27. Dyslipidemia Flashcards
TG > ____ can cause acute pancreatitis
> 500
Friedewald equation (LDL)
LDL = TC - HDL - (TG/5)
Do NOT use when TG > 400, can lead to falsely low LDL
Severe cholesterol elevations (including LDL ≥___ and TG ≥____) are very high risk and must be treated
LDL ≥ 190
TG ≥ 500
ASCVD risk is calculated using ___
Gender, age, race, smoking status
TC, HDL, LDL, statin use
BP, HTN med use
DM hx and aspirin use
Drugs that increase LDL and TG
Diuretics
Efavirenz
Immunosuppressants (e.g. cyclosporine, tacrolimus)
Atypical antipsychotics
Protease inhibitors
Drugs that increase LDL only
Fibrates
Fish oils (except Vascepa)
Drugs that increase TG only
IV lipid emulsions
propofol
clevidipine
bile acid sequestrants (~5%)
Conditions that increase cholesterol
Obesity, poor diet, alcohol use disorder, hypothyroidism, smoking, diabetes, renal/liver disease, nephrotic syndrome
ASCVD risk assessment should be repeated every ____ if low risk (<7.5%)
4-6 years
ASCVD risk score is not needed for pts with _____, as all pts in these groups should be started on a statin
clinical ASCVD, diabetes, or LDL≥190
Natural products for dyslipidemia
Red yeast rice (contains naturally occurring statin in varying amounts, can lower LDL)
OTC fish oils (can lower TG but increase LDL)
Garlic is no longer considered effective
Concern with cholesterol-lowering drugs and liver damage
Niacin, fibrates, potentially statins and ezetimibe may cause liver damage
Should not be used if AST or ALT is ≥ 3xULN
Statins MOA
inhibit HMG-CoA reductase, which prevents conversion of HMG-CoA to mevalonate
This is the rate-limiting step in cholesterol synthesis
Clinical ASCVD (CHD, stroke/TIA, PAD) - What intensity statin should be started in this patient?
High-intensity
Baseline LDL ≥190 - What intensity statin should be started in this patient?
High-intensity
DM and age 40-75 with LDL between 70-189 and multiple ASCVD risk factors - What intensity statin should be started in this patient?
High-intensity
DM and age 40-75 with LDL between 70-189 - What intensity statin should be started in this patient?
Moderate-intensity
Age 40-75 with LDL between 70-189 and ASCVD risk ≥20% - What intensity statin should be started in this patient?
high-intensity
Age 40-75 with LDL between 70-189 and ASCVD risk ≥ 7.5-19.9% + risk enhancing factors - What intensity statin should be started in this patient?
Moderate-intensity
High intensity statin options
Atorvastatin 40-80mg
Rosuvastatin 20-40mg
Moderate intensity statin options
Atorvastatin 10-20mg
Rosuvastatin 5-10mg
Simvastatin 20-40mg
Pravastatin 40-80mg
Lovastatin 40mg
Fluvastatin 40mg BID/80XL
Pitavastatin 1-3mg
Low-intensity statin options
Simvastatin 10mg
Pravastatin 10-20mg
Lovastatin 20mg
Fluvastatin 20-40mg
Statin equivalent doses
Pharmacists Rock At Saving Lives and Preventing Fatty deposits
Pitavastatin 2mg
Rosuvastatin 5mg
Atorvastatin 10mg
Simvastatin 20mg
Lovastatin 40mg
Pravastatin 40mg
Fluvastatin 80mg
Muscle damage from statins typically presents as muscle soreness, tiredness, or weakness that is symmetrical and occur within ___ of starting treatment (but can develop at any time)
6 weeks