cholesterol and HTN Flashcards
what is the normal total cholesterol?
< 200
we initiate statin therapy when the ASCVD risk is
> 7.5
normal triglyceride level
<150
normal HDL level
40-60 the higher the better
normal LDL
< 100
when is the routine time to do a lipid profile on a patient?
every 5 years unless risk factors are present even increased BMI is a risk factor
clinical signs of high cholesterol
Arcus senilis
Xanthelasma (younger people- more benign in elderly)
Arcus senilis
Arcus senilis is common in older adults. It’s caused by fat (lipid) deposits deep in the edge of the cornea. Arcus senilis doesn’t affect vision, nor does it require treatment.A person with arcus senilis may notice a white, gray, or blue circle or arc around the cornea of the eye. The circle or arc will have a sharp outer border
Xanthelasma
Xanthelasma is a harmless, yellow growth that appears on or by the corners of your eyelids next to your nose. Cholesterol deposits build up under your skin to form a xanthelasma. Having xanthelasmas could be a sign of another condition, such as: Diabetes
Before we do statins
simple lifestyle modifications
2 high intensity statins that we will use as go to treatment for hyperlipidemia
atorvastatin
rousouvastatin
at higher doses
signs and symptoms to be cautious with when people are starting statins
any new muscle pain or signs and symptoms of jaundice
what statin would we use for a patient who has an elevated cholesterol and whose dad died of a cardiovascular issue at 45?
A high-risk patient is definitely at risk for a cardiovascular event so we want to use a high
intensity statin for that type of patient.
If they have new muscle pain after starting a statin what might be going on?
Rhabdomyolysis
If we suspect Rhabdomyolysis what lab level we need to order?
A creatine kinase (CK) test measures the amount of creatine kinase in your blood. Elevated CK levels may indicate skeletal muscle, heart or brain damage or degeneration — either chronic (long-term) or acute (short-term). Other names for a creatine kinase test include: CK total. CK creatine.
In someone who is experiencing Rhabdomyolysis the CK level is going to be how high?
5 times the normal limit. So, we need to stop the statin.
What if the patient comes in with jaundice after starting a new statin? For that patient what lab would you draw?
That can definitely be
some acute drug induced hepatitis.
LFT’s
If a patient is in Rhabdomyolysis and we do not discontinue their statin, what might happen?
ACUTE RENAL FAILURE ***** (you absolutely need to know this)
Usually the KEY distinguishing symptom between possibly rhabdomyolysis and acute drug
induced hepatitis is what?
that we see that intense muscle pain with rhabdomyolysis specifically, we don’t usually see that with the hepatitis side.
What should a patient not ingest if they are taking a STATIN?
Grapefruit juice
What is a CK level?
A creatine kinase (CK) test measures the amount of creatine kinase in your blood. Elevated CK levels may indicate skeletal muscle, heart or brain damage or degeneration — either chronic (long-term) or acute (short-term). Other names for a creatine kinase test include: CK total. CK creatine.
What medication do we want to use if the trigylcerides are greater than 500?
Use Fenofibrate if triglycerides > 500
a normal level of triglycerides is
under 150, but if it’s greater than 500 what might happen in our patient?
Pancreatitis
After 500 they are pretty much at a high risk;
after 1000 it is almost inevitable that they will
develop pancreatitis.
What are those two possible clinical signs that we might see on a patient with necrotizing pancreatitis?
Cullen’s and Turner’s sign.