Dyslipidemia-Jacobsen Flashcards Preview

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Flashcards in Dyslipidemia-Jacobsen Deck (27):
1

CKD

GFR

2

Chronic kidney disease is an independent risk factor for CV disease

more advanced CKD=higher CVD risk

3

Dyslipidemia and CKD

Dyslipidemia is common in CKD, but isn't universal

4

What are the major determinants of whether or not a CKD patient will have dyslipidemia?

GFR
Diabetes
Severity of proteinuria-->more protein in urine-->more dyslipidemia
Use of immunosuppressants
Comorbidities
Nutritional status

5

What is nephrotic syndrome?

gross amounts of protein in urine

6

LDL is widely used as a predictor for future risk, but in CKD patients LDL is ____ for assessing CV risk

LDL is not suitable for assessing CV risk in CDK patients

7

Why isn't CKD included in the ASCVD 10-year risk calculator?

CKD was considered CV risk equivalent. this means the risk of having a MI is so high in these patients, it's equivalent to already having had an MI

8

KDIGO guidelines:

in >50 year old patients with GFR do statin/ezetimibe combo
1A rec.

9

Look at KDIGO guidelines

----

10

statin therapy in patients with CKD has similar effects to patients without CKD

YES

11

non-statin therapy not covered in KDIGO 2013

true

12

SHARP trial

simvastatin/ezetimibe vs. placebo
Non-dialysis patients-->22% RRR
Dialysis patients: no difference between treatment group vs. placebo

13

Statin Dosing in CKD if GFR>60ml/min:

basically any dose

14

Statin dosing if in CKD if GFR

adjustments are made

15

What drug should you avoid in patients with CKD?

fenofibrate

16

When should renal status be evaluated in patients starting fenofibrate?

before initiation, within 3 months of initiation and every 6 months thereafter

17

SAGE trial

high intensity statin vs. lower intensity
no difference between the two

18

Elderly Treatment Options:

statins-preferred because most evidence
BAS-problems with intolerance and DDI
Fibrates-dose adustment in CKD and may increase risk of gallstones in elderly
Zetia-considered safe and equally as effective as in younger patients

19

What are the characteristics predisposing patients to statin adverse effects:

>75 years old
multiple serious comorbidities
history of statin intolerance or muscle disorders
unexplained ALT elevations >3x upper limit of normal

20

What's the criteria for metabolic syndrome?

waist circumference >40 for men and greater than 35 for women
elevated TGs (>150 )
reduced HDL (130/85)
elevated fasting glucose (>100)

21

Preferred treatment of dyslipidemia in metabolic syndrome patients?

statins
adding fibrates and niacin hasn't shown to improve outcomes
statins still first line unless TG >500mg/dL

22

Which medication is recommended to add to a statin is dyslipidemia in diabetic patients?

Zetia
zetia + moderate intensity statin therapy provides additional CV benefit over moderate intensity statin therapy alone.
consider for patients with ACS and LDL>50 who can't tolerate high intensity statin

23

Generally, statin/fibrate combo isn't recommended because it doesn't improve ASCVD outcomes. When might you consider this therapy though?

for men with both high TG's and high HDL

24

DONT do combo statin/niacin

may increase chance of stroke

25

Is statin therapy contraindicated in pregnancy?

YES

26

What are high-level risk factors for a child to develop dyslipidemia?

hypertension with medications
current smoker
BMI >97th percentile
high risk conditions

27

What are moderate-level risk factors for a child to develop dyslipidemia?

hypertension without medications
BMI between 95th and 97th percentile
HDL