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Advanced pharmacology > Dyslipidemia /HTN > Flashcards

Dyslipidemia /HTN Flashcards

(63 cards)

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1
Q

Dyslipidemia

A

Elevation of plasma chol , triglyceride or both or a low high density lipoprotein that contributes to the development of atherosclerosis

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2
Q

LDL

A

Bad cholesterol … want this to be low < 100 ( less than 70 w/ heart disease or DM)

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3
Q

HDL

A

Good cholesterol … want this to high

40-60

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4
Q

Goal total cholesterol

A

< 200 mg/dL

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5
Q

Goal triglycerides

A

< 150 mg/dL

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6
Q

Non-pharm treatment for Dys

A

Always first step prior to medication

Heart - healthy diet ( avacado, almonds and blueberry) , regular exercise, avoid tobacco or smoking , weight loss

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7
Q

Treatment for children and aldolesence

A

Initial : lifestyle changes

Statins 1 st line agent in 10 years and older

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8
Q

Treatment for preg/ lactation

A

Statin therapy CONtRAindicated

Zétia ( C)

Discouraged in lactation

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9
Q

Tx in older pt

A

Age not a factor, depends on how long you expect them to live

Limited lifespan = do NOT initiate therapy

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10
Q

Primary prevention

A

Reduces the risk of MI and HF decreases the need for coronary procedures and improves quality of life

( before an event)

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11
Q

Secondary prevention

A

Clinical atherosclerotic cardiac disease already present or prevention of a second attack

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12
Q

Corner stone therapy

A

Lifestyle modification through weight loss , aerobic exercise and eating diets low in saturated fats

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13
Q

CVD risk Schemes ( big difference between prior to 2013 and after 2013)

A

Fasting lipids assess adherence / therapeutic response ( non-statin therapy discouraged due to lack of evidence)

You want a percentage decreased not exacting aiming at a number

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14
Q

Treatment for secondary prevention pt with ASCVD

A

< 75 yrs old = high intensity statin

> 75 yrs old = moderate in intensity statin

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15
Q

Tx for primary prevention pt with LDL > 190

A

High intensity statin

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16
Q

Primary prevention pt wit dm ( age 40-75) LDL 70-189

A

Moderate intensity statin unless ASCVD risk > 7.5 %

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17
Q

Tx with primary prevention pt when you assess there ASCVD score

A

> 7.5 high intensity statin

> 5 <7.5 moderate intensity stain

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18
Q

Statins ( decrease LDL)

A

Crestor, Lipitor, zocor,

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19
Q

Fibrates

A

Decrease TG and increase HDL

Ticor

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20
Q

Bile acid sequestrants

A

Decrease LDL

Questran

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21
Q

Nicotinic Acid Derivates

A

Decreases TG

Niacin

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22
Q

Omega 3 fatty acids

A

Decrease TG , last line

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23
Q

Selective cholesterol absorption inhibitors

A

Decrease LDL, TG and increase HDL

Zetia

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24
Q

PCSK9 inhibitors

A

Decrease LDL ( last line due to injection)

