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Exam 4 > Lipids/CKD > Flashcards

Lipids/CKD Flashcards

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1
Q

CKD is defined as ____ or more months of either kidney damage or eGFR < _____.

A

3, 60

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2
Q

Dominant risk factors for CKD

A

DM and HTN

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3
Q

Four interventions to reduce CKD progression

A

blood pressure control goal <130/80
use of ACE/ARB (not together) for albuminuria
DM control HgBA1C target <7%
correction of metabolic acidosis

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4
Q

eGFR Stages of CKD

A 
Stage 1- 90-100 normal
Stage 2- 60-89% mild
Stage 3- 30-59% moderate
Stage 4- 15-29% severe
Stage 5- 14% and less- failure
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5
Q

Which stage of CKD? eGFR 90-100%, asymptomatic, with health issues such as DM, HTN, and obesity

A

Stage 1

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6
Q

Modifiable risk factors for CKD

A

DM
HTN
frequent NSAID use
hx of AKI

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7
Q

Non-modifiable risk factors for CKD

A

family hx of CKD
age 60 or older
ethnicity- AA, Hispanic, Asian/PI, or American Indian

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8
Q

What lab tests are used to diagnose CKD?

A

eGFR

ACR- albumin to creatinine ratio, urine (kidney damage marker)

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9
Q

Normal UACR level

A

<30

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10
Q

Severe albuminuria UACR level

A

> 300

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11
Q

Urine dipstick proteinuria if level is > ____.

A

30

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12
Q

Especially avoid these medications in CKD

A 
NSAIDs
Bisphosphonates 
IV contrast
Metformin
RAAS blockers
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13
Q

Starting at stage 3 CKD these additional labs are needed

A

Serum albumin
phosphorus
calcium
intact parathyroid hormone (PTH)

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14
Q

At what stage should nephrology be consulted in patients with CKD

A

Stage 3 or eGFR <30

or persistent albuminuria UACR >300

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15
Q

Clinicians should not only check patients blood creatinine levels but also check their ______.

A

Urine- low pH, high specific gravity, protein, RBC/WBCs are early indicators of potential issues.

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16
Q

In order for erythropoiesis-stimulating agents (ESA) to be effective, this medication is needed

A

Iron supplementation

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17
Q

Sodium should be limited to ___g/day and phosphorus ___-____mg/day in patients with CKD

A

2

800-1000

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18
Q

Animal protein consumption should be reduced to

___-___g/kg/day in CKD patients

A

0.6-0.8

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19
Q

What stage of CKD do complications usually begin>

A

Stage 3 (anemia, bone/mineral issues, CV dz, low serum albumin)

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20
Q

Common meds that require dose reduction

A 
Allopurinol
Gabapentin
Reglan
Narcotics- methadone/fentanyl
Beta-blockers
Digoxin
Statins- lova, prava, simva, fluva, rosuva
Antimicrobials- sulfa, Macrobid, aminoglycosides
Lovenox
methotrexate
colchicine
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21
Q

Treatment of hyperkalemia in CKD

A

Stop NSAIDs and Cox-2 inhibitors
Stop K+ sparing diuretics (spironolactone)
Avoid salt substitutes

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22
Q

CKD increases the risk for ____ disease.

A

CV

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23
Q

Increased waist circumference, increased trigs, decreased HDL, increased BP, and increased fasting glucose are indicators of:

A

metabolic syndrome

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24
Q

How do ACE/ARBs help with CKD?

