lifestyle Modifications examples

A

Reduced caloric intake of saturated facts, dietary cholesterol
Eliminate trans fat
Average of 50 minutes of moderate to vigorous physical activity 3 to 4 times a week

27
Q

Potential net clinical benefit of pharmacotherapy

A

Recommend statins as first-line therapy
Consider combination of statin and non-statin, if indicated
Discuss potential risk reduction from lipid-lowering therapy
Discuss potential for adverse effects or drug-drug interactions

28
Q

ASCVD risk assessment

A

Assign to treatment group (use ASCVD Risk Estimator Plus)
Assess other patient characteristics – Risk-Enhancing Factors
Assess CAC, if risk decision is uncertain/additional information is needed

29
Q

recommend what as first line therapy

A

statins

30
Q

Major ASCVD Events

A

Recent ACS (within the past 12 mo)
History of MI (other than recent ACS event listed above)
History of ischemic stroke
Symptomatic peripheral arterial disease (history of claudication with ABI <0.85, or previous revascularization or amputation)

31
Q

High-Risk Conditions

A

Age ≥65 y
Heterozygous familial hypercholesterolemia
History of prior coronary artery bypass surgery or percutaneous coronary intervention outside of the major ASCVD event(s)
Diabetes mellitus
Hypertension
CKD (eGFR 15-59 mL/min/1.73 m2)
Current smoking
Persistently elevated LDL-C (LDL-C ≥100 mg/dL [≥2.6 mmol/L]) despite maximally tolerated statin therapy and ezetimibe
History of congestive HF

32
Q

Patient who might benefit form knowing their CAC score is zero

A

Patients reluctant to initiate statin therapy who wish to understand their risk and potential for benefit more precisely

Patients concerned about need to reinstitute statin therapy after discontinuation for statin-associated symptoms

Older patients (men, 55-80 y.o.; women, 60-80 y.o.) with low burden of risk factors who question whether they would benefit from statin therapy

Middle-aged adults (40-55 y.0.) with PCE-calculated 10-year risk of ASCVD 5% to <8.5% with factors that increase their ASCVD risk, although they are in the borderline risk group

33
Q

Monitoring

A

Middle-aged adults (40-55 y.0.) with PCE-calculated 10-year risk of ASCVD 5% to <8.5% with factors that increase their ASCVD risk, although they are in the borderline risk group

34
Q

Average 40 minutes of

A

Average 40 minutes of

35
Q

Lipid disorders r/t obesity – intensify

A

lifestyle therapy, moderate caloric restriction and regular aerobic physical activity

36
Q

In children and adolescents with obesity or other metabolic risk factors, it is reasonable

A

to measure a fasting lipid profile to detect lipid disorders as components of the metabolic syndrome

37
Q

to measure a fasting lipid profile to detect lipid disorders as components of the metabolic syndrome

A

fasting or non-fasting lipoprotein profile as early as age 2 years to detect FH or rare forms of hypercholesterolemia.

38
Q

In children and adolescents without cardiovascular risk factors or family history of early CVD, it may be reasonable to measure a

A

fasting lipid profile or non-fasting non HDL-C once between the ages of 9 and 11 years, and again between the ages of 17 and 21 years, to detect moderate to severe lipid abnormalities.

39
Q

In children and adolescents found to have moderate or severe hypercholesterolemia, it is reasonable to carry out

A

reverse-cascade screening of family members, which includes cholesterol testing for first-, second-, and when possible, third-degree biological relatives, for detection of familial forms of hypercholesterolemia

40
Q

In children and adolescents 10 years of age or older with an LDL-C level persistently 190 mg/dL (≥4.9 mmol/L) or higher or 160 mg/dL (4.1 mmol/L) or higher with a clinical presentation consistent with FH and who do not respond adequately with 3 to 6 months of lifestyle therapy, it is reasonable to initiate

A

statin therapy

41
Q

In adults 75 years of age or older with an LDL-C level of 70 to 189 mg/dL, initiating

A

a moderate-intensity statin may be reasonable.

42
Q

In adults 75 years of age or older, it may be reasonable to stop

A

statin therapy when functional decline (physical or cognitive), multimorbidity, frailty, or reduced life-expectancy limits the potential benefits of statin therapy.

43
Q

In adults 76 to 80 years of age with an LDL-C level of 70 to 189 mg/dL, it may be reasonable to measure

A

CAC to reclassify those with a CAC score of zero to avoid statin therapy

44
Q

Consider conditions specific to women, such as

A

premature menopause (age <40 years) and history of pregnancy-associated disorders (hypertension, preeclampsia, gestational diabetes mellitus, small-for-gestational-age infants, preterm deliveries), when discussing lifestyle intervention and the potential for benefit of statin therapy.

45
Q

Women of childbearing age who are treated with

A

statin therapy and are sexually active should be counseled to use a reliable form of contraception.

46
Q

statin therapy and are sexually active should be counseled to use a reliable form of contraception.

A

hypercholesterolemia who plan to become pregnant should stop the statin 1 to 2 months before pregnancy is attempted, or if they become pregnant while on a statin, should have the statin stopped as soon as the pregnancy is discovered.

47
Q

. In all individuals, emphasize a

A

heart-health lifestyle across the life course.

48
Q

In patients with clinical ASCVDF, reduce

A

low-density lipoprotein cholesterol (LDL-C with high intensity statin therapy or maximally tolerated statin therapy.

49
Q

In very high-risk ASCVD, use a

A

LDL-C threshold of 70 mg/dL (1.8 mmol/L) to consider addition of nonstatins to statin therapy.

50
Q

In patients with severe primary hypercholesterolemia (LDL-C level ≥ 190 mg/dL[≥4.9 mmol/L]) without calculating 10-year ASCVD risk, begin

A

high-intensity statin therapy without calculating 10-year ASCVD risk.

51
Q

In patients 40 to 75 years of age with diabetes mellitus and LDL-C ≥70 mg/dL (≥1.8 mmol/L), start

A

moderate-intensity statin therapy without calculating 10-year ASCVD risk

52
Q

In adults 40 to 75 years of age evaluated for primary ASCVD prevention, have a clinician

A

patient risk discussion before starting statin therapy.

53
Q

In adults 40 to 75 years of age without diabetes mellitus and with LDL-C levels ≥70 mg/dL (≥1.8 mmol/L), at a 10-year ASCVD risk of ≥7.5%, start a

A

In adults 40 to 75 years of age without diabetes mellitus and with LDL-C levels ≥70 mg/dL (≥1.8 mmol/L), at a 10-year ASCVD risk of ≥7.5%, start a

54
Q

In adults 40 to 75 years of age without diabetes mellitus and with LDL-C levels ≥70 mg/dL (≥1.8 mmol/L), at a 10-year ASCVD risk of ≥7.5%, start a

A

initiation of statin therapy (see No. 7)

55
Q

In adults 40 to 75 years of age without diabetes mellitus and with LDL-C levels ≥70 mg/dL- 189 mg/dL (≥1.8-4.9 mmol/L), at a 10-year ASCVD risk of ≥7.5% to 19.9%, if a decision about statin therapy is uncertain,

A

consider measuring CAC.

56
Q

. Assess adherence and percentage response to LDL- C–lowering medications and lifestyle changes with repeat lipid measurement 4 to 12 weeks after

A

statin initiation or dose adjustment, repeated every 3 to 12 months as needed.

Nurs 5229 Clinical Pharmacotherapeutics (78 decks)

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