Cardiovascular Conditions: Dyslipidemia Flashcards

1
Q

HDL cholesterol

A

“good cholesterol”

takes cholesterol from blood, moves to liver to be removed

lowers ASCVD risk

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2
Q

Non-HDL cholesterol

A

includes lipoproteins that contribute to ASCVD

Non-LDL strong predictor of ASCVD

Non-HDL calc = TC - HDL

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3
Q

Triglycerides (TGs)

A

hypertriglyceridemia associated with ASCVD risk

> 500mg/DL can cause acute pancreatitis

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4
Q

Friedewald equation

A

LDL = TC - HDL - TG/5

Dont use if TGs > 400

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5
Q

LDL lvls

A

< 100 = good
> 190 = very high

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6
Q

Non-HDL lvls

A

< 130 = good

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7
Q

HDL lvls

A

> 40 men = good
50 women = good

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8
Q

TG lvls

A

< 150 = good
> 500 = very high

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9
Q

Primary (familial) hypercholesterolemias

A

genetic defects that cause severe cholesterol elevations

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10
Q

Why isASCVD risk not needed for pts with clinical ASCVD, diabetes or LDL > 190

A

all should be on statin

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11
Q

Lifestyle changes to help lower cholesterol

A

limit smoking and drinking
rich in veggies, fruits, whole grains
limt saturated and trans fat, also cholesterol
fish rich in omega 3
exercise 3-4 times a week, at least 40min

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12
Q

Natural products that can help lower LDL

A

red yeast
OTC fish oils can lower TGs
** garlic no longer considered effective**

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13
Q

Cholesterol lowering drugs should not be used if AST/ALT is….

A

> 3 times upper limit of normal

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14
Q

Statin indication if secondary prevention ASCVD

A

High intensity

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15
Q

Statin indication if primary prevention with primary severe dyslipidemia, LDL > 190

A

High intensity

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16
Q

Statin indication if diabetes, 40-75yrs old and LDL 70-189

A

High intensity if multiple ASCVD risk factors
Moderate intensity otherwise

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17
Q

Statin indicating if 40-75yrs old, LDL 70-189

A

ASCVD risk > 20% = high intensity
ASCVD 7.5-19.9% = moderate intensity

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18
Q

High intensity statin and doses

A

Atorva = 40-80
Rosuvastatin = 20-40

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19
Q

Low intensity statin and doses

A

Simvastatin = 10
Pravastatin = 10-20
Lovastatin = 20
Fluvastatin = 20-40

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20
Q

Muscle damage from statin

A

usually within 6 wks of starting
muscle soreness, tiredness or weakness
Rhabdomyolysis is most severe form

21
Q

Managing myalgias with statins

A

dont use simvastatin 80mg/day
dont use statin with gemfibrozil

stop statin, retry 2-4 weeks later at lower dose, if still doesnt work then stop and retry in few weeks with another statin

22
Q

Statin CI

A

Breastfeeding
Liver Disease
strong CyP3A4 inhib (w/ simvastatin/lovastatin)

23
Q

Statin warning

A

Muscle damage
increase CPK/renal failure = inc risk with inc dose/age/using w/ niacin
Dont use during pregnancy

24
Q

Statin monitoring

A

Lipid panel 4-12 wk after starting, then usually annually
LFTs at BL then if symptoms
Myalgia = check CPK
Dec urine = check SCr/BUN

25
Which statins have the least drug interactions?
Pravastatin and rosuvastatin
26
Max amlodipine dose with simvastatin/atorvastatin/lovastatin?
20mg/day
27
Max simvastatin dose with Diltz/Verapamil?
10mg
28
Max lovastatin dose with Dilt/Verapamil?
20mg
29
Max simvastatin n lovastatin dose with Amiodarone?
20mg sim 40mg lovo
30
Which statin should be used in the evening?
Simvastatin rest can be used any time
31
what to do if statin therapy isn't lowering LDL?
can add Ezetimibe or PCSK9i ($$$$$$)
32
Ezetimibe should not be used with....
Gemfibrozil
33
Colesevelam CI
Bowel obstruction
34
Bile acid sequestrates/binding resin Side effects
constipation abdominal pain cramping bloating gas inc TG
35
Cholestyramine notes
can cause tooth discoloration, erosion of enamel or decay
36
Colesevelam can be used in pregnancy?
Yes
37
Fenofibrate/Gemfibrozil CI
Severe liver disease gallbladder disease breastfeeding dont use with simvastatin** (Gemfibrozil specifically)
38
Fenofibrate/Gemfibrozil warnings
inc myopathy risk when used with statins
39
Fenofibrate/Gemfibrozil SE
Dyspepsia ( gemfibrozil) inc LFTs abdominal pain inc CPK
40
Niacin warnings
Rhabdomyolysis Hepatotoxicity Inc BG/ uric acid
41
Niacin Side effects
Flushing pruritus (itching) vomiting diarrhea inc BG inc hyperuricemia (gout)
42
Niacin monitoring
LFTs
43
Niacin dosage notes
IR = poorly tolerated due to flushing/itching CR/SR = less flushing but more hepatotoxicity ER = preferred due to less of both but more $$ formulations not interchangeable take 4-6hrs after bile sequestering agents
44
How to reduce flushing with niacin
take aspirin 325mg or ibuprofen 200mg 30-60min before dose, take with food, avoid spicy foods alc or hot Bev can worsen flushing
45
How long to space drugs out after bile sequestrants?
1-4hrs before 4-6hrs after
46
Fish oil Side effects
burping taste
47
Fish oil warnings
dont use if hypersensitivity to fish/or shellfish
48
Fish oil effects on LDL?
Lovaza can inc LDL, not seen with Vascepa
49
Fish oil drug interactions
Can increase bleeding time, careful with others ie Warfarin