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CCFP 3 > Hyperlipidemia * + HTN *** > Flashcards

Hyperlipidemia * + HTN *** Flashcards

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
Q

CVA sx + rx

A

Sx: unilateral weakness, aphasic, impaired gait
Rx: use labetalol to lower BP if needed

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26
Q

CI + SE to ACEi/ARB

A

Avoid in black pts
CI: bilateral renal artery stenosis, angioedema, pregnancy
Monitor for renal impairment
SE: cough, angioedema, AKI

27
Q

CI + SE to BB

A

CI: asthma, 2nd + 3rd degree heart block, uncompensated HF, severe PAD
SE: ED, bradycardia, bronchospasm, insomnia

28
Q

CI + SE to CCB

A

CI: sick sinus syndrome, 2nd + 3rd degree heart block
SE: edema, flushing

29
Q

CI + SE to Thiazide

A

CI: gout
SE: hypokalemia, renal failure

30
Q

In a pt with abdo bruits, what cause of secondary HTN would you be concerned for + what investigation would you order?

A

fibromuscular dysplasia - CTA

31
Q

In pts with hypokalemia in absence of diuretics, what cause of secondary HTN would you be concerned for + what investigation would you order?

A

hyperaldosteronism - plasma aldosterone + renin

32
Q

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?

A

pheochromocytoma
MRI abdomen/ adrenal glands, 24hr urine total catecholamine

33
Q

Rx for diastolic HTN

A

Diastolic
1st: thiazide
2nd: BB, ACEi, CCB, ARB

34
Q

Rx for systolic HTN

A

Systolic
1st: Thiazide
2nd: CCB, ARB

35
Q
A

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
Q

Rx for HTN + angina

A

Angina
1st: BB
2nd: CCB

37
Q

Rx for HTN + MI

A

MI
1st: BB + ACEi
2nd: ARB or CCB

38
Q

Rx for HTN + HFrEF

A

HFrEF
1st: ACEi + BB
2nd: Spironolactone

39
Q

Rx for HTN + CVD

A

CVD
ACEi + thiazide

40
Q

Rx for HTN + CKD

A

CKD
1st: ACEi
2nd: ARB

41
Q

Rx for HTN + DM

A

DM
1st: ACEi/ ARB
2nd: add CCB

42
Q

Which risk calculators for hyperlipidemia, and when are they not validated for use?

A

Framingham + CLEM - not for use in South asian, first nation or new immigrants or renal dz

43
Q

FRS components

A

sex, age, total cholesterol, HDL cholesterol, smoker, systolic BP, on BP treatment

44
Q

What is the CHD risk equivalent?

A

10 yr risk for MI is >20% in people with: CAD, PAD, AAA, DM, CKD, CHD

45
Q

When to screen for lipids

A

> 40, earlier if South Asian, First nations, CVD, smoker

46
Q

What to screen for in hypertension in pregnancy?

A

Screen for hyperlipidemia

47
Q

When to do LpA?

A

Once in a lifetime

48
Q

What are alternatives to statins?

A

Ezetimibe + PCSK9 inhibitors + inclisiran (subq RNA)

49
Q

Indications for PCSK9 inhibitors

A

familial hypertryglyceridemia

50
Q

When to order fasting lipids

A

if TG >4.5

51
Q

When to order coronary artery calcium

A

asymptomatic >40 y/o, intermediate risk (FRS 10-20), fam hx of premature cardiac event (<55)

52
Q

1st line for hypertryglyceridemia

A

omega 3 fatty acids

53
Q

How to assess lipids in pt w/ high TG?

A

ApoB

54
Q

What to use if pt has a large arm and needs BP check

A

use wrist device

55
Q

What meds to avoid in HTN

A

alpha blocker alone, BB if >60 y/o, ACE if black or pregnant

56
Q

HCTZ warning

A

some studies increasing risk of skin cancer, dose dependent

57
Q

Dx of hypertensive emergency

A

asymptomatic DBP >130, acute end organ damage, pre-eclampsia

58
Q

Rx for hypertensive emergency

A

nifedipine, labetalol, captopril, hydralazine, nitrates, clonidine

59
Q

Rx for HTN in breastfeeding pt

A

labetalol, methyldopa, nifedipine

60
Q

How + when to measure BP in kids, what workup if BP high

A

age >3, RIGHT arm, workup w/ echo

61
Q

Long term treatments for gout

A

probenicid, febuxostat

62
Q

Antihypertensives for black pts

A

thiazides or CCB

63
Q

What med to avoid in pts >60 y/o w/ HTN?

A

BB

CCFP 3 (67 decks)

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