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Therapeutics 2 Exam 5 > Pathophysiology and Evaluation of Dyslipidemia > Flashcards

Pathophysiology and Evaluation of Dyslipidemia Flashcards

1
Q

What is the pathogenic pathway of atheroscleorisis?

A

Endothelial injury
Inflammatory response
Macrophage Infiltration
Platelet Adhesion
Smooth Muscle Cell Proliferation
Extracellular Matrix Accumulation

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2
Q

True or Fale: most patients with dyslipidemia experience many symptoms

A

False, most patients with dyslipidemia are asymptomatic until they are very progressed

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3
Q

What are the signs of dyslipidemia?

A

-Pancreatitis
-Eruptive xanthomas (fatty deposits on skin)
-Peripheral polyneuropathy
-Increased BP
-Increased waist size
-Obesity

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4
Q

What is LDL-P vs LDL-C?

A

LDL-P is the number of LDL particles in the body

LDL-C is the amount of cholesterol in LDL particles

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5
Q

What is the lab value Apo-B used to indicate?

A

Number of atherogenic particles

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6
Q

What is the Friedewald equation used to estimate?

A

LDL

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7
Q

What is the goal TC/HDL?

A

< or = 5:1

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8
Q

What is the first-line treatment for dyslipidemia?

A

Non-Pharm Options!!!

(diet, exercise)

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9
Q

When on a DASH diet, what percent of calories should saturated fats be limited to?

A

5-6%

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10
Q

When on a DASH diet, what should sodium intake be limited to?

A

< 1500 mg daily

*Or at least reduce by 1000mg/day for most adults

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11
Q

How much exercise should be recommended to patients as treatment for dyslipidemia?

A

90-150mins a week

*Divide into 3-4 sessions/week for 40 mins/session

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12
Q

How many calories are there in 1 gram of fat?

A

9kcal/1 gram

*no conversion needed between kcal and cal

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13
Q

What are some Therapeutic Lifestyle Changes that can be made to help treat dyslipidemia?

A

-Increase soluble fiber intake
-Increase plant stanol and sterol intake
-Weight reduction
Increase physical activity
-Smoking cessation

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14
Q

If a patient is overweight, how much weight reduction is recommended to help treat dylipidemia?

A

10% weight loss

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15
Q

What are omega-3 fatty acids used for?

A

To lower triglycerides

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16
Q

What is a major side effect of omega-3 fatty acids?

A

Increase LDL by 4-49%

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17
Q

What do the REDUCE-IT, OMEMI, and STRENGTH trials show?

A

People taking omega-3 fatty acids have increased rates of atrial fibrillation

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18
Q

What are the 2 high intensity statins?

A

Atorvastatin

Rosuvastatin

19
Q

What is the high-intensity dose of atorvastatin?

A

40-80mg

20
Q

What is the high-intensity dose of rosuvastatin?

A

20-40mg

21
Q

What are the 2 hydrophilic statins?

A

Rosuvastatin

Pravastatin

22
Q

Which statin should absolutely be taken at night?

A

Simvastatin

(has a short half life of 6 hours, most cholesterol is made at night)

23
Q

What did the SEARCH trial show?

A

Increased risk of ADR (myopathy and rhabdomyalgia) when taking simvastatin 80mg vs other doses

*Do not use simvastatin 80mg in patients unless they have been on it for > or = 12 months

24
Q

What is an important consideration when prescribing 80mg simvastatin?

A

DO NOT PRESCRIBE 80 mg SIMVASTATIN TO NEW PATIENTS

-only keep prescribing in patients who have been on it for a year or more

let this med die out

25
Q

How often should LFT’s (liver function tests) be collected when a patient is on statins?

A

-At baseline
-When clinically indicated

26
Q

At what LFT (liver function test) should statins be discontinued?

A

3 x upper limit of normal

27
Q

When taking a statin, what is the mount of grapefruit intake per day that should be avoided?

A

> 1 quart daily

28
Q

What are the contraindications associated with statins?

A

-Pregnancy

-Women who may become pregnant (must demonstrate low risk of becoming pregnant if they want to start a statin)

-Breastfeeding

-Acute Liver Disease

-Unexplained persistent elevations of serum transaminases

29
Q

At what age should be consider taking patients off of statins?

A

> 75 years old
(risk outweighs benefit)

30
Q

If a patient experiences muscle symptoms or fatigue while on a statin, what should we do?

A

-Discontinue statin and evaluate for rhabdomyolysis

-Evaluate for exacerbating conditions

-Restart same or lower dose after symptoms recede

31
Q

What drugs are contraindicated with simvastatin?

A

“conazole”
“romycin”
HIV protease inhibitors
Nefazodone
Gemfibrozil
Cyclosporine
Danazol

32
Q

With what drugs should simvastatin not exceed 10 mg with?

A

-Verapamil

-Diltiazem

33
Q

With what drugs should simvastatin not exceed 20 mg with?

A

Amiodarone

Amlodipine

Ranolazine

34
Q

What do the JUPITER and PROVE-IT TIMI 22 trials show?

A

Statins increase blood sugar and increase risk for diabetes

*risks still outweigh benefits, should keep patients on them

35
Q

How often should FLP’s (lipid panels) be taken when a patient is on a statin?

A

-At baseline

-4-12 weeks following initiation

-Every 3-12 months as indicated

36
Q

What are the 2 disadvantages of bile acid resins?

A

-May increase TG

-Must take other meds 1 hour before or 4 hours after

37
Q

Why do we typically not recommend that patients take niacin?

A

*Content is not federally regulated in the US

38
Q

What are the 2 big side effects of niacin?

A

Prostaglandin mediated:

-Flushing

-Itching

39
Q

What can we do to avoid he side effects associated with niacin?

A

Administer aspirin 325mg 30 minutes before taking

40
Q

By how much can ezetimibe decrease LDL when added onto statin therapy?

A

12-20%

41
Q

What are the side effects of ezetimibe?

A

-Fatigue

-Diarrhea

-GI upset

42
Q

What is the active ingredient in Red Yeast Rice?

A

Lovastatin

43
Q

What boxed warning is associated with Iomitapide (Juxtapid)?

A

Risk of hepaotoxicity

Therapeutics 2 Exam 5 (9 decks)

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