Dyslipidemia Flashcards
ASCVD, primary and secondary HLD, natural products, statins and add ons, key counseling points
non HDL cholesterol goal
<130
LDL goal no ASCVD or DM
<100
HDL goal
> 40 men
50 women
TG goal
<150
LDL equation
LDL = TC - HDL - TG/5
ASCVD events
MI, stroke/TIA, stable angina, PAD
what medications increase LDL only
fibrates
non-Vascepa fish oils
what medications increase TG only
IV lipids
propofol
clevidipine
BAS
what medications increase both LDL and TG
diuretics
efavirenz
CYA
tacro
atypical APs
protease-i
when should a statin always be started
DM
clinical ASCVD secondary prevention
LDL 190+
patient 63yo male with a PMH significant for MI, t2DM x3 years
What intensity statin should they be on?
What is the LDL goal?
diabetics with ASCVD hx should always be put on a high intensity statin
LDL goal is <55 due to ASCVD event and risk
patient 69yo female a PMH of OP, RA, gout and depression. LDL 195
What intensity statin should they be on?
What is the LDL goal
high, all patients with an LDL 190+ should be placed on high intensity statin regardless of ASCVD or DM status
LDL goal is <100
LDL goals
no ASCVD +/- DM–> <70
ASCVD or high risk –> <55
no ASCVD or DM –> <100
moderate intensity statins
rosuvastatin 5-10
atorvastatin 10-20
simvastatin 20-40
lovastatin 40
pravastatin 40-80
fluvastatin 80
moderate intensity statins
rosuvastatin 5-10
atorvastatin 10-20
simvastatin 20-40
lovastatin 40
pravastatin 40-80
fluvastatin 80
moderate intensity statins
rosuvastatin 5-10
atorvastatin 10-20
simvastatin 20-40
lovastatin 40
pravastatin 40-80
fluvastatin 80
high intensity statins
rosuvastatin 20-40
atorvastatin 40-80
how should a lipid panel be monitored in dyslipidemia
q4-12 weeks after initiation or dose change then yearly thereafter
which are the hydrophilic statins
rosuvastatin
pravastatin
what medications inhibit statin metabolism via 3A4
G PACMAN
grapefruit
protease-i
azole antifungals
cya, cisplatin
macrolides (erythro, clarithro)
amiodarone
non-DHP CCB (dilt, verap)
when do we initiate add on treatment to statins
when the patient is on a maximally tolerated statin
zetia
avoid in …
dosing
LDL lowering %?
avoid in pregnancy, breast feeding, liver disease
10mg po qd
dec LDL 18-23%
PCSK9i
medications in class (brand and generic)
LDL and HDL lowering expected
alirocumab (Praluent)
evolocumab (Repatha)
dec LDL ~60%
dec HDL ~36%
which drugs are the BAS?
effects on lipids?
CI?
colesevelam (Welchol)
cholestyramine
dec LDL 10-30%, inc TG 5%
CI in TG >500, bowel obstruction, inc TG 2/2 pancreatitis
which lipid-lowering drug is safe in pregnancy
colesevelam (Welchol)
which lipid lowering drugs impair absorption of ADEK, folic acid and iron
BAS (colesevelam, cholestyramine)
when is it appropriate to initiate fish oil
when TG 500+
which fish oil increases LDL?
omega-3 acid ethyl esthers (Lovaza)
fish oil will decrease TG by ___%
45%
which meds are fibrates
fenofibrate (Tricor) and gemfibrozil (Lopid)
when is fenofibrate CI
gallbladder disease, CrCl </=30, severe liver disease
when is gemfibrozil CI
gallbladder disease, CrCl </=30, severe liver disease, use with simvastatin, repaglinide, zetia, statins, SUs, warfarin, colchicine
Niacin major SE
flushing and liver toxicity
BAS counseling points
take w meals
constipation
dec absorption of ADEK, Fe, folate
fibrates can cause
cholelithiasis
pancreatitis
PCSK9-inhibitors Repatha and Praluent are good at room temp for
30 days
