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CCFP Version 1 > Hyperlipidemia * + HTN *** > Flashcards

Hyperlipidemia * + HTN *** Flashcards

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1
Q

Framingham risk factors

A

Sex
Age
Total Cholesterol
HDL
Systolic Blood Pressure
Smoking Status
Diabetes
Blood Pressure Medication Use

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2
Q

What LDL and total cholesterol do you aim for?

A

LDL <2.0 or >50% Reduction in LDL
Total Cholesterol <4

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3
Q

Meds that lower lipids + examples of each

A

Statins (simvastatin)
Bile Acid Sequestrants (cholestyramine - only lipid lowering drug safe in pregnancy)
Nicotinic Acid (Niacin)
Fibrates (clofibrate - used for lowering TG)
Cholesterol Absorption Inhibitors (ezetimibe)
PCSK9 Inhibitors (alirocumab, evolocumab)

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4
Q

RF

A

Increasing age
Male
Smoking
DM
Erectile dysfunction
Family history
Obesity

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5
Q

Secondary causes of raised LDL

A

Meds: diuretics, steroids, amiodarone, retinoids
Biliary obstruction
Nephrotic syndrome
Hypothyroidism
Anorexia
pregnancy

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6
Q

Secondary causes of raised TG

A

Meds: estrogen, steroids, BB, thiazides, tamoxifen, APs, retinoids,
Nephrotic syndrome
Hypothyroidism
Obesity
Pregnancy
Alcohol

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7
Q

Screening for hyperlipidemia

A

40-75 y/o = non fasting lipids q5yr, earlier if RF present
a1c, eGFR, Lp(a), fasting lipids if TG >4.5
Risk satisfy w/ FRS

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8
Q

Lifestyle recommendations to lower cholesterol

A

Alcohol use
Physical activity
Wt loss
Smoking cessation
Sufficient sleep
Diet (Mediterranean, Portfolio, DASH)

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9
Q

Target lipid levels + management for low, med + high risk

A

Low risk (FRS <10%) - lifestyle changes
Moderate risk (FRS 10-19%) - mod intensity statin, expect LDL <30%. Add ezetimibe if LDL >2
High risk (FRS >20%) - high intensity statin, expect LDL <50%, ezetimibe if LDL >2

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10
Q

How to manage LDL >5, pts with DM or CKD + pts w/ ASCVD

A

LDL >5 or FH = high intensity statin, expect LDL <50%, add ezetimibe if not in target
DM or CKD = mod intensity statin, expect LDL <2, add ezetimibe if LDL >2
ASCVD (MI, ACS, angina, CAD, CVA, TIA, PAD, claudication) = high intensity statin, expect LDL <1.8, add ezetimibe if LDL >1.8, add PCSK9 if LDL >2.2

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11
Q

Screening for HTN

A

ABPM > HBPM > AOBP > OBPM
Annual AOBP >40 y/o or w/ RF
q5yrs for adults 18-39 y/o

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12
Q

BP technique for office + home

A

Technique:
Bladder cuff width 40% arm circumference + length >80%
Non dominant arm
Quiet, rest 5 mins, empty bladder, arm at heart height, back supported, feet flat
Home: 7 days, before meds, 2 readings before breakfast + 2 readings after dinner, average days 2-7

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13
Q

Types of HTN

A

White coat HTN: increased BP in office but normal at home
Uncontrolled HTN: increased BP in office + home
Masked HTN: normal BP in office, high at home
Induced: NSAIDs, steroids, OCP, SSRIs, decongestants, cocaine, alcohol, caffiene
Secondary: renovascular, primary hyperaldosteronism, hyperthyroidism, Cushings, pheochromoctyoma, OSA, coarctation of aorta

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14
Q

RF for HTN

A

> 55
Male
Fam hx
LVH
PAD
CVA/ TIA
DM
Obesity
Smoking
Stress

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15
Q

Ix for HTN

A

Urinalysis, lytes, Cr, a1c, lipids
ECG
Urinary albumin if diabetic

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16
Q

Complications of HTN

A

Cardio: LVH, CHF, CAD, MI
Cerebrovascular: TIA, ischemic/ hemorrhagic CVA, SAH, dementia
Retinopathy
Renal: CKD
PAD
Emergency: HTN encephalopathy, aortic dissection, LVF, ACS, AKI, ICH, CVS

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17
Q

In a young pt needing multiple meds, what cause of secondary HTN would you be concerned for + what investigation would you order?

A

renovascular - renal scan, CTA

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18
Q

Monitoring for HTN - when pursuing lifestyle measures only vs on meds

A

Lifestyle only - q6 months
On pharmacotherapy - q1 month until readings on target then q6 months

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19
Q

Rx for HTN when systolic <160

A

Lifestyle changes:
Exercise 30 mins moderate 5/7
Wt loss
Reduce alcohol
DASH diet (fruits, veg, whole grain)
Reduce salt
Stress reduction
Stop smoking, maintain healthy weight

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20
Q

What are the target BPs?

