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Dislipidemia Flashcards

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1
Q

Dyslipidemias include?

A

High LDL

Low HDL

High TG

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2
Q

Chylomicrons?

A
  • Transport fatty acids and cholesterol from the intestine to the liver
  • TG rich
  • Clears from the blood stream within 12 hours
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3
Q

Lipoprotein Analysis should be done when patient has?

A

Fasted for 9-12 hours

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4
Q

Along with age and family history risk factors for CHD include?

A

Hypertension or on HTN meds

Low HDL

male- <40mg/d

FM- <50 mg/dl

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5
Q

C-reactive protein or CRP is what type of marker?

What are the ACC/AHA guidelines?

A

Inflammatory marker

hsCRP

< 1 mg/l= low risk

1-3= moderate

>3 is high risk

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6
Q

Normal levels of Lp (a) are?

How can it be treated?

A

< 30 or 75 nmol/L

Niacin, Estrogens, PCSK9-I

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7
Q

Vit D insuffieciency is linked to?

A

CHD and total mortality

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8
Q

Combined cholesterolemia is?

A

High TG and Cholesterol

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9
Q

Mixed Dyslipidemia is?

A

High TG and low HDL

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10
Q

What are the two types of Familial Hypercholesterolemia?

A

Heterozygous

Homozygous

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11
Q

What are the secondary causes of Hypercholesterolemia?

A
  1. DM
  2. Obese
  3. Alcohol
  4. Hypothyroidism
  5. HIV
  6. Liver impairment
  7. CKD
  8. Pregnancy
  9. Menopause
  10. Autoimmune dissorders
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12
Q

LDL-C

Desirable?

very high

A

<100

>190

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13
Q

TG levels?

Normal?

very high?

A

<150

>= 500

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14
Q

Non HDL Cholesterol

Desirable?

Very high

A

<130

>= 220

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15
Q

Drug induced Dyslipidemia?

Thiazides

BBs

Estrogens

Atypical

Steroids

Cyclosporine

Protease inhibitors

Retinoids

A
  • ^LDL and TGs
  • Decrease HDL, ^ TGs
  • ^HDL and TGs, decrease LDL
  • decrease HDL ^TGs
  • ^LDL and TGs
  • ^LDL and TGs
  • ^LDL and TGs, Decrease HDL
  • ^LDL and TGs, decrease HDL
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16
Q

The 2013 ACC/AHA Guideline Key Points?

A
  1. Encourage adherence of a heart healthy lifestyle
  2. Statins are recommended for adults in groups demonstrated to benefit
  3. Engage in Clinic patient discussion before initiating statin therapy
  4. Initiate the appropriate intensity of statin therapy to reduce ASCVD risk
  5. Used Pooled cohort equation for estimating 10-ASCVD risk
  6. Evidence is inadequate to support specific LDL ot non HDL goals
  7. Nonstatin drug therapy may be considered in selected individuals
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17
Q

NHLBI

A

Recommendations based on RCT evidence

Less expert opinion than in prior guidelines

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18
Q

The changes from ATP-III

A
  • Dont focus on specific LDL or non HDL goals
    • Obtain a lipid panel to monitor adherence
  • Use medications proven to reduce ASCVD risk
    • Moderate to high intensity statin
  • Four Statin-Benefit groups
  • Risk decisions in primary prevention
    • Optimal lifestyle
    • Clinic patietn discussion-shared decision making
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19
Q

What is the first statin benefit group?

A

Clinical ASCVD

  • MI, Angina, Revascularization
  • Stroke
  • Peripheral Vascular Disease
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20
Q

2nd Statin benefit group?

A

LDL-C >= 190 and >= 21 years

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21
Q

3rd statin benefit group?

A

DM: Age 40-75 years, LDL-C 70-189 mg/dL

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22
Q

4th statin benefit group

A

Primary Prevention

  • Risk calculator >= 7.5% 10 year
    • No DM
    • Age 40-75
    • LDL-C 70-189 mg/dL
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23
Q

Summary of statin initiation recommendation to Reduce ASCVD risk

Is the patient older than 21 and have ASCVD?

If so is the patient older than 75?

A

if older than 21 and less than 75 initiate high-intensity statin therapy

Patient is greater than 75 or not a canidate for High-intensity initiate moderate intensity

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24
Q

Summary of statin initiation recommendation to Reduce ASCVD risk

Does the patient not have ASCVD?

A

Then if patient has a LDL >=190 initiate high intensity therpay

If it is not that high but the patient has DM with an LDL 70-189 age 40-75 Initiate moderate statin

But if the patient calculated risk is >=7.5% then initiate high intensity therapy

