Cardiovascular Conditions: Dyslipidemia Flashcards
HDL cholesterol
“good cholesterol”
takes cholesterol from blood, moves to liver to be removed
lowers ASCVD risk
Non-HDL cholesterol
includes lipoproteins that contribute to ASCVD
Non-LDL strong predictor of ASCVD
Non-HDL calc = TC - HDL
Triglycerides (TGs)
hypertriglyceridemia associated with ASCVD risk
> 500mg/DL can cause acute pancreatitis
Friedewald equation
LDL = TC - HDL - TG/5
Dont use if TGs > 400
LDL lvls
< 100 = good
> 190 = very high
Non-HDL lvls
< 130 = good
HDL lvls
> 40 men = good
50 women = good
TG lvls
< 150 = good
> 500 = very high
Primary (familial) hypercholesterolemias
genetic defects that cause severe cholesterol elevations
Why isASCVD risk not needed for pts with clinical ASCVD, diabetes or LDL > 190
all should be on statin
Lifestyle changes to help lower cholesterol
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
Natural products that can help lower LDL
red yeast
OTC fish oils can lower TGs
** garlic no longer considered effective**
Cholesterol lowering drugs should not be used if AST/ALT is….
> 3 times upper limit of normal
Statin indication if secondary prevention ASCVD
High intensity
Statin indication if primary prevention with primary severe dyslipidemia, LDL > 190
High intensity
Statin indication if diabetes, 40-75yrs old and LDL 70-189
High intensity if multiple ASCVD risk factors
Moderate intensity otherwise
Statin indicating if 40-75yrs old, LDL 70-189
ASCVD risk > 20% = high intensity
ASCVD 7.5-19.9% = moderate intensity
High intensity statin and doses
Atorva = 40-80
Rosuvastatin = 20-40
Low intensity statin and doses
Simvastatin = 10
Pravastatin = 10-20
Lovastatin = 20
Fluvastatin = 20-40
Muscle damage from statin
usually within 6 wks of starting
muscle soreness, tiredness or weakness
Rhabdomyolysis is most severe form
Managing myalgias with statins
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
Statin CI
Breastfeeding
Liver Disease
strong CyP3A4 inhib (w/ simvastatin/lovastatin)
Statin warning
Muscle damage
increase CPK/renal failure = inc risk with inc dose/age/using w/ niacin
Dont use during pregnancy
Statin monitoring
Lipid panel 4-12 wk after starting, then usually annually
LFTs at BL then if symptoms
Myalgia = check CPK
Dec urine = check SCr/BUN
Which statins have the least drug interactions?
Pravastatin and rosuvastatin
Max amlodipine dose with simvastatin/atorvastatin/lovastatin?
20mg/day
Max simvastatin dose with Diltz/Verapamil?
10mg
Max lovastatin dose with Dilt/Verapamil?
20mg
Max simvastatin n lovastatin dose with Amiodarone?
20mg sim
40mg lovo
Which statin should be used in the evening?
Simvastatin
rest can be used any time
what to do if statin therapy isn’t lowering LDL?
can add Ezetimibe or PCSK9i ($$$$$$)
Ezetimibe should not be used with….
Gemfibrozil
Colesevelam CI
Bowel obstruction
Bile acid sequestrates/binding resin Side effects
constipation
abdominal pain
cramping
bloating
gas
inc TG
Cholestyramine notes
can cause tooth discoloration, erosion of enamel or decay
Colesevelam can be used in pregnancy?
Yes
Fenofibrate/Gemfibrozil CI
Severe liver disease
gallbladder disease
breastfeeding
dont use with simvastatin** (Gemfibrozil specifically)
Fenofibrate/Gemfibrozil warnings
inc myopathy risk when used with statins
Fenofibrate/Gemfibrozil SE
Dyspepsia ( gemfibrozil)
inc LFTs
abdominal pain
inc CPK
Niacin warnings
Rhabdomyolysis
Hepatotoxicity
Inc BG/ uric acid
Niacin Side effects
Flushing
pruritus (itching)
vomiting
diarrhea
inc BG
inc hyperuricemia (gout)
Niacin monitoring
LFTs
Niacin dosage notes
IR = poorly tolerated due to flushing/itching
CR/SR = less flushing but more hepatotoxicity
ER = preferred due to less of both but more $$
formulations not interchangeable
take 4-6hrs after bile sequestering agents
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
How long to space drugs out after bile sequestrants?
1-4hrs before
4-6hrs after
Fish oil Side effects
burping
taste
Fish oil warnings
dont use if hypersensitivity to fish/or shellfish
Fish oil effects on LDL?
Lovaza can inc LDL, not seen with Vascepa
Fish oil drug interactions
Can increase bleeding time, careful with others ie Warfarin
