Flashcards in Dyslipidemia and Stroke Deck (28):
1
In general, when should anti lipids be started?
7.5% risk or greater of CV event
2
What meds can cause dyslipidemia
Steroids, thiazide diuretics, estrogen, anabolic steroids, cigarette smoking, alcohol
3
What diseases can cause dyslipidemia?
DM, hypothyroidism, nephrotic syndrome, ESRD, Cushing's syndrome
4
Exam findings for dyslipidemia
Corneal arcus, xanthelasmas around eyes and tendons. Also check bruit
5
Labs for dyslipidemia?
Renal, LFTs, CK, TSH,
6
When to start high intensity treatment for dyslipidemia?
1. Patients with atherosclerotic CV disease
2. patients with LDL > 190
7
When to start low intensity treatment for dyslipidemia?
1. DM with LDL 70-189
2. No CVD or DM, but 10 year risk of 7.5% or greater
8
Statins: intensities, side effects, and caution and other medication
-Atorvastatin 40-80, low 10-20
-Rouvastatin (half of Atorvastatin dose)
-Decreases LDL, Trigly, increases HDL
-Myositis and LFTs
-Don't use with gemfibrozil
9
Bile Acid Sequesterants- names, affect on lipids, and contraindications
-(chols)-Cholesytyramine, colesevelam
-Decrease LDL, incr HDL, Marginal effect on triglycerides
-Don't use if trig >300
-Don't give with other medications
10
Cholesterol absorption Inhibitor: name, action/result, drugs to monitor, and adverse effects
-Ezetimibe
-Decreaes LDL
-Monitor warfarin
-May increases LFTs x3
11
Omega 3 Fatty Acids
Decrease triglycerides
12
What might Niacin do, and contraindications?
-Hyperglycemia (Ok for A1C <7), hyperuricemia
-flushing- give ASA
-Contraindicated in PUD, GI disease, liver disease
13
Risk factors for Stroke?
Stress, no physical activity, high homocysteine, carotid artery stenosis, TIA, anterior MI, long term oral anticoagulants, aortic wall plaques
14
Assessment for Stroke?
Pregnancy, carotid bruit, heart sounds, valvular disorder
15
Differential diagnosis of stroke?
SAH, brain absess, pseudo tumor cerebri, carotid artery dissection, encephalitis, TIA, encephalitis, syncope, intoxication, conversion disorder, migraine, bell's palsy
16
When do you treat carotid stenosis?
If there is > 50% blockage
17
What meds should patients be on after ischemic stroke?
Aspirin and plavix, smoking cessation
18
What additional labs can help with decisions on when to start lipid therapy?
CRP >2
CT Calcium Score > 300
Homocysteine level
19
Who do you refer familial hypercholesterolemia to?
Endocrinologist
20
What medication is a good alternative for patients who can't handle high dose statins?
Pravastatin, it's water soluble
21
What lab to not forget when starting someone on a statin?
Initial CK
22
How much does high and low intensity drop statins?
High = >50%
Low= 30%
23
Side effects of statins? (x3)
Memory loss, increase risk of DM, myopathy and hepatic injury.
24
Metabolic syndrome, need 3 out of the 5
1.Abdominal Obesity (men 40, women 35), 2.Tryglicerides >150
3. Low HDL
3. Hypertension- 135/85;
4.Fasting glucose >110
25
When do you start screening for hyperlipidemia?
20 years old
26
When do you treat hypertriglyceridemia? And why?
When they are over 500, to prevent pancreatitis
27
What else can you use bile acid sequesterants for besides hyperlipidemia?
Parities from cholestatic disease or biliary obstruction
28