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25
Summary of statin initiation recommendation to Reduce ASCVD risk If the patient does not fit initial criteria move to primary prevention
If patient if patient has LDL 70-189 and not receiving statin therpay Calculate their 10 year risk factor If \>= 7.5% Moderate to High intenesity 5-less than 7.5 Moderate intensity But during this time Clinicial-patient discussion must be made to decide if statin is the best choice for the patient. If no Encourage healthy lifestyle and manage other risk factors IF yes to statin do the same and initiate appropriate statin intensity.
26
High intensity statin therapy include what two drugs and what doses?
Atorvastatin 40 up to 80 mg Rosuvastatin 20 up to 40 mg
27
Moderate intensity statin therapy drugs
Atorvastatin 10 Rosuvastatin 5 Simvastatin Pravastatin lovastatin Fluvastatin
28
Low intensity statin therapy?
Pravastatin 20 mg lower than moderate Lovastatin 20mg loser than Moderate
29
ASCVD risk estimator \>= 7.5%?
Moderate high intensity statin
30
Patients not in the benefit group what helps make clinical decisions?
* Familial Hx * Elevated lifetime risk * LDL \>= 160 * CRP \>= 2.0 * CAC score \>= 300
31
If patient is tolerant to therapy statin therapy when should you follow up?
4-12 wks
32
To Lower LDL a patient should start eating? Shouldnt eat?
Veggies, Fruits, whole grains, low fat dairy, poultry, fish, olive oil and nuts Sweets, sugar sweetend beverages and red meats Restrict saturated and trans fats
33
What type of exercise should patients do\>
aerobic activity 3-4 sessions weekly 40 minutes per session
34
Weight reduction and physical activity can have the biggest impact on?
Lowering TGs
35
Smoking cessation lowers your risk for what dramatically?
CHD
36
Estrogens can lower LDL but they also increase?
TG
37
Plant stanols a type of plant cholesterol can reduce?
LDL
38
Bile Acid Resins names
Colesevelam Cholestyramine Colestipol
39
Bile acid resins increase LDL receptor activity as a result these?
Reduce LDL but have also been known to increase HDL and TG
40
What are some adverse effects of Bile acid resins like, Colesevelam, Choletyramine, Colestipol These can also interact with?
Poor taste, GI dicomfort DI with digoxin, levothyroxine, thiazides, warfarin, BBs,
41
Nicotinic Acid or Niacin does what? Move everything
Moves everything in the right direction
42
Adverse effects of Niacin?
Flushing is the main one and it can also increase uric acid and blood glucose can also cause hepatotoxicity but only with the sustained release forms increases AST and ALT
43
Niacin interacts with what drugs? Disease interactions?
Statins and fibrates DM, gout (uric acid0, PUD
44
With niacin dosing what should you do?
Start low and go slow
45
Fibrates? What do they do?
Gemfibrozil Clofibrate Fenofibrate Fenofibric Acid Lower hepatic TG production and VLDL synthesis
46
Fibrate AE? DI?
Gallstones, pancreatitis Increase LFT, myalgias GI distress These increase myopathy with statins (gemfibrozil) Increase prothrombin time in warfarin patients
47
Cholesterol absorption inhibitor?
Ezetimibe
48
Ezitimibe can be used?
As a therapy of its own or added to a statin
49
What is the action of Ezetimibe?
Selectively blocks intestinal absorption of dietary and biliary cholesterol NPC1-Like 1
50
Ezetimibe reduces was type of cholesterol?
LDL and TG also increases HDL
51
Ezetimibe has a DI with? AE
Cholestertyramine More GI complaints compared to placebo
52
Statins inhibit?
HMG CoA reductase Increase LDL receptor activity this decreases LDL and TG and increases HDL
53
AE of Statins?
* Myopathy * Rhabdomyolysis * increases AST and ALT * Glucose impairment * GI abdominal pain, cramping, farts * Sleep disturbances
54
Statin DIs
* These DIs increase myopathy * Itraconazole, ketoconazole, fluconazole * Amiodarone * Verapamil, Diltiazem * Erythromycin, clarithromycin * Grapefruit juice * Cyclosporine * Gemfibrozil * Kind of niacin and Fenofibrate * Warfarin elevated prothrombin time
55
Patients can be predisposed to Adverse effects what are some ways?
* Multiple or serious comorbidities, impaired renal or hepatic function * Hx of previous statin intolerance or muscle disorders * Unexplained ALT elevations \>= time ULN * Use of drugs affecting statin metabolism * Age \>75 * Asian ancestry
56
It is important to check ____ function at baseline
Hepatic function at baseline
57
Decreasing the statin dose is reasonable if LDL levels fall below ___ two times
\<40
58
It may be harmful to initiate ____ at 80 mg or increase to ___ mg
Simvostatin to 80
59
Fish oil dosing?
Cardioprotective 1000-2000 mg EPA/DHA Dylipidemia 2000-5000 mg
60
Fish oil is MOA?
Antiplatelet Antiinflammatory TG lowering Antiarrhythmic AntiHTN
61
Precription fish oil products?
Lovaza Vascepa Epanova
62
Increase the dose of ____ gradually has been known to decrease?
Fish oil has been known to decrease SE
63
PCSK9 Inhibitors can drastically decrease?
LDL levels and can also decrease TG some
64
Mipomersen does what?
Decreases secretion of apo B containing lipoproteins from the liver adjunct therapy with lipid lowering meds
65
Lomitapide?
MTP inhibitor that decreases lipoprotein production
66
Management of reduced HDL levels \<40
* First deal with LDL * Intensify non-pharm * Exercise * Diet/weight * SMoking * Acheive non-HDL goal * RCT data doesnt support treatment * Niacin and fibrates can increase HDL
67
You should treat LDL first unless TGs are \>= \_\_\_?
500
68
High TGs are associated with? Treatment?
Artherosclerosis * Fat restrictions * focus on good carbs * etoh restriction * weight reduction * DM control * Fibrates, niacin, fish oil, statins
69
Indications for LDL Apheresis?
1. Hypercholesterolemic homozygotes with LDL \> 500 2. Heterozygotes with LDL \> 300 3. Heterozygotes with LDL \> 200 with documented CHD
70
The Improve-it study concluded that?
Addition of Ezitimibe with Simvostatin did in fact reduce LDL better than monotherapy of just statin
71

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