A

lowers BP and reduces hyperfiltration injury inpatients with limited nephrons

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25
What is the primary intervention for metabolic syndrome?
lifestyle therapy
26
Statin intensity for clinical ASCVD
high intensity if <75y | mod-high if >75y
27
Statin intensity for age 40-75 with DM and LDL 70-189
moderate intensity, consider increase if multiple ASCVD risk factors
28
Severe primary hypercholesterolemia LDL >190 initiate ____ intensity statin without calculating ASCVD risk
high
29
Statin intensity for age 20-75 with LDL >190
high
30
ASCVD risk enhancers
``` family hx of premature ASCVD persistently elevated LDL >160 or trigs >175 CKD metabolic syndrome preeclampsia, premature menopause Inflammatory disorders: RA, psoriasis, HIV ethnicity (South Asian ancestry) ABI <0.9 ```
31
Signs/Symptoms of Stage 2 CKD
eGFR 60-89% | protein leaking in urine <200mcg
32
Signs/Symptoms of Stage 3 CKD
``` eGFR 30-59% Edema Fatigue Back pain Foamy, darker urine Microalbumin >200mcg Food restrictions: Na+ and phosphorus ```
33
Signs/Symptoms of Stage 4 CKD
``` eGFR 15-29% Stage 3 symptoms plus: n/v difficulty concentrating tingling in fingers/toes loss of appetite sleep problems dialysis need renal dietician required less dietary potassium intake ```
34
Signs/Symptoms of Stage 5 CKD
``` eGFR 0-14% Stage 4 symptoms plus: fatigue/weakness easy bruising/bleeding anemia thirst/cramps skin color changes making little to no urine dialysis or transplant ```
35
A daily dose of high-intensity statin can lower LDL by ____%
50
36
A daily dose of moderate-intensity statin can lower LDL by ____%
30-49%
37
A daily dose of low-intensity statin can lower LDL by ____%
<30%
38
High-intensity statins have a longer _____-_____ and can be given any time of day. These medications are good for patients who have adherence problems.
half-life
39
High-intensity statin list
Atorvastatin 40-80mg | Rosuvastatin 20-40mg
40
Moderate-intensity statin list
``` Atorvastatin 10-20mg Rosuvastatin 5-10mg Simvastatin 20-40mg Pravastatin 40-80mg Lovastatin 40mg Fluvastatin XL 80mg Fluvastatin 40mg BID Pitavastatin 2-4mg ```
41
Low-intensity statin list
Simvastatin 10mg Pravastatin 20mg Lovastatin 20mg Fluvastatin 20-40mg
42
If CAC score is > ____ or >_____ percentile, statin therapy is indicated unless patient refuses.
100, 75th
43
After beginning the treatment plan, lipids should be repeated in ___ to ____ weeks and repeat every ___ to ___ months if needed to check for statin intolerance.
4-12 weeks | 3-12 months
44
If ASCVD risk <5% (low risk) the clinician should:
discuss risk and emphasize healthy lifestyle habits to reduce risk factors
45
If ASCVD risk 5% to <7.5% (borderline risk) the clinician should:
If the patient has risk enhancing factors, consider mod-intensity statin. If the decision about statin remains uncertain it is reasonable to use a CAC score to withhold, postpone or initiate therapy.
46
If ASCVD >7.5% to <20% (intermediate risk) the clinician should:
Consider mod-high intensity statin or a nonstatin for those who cannot tolerate statins. Consider requesting a CAC score.
47
If ASCVD >20% (high risk) the clinician should:
High risk with multiple high-risk clinical factors, initiate statin therapy to reduce LDL by 50%
48
If LDL remains >70 despite max tolerated statin therapy, the clinician should consider adding:
Zetia (add to moderate-intensity statin)
49
Major ASCVD events
ACS in past 12months hx of MI or ischemic stroke symptomatic PAD ( hx of claudication with ABI <0.85 or previous revascularization or amputation)
50
Bile sequestrants may increase ________.
triglycerides
51
Patients with impaired renal function should be prescribed which statins?
Atorvastatin or fluvastatin. Caution use of Rosuvastatin in these patients.
52
Patients with heart failure related to ischemic disease should be started on what intensity statin?
moderate
53
Adults with severe hypertriglyceridemia (>1000) should begin statin therapy. If the level remains high, the clinician should also prescribe _______.
fibrate therapy (fenofibrate) to prevent acute pancreatitis. Dietary modifications are also needed: a very low-fat diet, no refined carbs or ETOH, add omega 3.
54
To have a true statin intolerance, the symptoms must:
occur after initiating therapy, improve with statin DC, and reappear when reintroducing statin.
55
True or False: Statins can be given during pregnancy
False. Statins are listed as category X
56
LDL target for patients with very high risk CV disease is
50
57
ALL patients should limit this in their dietary intake:
sat/trans fat, sweets, sugar-sweetened beverages, red meats
58
Universal pediatric lipid screening is recommended at what ages?
ALL 9-11-year-olds 12-17-year-olds with new family hx, a parent with HLD, or other risk factors ALL 17-21-year-olds
59
In children and adolescents 10 years or older with an LDL persistently >190 or 160 with family hx, who do not respond adequately with __-__ months of lifestyle therapy it is reasonable to initiate statin.
3-6
60
These statin medications have been approved for use in children beginning at age 8.
Rosuvastatin and Pravastatin
61
Children with LDL 250 or greater and or trigs >500 should be referred to a _____ _________.
Lipid specialist
62
Xanthomas are indicative of ________ _________.
Familial hyperlipidemia
63
These non-statin medications may be added with statins to help further reduce LDL.
Ezetimibe Bile sequestrants (Questran, Colestipol) PCSK9 inhibitors Niacin and Fibrates
64
Statin associated side effects
``` BILATERAL myalgias (most common) hepatotoxicity GI upset cataracts Rhabdomyolysis Increased risk of DM ```
65
Hydrophilic statins are _____ soluble and may be tolerated better due to less distribution into the body's tissues.
water
66
Lipophilic statins are _____ soluble and tend to cause more muscle-related adverse effects since they are distributed into the body's fat.
fat
67
Patients with complaints of myalgias would benefit from _______ statins.
Hydrophilic
68
List hydrophilic statins
Rosuvastatin Pravastatin Fluvastatin Pitavastatin (slightly hydrophilic)
69
List lipophilic statins
Atorvastatin Lovastatin Simvastatin
70
Patients on statin therapy should avoid this fruit.
Grapefruit
71
Drug-drug interactions with statins (Simvastatin, Lovastatin, Atorvastatin) metabolized through CYP3A4
``` Amiodarone Amlodipine Azole antifungals Diltiazem Verapamil ```

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