Treatment of Dyslipidemia Flashcards Preview

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Flashcards in Treatment of Dyslipidemia Deck (27):
1

Steps to evaluating dyslipidemia 

  1. Fasting Lipid Profile 
  2. Rule out secondary causes
  3. CHD Risk equivalents 
  4. Major CHD Risk Factors
  5. Estimate 10 year risk with Framingham Score
  6. Establish treatment goals and therapy based on risk category 

 

2

For what population is a lipid screening appropriate for?

All adults aged 20 or over, every 5 years

3

Secondary causes of Dyslipidemia

  • Diabetes
  • Hypothyroidism
  • Obstructive liver disease
  • Chronic renal failure
  • Drugs that can increase LDL, decrease HDL (prostaglandins, thiazide diuretics, beta blockers, isotretinoin)

4

CHD Risk Equivalents 

DM 

peripheral arterial disease

abdominal aortic aneurysm 

symptomatic carotid artery disease

multiple RF's that confer a 10 year risk >20%

5

Major CHD RIsk Factors 

  • current smoker
  • HTN >140/90 or on antihypertensive 
  • Low HDL <40
  • FHx of premature CHD (55/65 MI or sudden death)
  • Age and gender (45/55)
  • Negative point: HDL >60

**If two or more risk factors are present, assess 10 year CHD risk 

6

  Therapeutic Lifestyle Changes

Healthy diet

Weight reduction 

Increased physical activity 

7

Metabolic syndrome 

Three or more of: 

Abdominal obesity 

High TG

Low HDL 

High BP 

Insulin resistance 

8

More common name of HMG Co A Reductase Inhibitors 

statins 

9

Statin mechanism of action 

inhibit HMG CoA Reductase, thereby blocking endogenous cholesterol synthesis 

stimulate hepatic LDL receptors, enhancing LDL clearance from plasma 

10

Adverse effects of statins 

Hepatic toxicity 

Myopathy 

Neuropathy 

Reversible cognitive side effects 

11

Contraindications of statins

pregnancy category X

active or chronic liver disease 

Relative CI: niacin or gemfibrozil concomitant use 

12

Statins have what kind of dosing curve do statins have?

Non linear--after a certain amount, little effect is had by doublin doses 

Works best when dose at night 

13

Bile Acid Resins (BAR)

Mechanism of action

Bind bile acids, forming an insoluble complex that is eliminated in the stool. 

This promotes conversion of cholesterol to BAs in the liver. 

May increase hepatic VLDL, increasing TGs

14

Adverse effects of Bile Acid Resins

GI symptoms--constipation, belching, flatulence, heart burn, abdominal distention nausea

15

CI of Bile Acid Resins

High TGs 

H/O severe constipation 

Decreases the absorption of other meds so stagger 

16

Reasons to use BAR

Good in young pts with moderately high LDL, or in combination of statins for severe hyperlipidemia 

Can be used with niacin and fibric acids

17

Fibric Acids mechanism of action 

Increase lipoprotein lipase activity, enhacing VLDL and IDL catabolism, decreasing TGs 

Promotes secretion of cholesterol in bile

18

Adverse effects of fibric acids

GI complaints 

Increase bile lithogenicity 

19

When to use fibric acids

Very good at lower TGs

Good for combined dyslipidemia

Avoid with statins (increase myositis)

20

Nicotinic Acid mechanism of action 

Inhibits synthesis of VLDLs, lowering LDLs

21

Adverse effects of nicotinic acid 

Flushing (MC)

May cause glucose intolerance and increase uric acid

Older forms cause hepatitis 

22

CI of nicotinic acid

Liver disease 

DM

gout

hyperuricemia 

23

When to use nicotinic acid

Good for mixed hyperlipidemias 

Start low, go slow, montitor for hepatic toxicity 

Can take with aspirin to dec flushing 

24

Cholesterol absorption inhibitors (ezetimibe) mechanism of action

Selectively inhibits the absorption of cholesterol

25

Adverse effects of cholesterol absorption inhibitors (ezetimibe)

fatigue,

abdominal pain

HA

diarrhea

arthralgia 

26

When to use cholesterol absorption inhibitors (ezetimibe)

Can use in conjunction with statins if not reaching goal 

27

Supplements for lowering cholesterol

Plant stanol esters: dec cholesterol absorption 

Fish oils: esp if need lower TGs

Blond psyllium 

Oat bran