A

Target BPs:
<140/90 or <130/80 if DM or <120 if CKD or CVD

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21
Q

Hypertensive emergencies

A

Decompensation of organ function d/t BP
High BP + MI, encephalopathy, LV failure, aortic dissection

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22
Q

Encephalopathy sx + rx

A

Sx: papilledema, HA, visual changes, N/V, neuro deficit, sz, coma
Rx: IV labetalol infusion

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23
Q

Pulmonary edema sx + rx

A

Sx: SOB, pink sputum, CP
Rx: nitro infusion, IV enalapril, SL captopril

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24
Q

Aortic dissection sx + rx

A

Sx: sharp, tearing CP + back pain
Rx: nitroprusside or esmolol infusion, labetalol infusion

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25
CVA sx + rx
Sx: unilateral weakness, aphasic, impaired gait Rx: use labetalol to lower BP if needed
26
CI + SE to ACEi/ARB
Avoid in black pts CI: bilateral renal artery stenosis, angioedema, pregnancy Monitor for renal impairment SE: cough, angioedema, AKI
27
CI + SE to BB
CI: asthma, 2nd + 3rd degree heart block, uncompensated HF, severe PAD SE: ED, bradycardia, bronchospasm, insomnia
28
CI + SE to CCB
CI: sick sinus syndrome, 2nd + 3rd degree heart block SE: edema, flushing
29
CI + SE to Thiazide
CI: gout SE: hypokalemia, renal failure
30
In a pt with abdo bruits, what cause of secondary HTN would you be concerned for + what investigation would you order?
fibromuscular dysplasia - CTA
31
In pts with hypokalemia in absence of diuretics, what cause of secondary HTN would you be concerned for + what investigation would you order?
hyperaldosteronism - plasma aldosterone + renin
32
In pts w/ severe BP refractory to meds + palpitations, flushing + HAs, what cause of secondary HTN would you be concerned for + what investigation would you order?
pheochromocytoma MRI abdomen/ adrenal glands, 24hr urine total catecholamine
33
Rx for diastolic HTN
Diastolic 1st: thiazide 2nd: BB, ACEi, CCB, ARB
34
Rx for systolic HTN
Systolic 1st: Thiazide 2nd: CCB, ARB
35
CAD 1st: ACEi/ ARB 2nd: add CCB Angina 1st: BB 2nd: CCB MI 1st: BB + ACEi 2nd: ARB or CCB HFrEF 1st: ACEi + BB 2nd: Spironolactone CVD ACEi + thiazide CKD 1st: ACEi 2nd: ARB DM 1st: ACEi/ ARB 2nd: add CCB
36
Rx for HTN + angina
Angina 1st: BB 2nd: CCB
37
Rx for HTN + MI
MI 1st: BB + ACEi 2nd: ARB or CCB
38
Rx for HTN + HFrEF
HFrEF 1st: ACEi + BB 2nd: Spironolactone
39
Rx for HTN + CVD
CVD ACEi + thiazide
40
Rx for HTN + CKD
CKD 1st: ACEi 2nd: ARB
41
Rx for HTN + DM
DM 1st: ACEi/ ARB 2nd: add CCB
42
Which risk calculators for hyperlipidemia, and when are they not validated for use?
Framingham + CLEM - not for use in South asian, first nation or new immigrants or renal dz
43
FRS components
sex, age, total cholesterol, HDL cholesterol, smoker, systolic BP, on BP treatment
44
What is the CHD risk equivalent?
10 yr risk for MI is >20% in people with: CAD, PAD, AAA, DM, CKD, CHD
45
When to screen for lipids
>40, earlier if South Asian, First nations, CVD, smoker
46
What to screen for in hypertension in pregnancy?
Screen for hyperlipidemia
47
When to do LpA?
Once in a lifetime
48
What are alternatives to statins?
Ezetimibe + PCSK9 inhibitors + inclisiran (subq RNA)
49
Indications for PCSK9 inhibitors
familial hypertryglyceridemia
50
When to order fasting lipids
if TG >4.5
51
When to order coronary artery calcium
asymptomatic >40 y/o, intermediate risk (FRS 10-20), fam hx of premature cardiac event (<55)
52
1st line for hypertryglyceridemia
omega 3 fatty acids
53
How to assess lipids in pt w/ high TG?
ApoB
54
What to use if pt has a large arm and needs BP check
use wrist device
55
What meds to avoid in HTN
alpha blocker alone, BB if >60 y/o, ACE if black or pregnant
56
HCTZ warning
some studies increasing risk of skin cancer, dose dependent
57
Dx of hypertensive emergency
asymptomatic DBP >130, acute end organ damage, pre-eclampsia
58
Rx for hypertensive emergency
nifedipine, labetalol, captopril, hydralazine, nitrates, clonidine
59
Rx for HTN in breastfeeding pt
labetalol, methyldopa, nifedipine
60
How + when to measure BP in kids, what workup if BP high
age >3, RIGHT arm, workup w/ echo
61
Long term treatments for gout
probenicid, febuxostat
62
Antihypertensives for black pts
thiazides or CCB
63
What med to avoid in pts >60 y/o w/ HTN?
BB

CCFP Version 1 (67 decks)

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