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25
Statins ( background)
Competitive inhibitors of HMG CoA reductase - the limiting step in cholesterol biosynthesis - thus removing LDL from the blood Cholesterol synthesis occurs at nigh so take shorter half live statins at night ( take longer acting during day) Adverse: muscle aches, myopathy, rhabdo, bloating Monitor: CK, LFTS,
26
High intensity statin
Decrease LDL by > 50 % Lipitor 40-80mg Crestor 20-40
27
Moderate intensity statin
Daily dose lowers LDL by 30-50 % | Lipitor 10-20 mg
28
Low intensity statin
Daily dose lowers LDL by < 30 % | Simvastatin 10 mg
29
Non statin therapy
Addition of non statin chol lowering agent when max intentsity agent who has less than anticipated response Can use Niacin, BAS, omega 3
30
Lowering dose criteria
LDL < 40 on 2 consective checks
31
Statin big adverse effect
Muscle events
32
Myalgia
Similar to influenza aches and pain, involves muscle discomfort, ( CK WNL)
33
Myopathy
Muscle weakness not due to pain ( w/ or w/o CK elevation)
34
Myositis
Muscle inflammation
35
Myonecrosis
Elevation in muscle enzyme compared with baseline
36
Clinical rhabdomyolysis
Myonecrosis w/ myoglobinuria or acute renal failure
37
Management of statin associated myopathy
Stop statin and have CK go back to normal ( fluvastatin and pravastatin - lowest risk of statin myopathy ) Check for drug interaction Start on fluvastatin or pravastatin
38
Hypertension definition
Based upon the average of 2+ readings at each of the two or more office visits after initial screening ( normal 120/80)
39
Stage one HTN
130-139/ 80-89
40
Stage two HTN
140-149/90
41
Isolated systolic / diastolic HTN
> 130/ < 80 | < 130/>80
42
HTN emergency
Diastolic >110
43
HTN risk factors
Age ( systolic BP) | Obesity, fam hx, race ( blacks), high sodium, alcohol consumption, dm and dyslipidemia
44
Blood pressure goals ( general, >60, <60, CKD/DM, >18 w/ dm or CKD)
General : <140/90 > 60 : 150/90 CKD/DM : <130/80 >18 with dm or CKD < 140/90
45
Drug treatment titration strategy
1. Max first med before adding a second or ADD second med before reaching max dose of first med OR start with 2 medication classes or as a fixed dose combination
46
JNC 8 initial drug recommendations
Non blacks : TD, ACEI, ARB, CCB ( alone or combined ) Blacks : TD or CCB CKD pt : ACEI or ARB NO beta blocker treatment
47
Black population HTN treatment
Thiazide Diuretics and CCB’s are shown better efficacy as mono therapy NO longer ACEI or ARBS - increases fluid overload
48
Thiazide Diuretics
HCTZ, Metolazone, Monitoring parameters: K ( decreases) Ca ( increases) NA ( decreases ) increased (Scr), increased glucose Weight and blood pressure Given once daily ( don’t give at night)
49
Ace inhibitors
Lisinopril, captopril ( PRIL) Monitoring : K increases Scr increases - check 1-2 week after initation - cough and angioedema, AKI
50
Angiotensin receptor blockers ( ARBS)
Losartan, Valsartan (ARTAN) Monitoring: increased K and Scr, angioedema (less)
51
CCB
Dihydropyrodines (HTN) - amlodipine (DIPINE) Non-Dihydropyridines ( rate control ) - verapamil / diltiazem ( concern for heart black ) (don’t use in HF) Monitoring: peripheral edema, reflex tachycardia, HA
52
2nd line agents for HTN
``` Potassium sparing diuretics Beta-blockers Alpha 1 blockers Central acting agents Direct vasodilators ```
53
Potassium sparing diuretics
Spironolactone Monitoring : increased K ( caution in dual use with ACEI/ARB arrthymias Gynecomastia in men
54
Beta blocker ( last line)
``` Metoprolol succinate ( QD) Metoprolol tartate (BID) ``` (LOL) Uses : use with combined CHF or CVD, dresses HR > BP effects , caution for bronchospasm (COPD/ASTHMA) Rebound HTN may happen with rapid d/c
55
Alpha 1 blockers
Terazosin ( ZOSIN) Use with cormorbid BPH Adverse: orthostatsis, reflex tachy, dizziness, peripheral edema
56
Centrally acting agents
Clonidine ( available in once a week patch called Catapres) Adverse: rebound hypertension, sedation, dry mouth, impotence
57
Direct Vasodilators
Hydralazine Monitoring : reflex tachy , helps with HF and Minoxidil helps with getting rid of excess fluid
58
Dose adjusting and monitoring
If BP not reached after 4 weeks of initation therapy —> increase dose of drug or add a second ( 1st line agent ) from a different class If BP goal is not achieved with 2 agents —> dada 3rd recommended agent ( avoid ACEI/ARB combos) If goal still not consider : patient adherence and dose optimization Simplify regimens/reduce pill burden to avoid non adherence
59
Resistant HTN
BP above goal with > agents from differing classes at optimal dose Consider white coat hypertension ( most common) Drug causes : (NSAIDS, stimulants, oral contraceptives, Consider spironolactone therapy as add on agent
60
Lifestyle modifications and SBP reduction range
Weight —> 5-20 | DASH eating —> 8-14
61
Treatment for children
Ace #1 or ARBS TD, CCB Beta blockers no recommended
62
Treatment of HTN in preg
ACE and ARBD are CONtRAindicated die to renal abnormalities Labetalol or Methyldopa
63
Treatment for geriatrics in HTN
Therapy requires gently initiation ( risk of falls) | Progress towards goals help preserve cognitive function

Advanced pharmacology (12 decks)

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