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PEBC > 37 - Dyslipidemias > Flashcards

37 - Dyslipidemias Flashcards

1
Q

Who and how often should we screen for dyslipidemias?

A
  • those with fam Hx
  • those over 40
  • women who are postmenopausal

screen every 3 years

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2
Q

What is the Fridewald equation?

A

LDL-C = Total-C - (HDL-C + TG/2.2)

*cannot be used if TG > 4.52

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3
Q

Is fasting before test required?

A

no longer required unless TG > 4.5

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4
Q

What are some optional targets after reaching LDL-C goals?

A

non-HDL-C < 2.6 mmol/L

apolipoprotein B < 0.8 g/L

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5
Q

What are very high TGs (>10 mmol/L) are risk factor for?

A

pancreatitis

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6
Q

Non-pharms

A
  • diet (aimed at decreasing blood levels of lipids and weight if needed)
  • For primary prevention, try diet x 3 months
  • For secondary prevention or high risk patients, initiate cholesterol-lowering med at the same time as dietary changes
  • eat sterol enriched foods (margarine, fruit juice)
  • other lifestyle mods to reduce risk of CVD (smoking cessation, stress management, weight loss, physical activity)
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7
Q

What is 1st line?

A

Statins bc they have established CV benefit

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8
Q

s/e of statins

A
  • muscle-related symptoms
  • concern with new onset DM
  • anecdotal reports of memory loss
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9
Q

cholesterol absorption inhibitor: example?

A

ezetimibe

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10
Q

What is Ezetimibe (cholesterol absorption inhibitor) indicated for?

A

monotherapy or in combo with statins

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11
Q

Ezetimibe is better tolerated than ____

A

resins (ex. cholestyramine)

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12
Q

Does ezetimibe improve CV outcomes

A

no - not been proven to

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13
Q

Give examples of fibrates

A
  • gemfibrozil
  • bezafibrate
  • fenofibrate
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14
Q

How do fibrates work?

A
  • lower TG
  • raise HDL-C

may benefit patients with diabetic dyslipidemias

*effect of fibrates on LDL-C is variable

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15
Q

Which fibrates lower LDL-C more consistently and can be combined with a statin?

A
  • Benzafibrate

- Fenofibrate

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16
Q

Give an example of a microsomal triglyceride transfer protein inhibitor

A

Lopitamide

17
Q

What is lopitamide indicated for?

A

as adjunctive Tx in adult homozygous familial hypercholesterolemia

18
Q

What can Lopitamide cause?

A

hepatic toxicity, therefore need to monitor hepatic transaminases

19
Q

What is nicotinic acid (niacin)?

What does it do?

A

a B vitamin that at high doses lowers TG and LDL-C and raises HDL-C more than any other lipid-lowering agent

*also lowers lipoprotein (a)

20
Q

What types of forms of niacin is more hepatotoxic?

A

slow-release forms more hepatotoxic than IR forms

21
Q

What are examples of PCSK9 inhibitors?

A

alirocumab and evolocumab

22
Q

What do PCSK9 inhibitors do?

A
  • they are SC injection

- result in substantial LDL-C reduction beyond that achieved with statins alone

23
Q

Give 3 examples of Bile acid sequestering resins

A
  • Cholestyramine
  • Colesevelam
  • Colestipol
24
Q

Resins help improve ___ outcomes when used alone

A

CV

25
Q

What are the main drawbacks to using resins?

A
  • GI distress

- concomitant drug malabsorption

26
Q

T or F: Resins are appropriate for children, pregnancy and breastfeeding

A

true

27
Q

Ezetimibe can be used in kids ___ and older

A

10

28
Q

Non-Rx Agents:

How much psyllium do you need to lower LDL-C?

A

daily consumption of 10 g psyllium can decrease LDL-C by 7%

29
Q

Non-Rx Agents:

Is omega-3 FA recommended?

A

it is recommended (1 g/day) but no evidence to improve CV outcomes

30
Q

Non-Rx Agents:

Patients taking 2-4 g of O3FA decrease TG by ____%

A

25-30%

31
Q

Non-Rx Agents:

If they take >3g/day of O3FA they need to do so under Dr.’s supervision as this can increase risk of ____

A

bleeds

32
Q

Pregnancy:

d/c all lipid-lowering agents except _____

A

resins

33
Q

Pregnancy:

If resins are tolerable, what should you initiate?

A

a lipid-soluble vitamin supplement

34
Q

Pregnancy:

Is it a big deal to stop all lipid-lowering agents for duration of therapy?

A

No - interrupting lipid-lowering Tx during childbearing potential has little impact on overall risk

35
Q

Breastfeeding:

Which drugs are recommended?

A

NONE

don’t use these drugs while breastfeeding, begin lipid-lowering agent again after breastfeeding completed

36
Q

Doubling the dose of a statin will further reduce the LDL-C level by only ___%

A

6%

37
Q

Appears to be safe to target LDL-C levels to _____ in individuals with overt CHD and multiple risk factors

A

1.3 mmol/L

PEBC (130 decks)

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