Dyslipidemia Flashcards
On physical exam what are six signs of HLD?
- Xanthelasma
- Circumferential arcus
- PVD
- Thickened achilles
- HTN
- DM
What is the desired, borderline and high TC level?
- Desirable under 200
- Borderline 200-239
- High is over 240
What is the optimal, near optimal, borderline high, high, and very high levels for LDL?
- Optimal is under 100
- Near optimal is 100-129
- Borderline high is 130-159
- High is 160-189
5 Very high is over 190
Of our diet, what elevates HDLs?
Alcohol saturated fats and weight loss
Of our diet, what lowers HDLs?
Low fat diet, sugar, excess calories, excess polyunsaturated fats.
Of our diet, what elevates LDLs?
saturated fat, trans fatty aids and dietary cholesterol
Of our diet, what lowers LDL?
MUFAs, complex carbs and soy
Of our diet what elevates TC?
Saturated fats and transfatty acids
Of our diet what decreases TC?
Substituting MUFAs and complex carbs for saturated fats, soy
Of our diet what increases TG?
alcohol, sugar, high carb diet, excess calories
Of our diet, what decreases TG?
weight loss and fish oil
What is the dietary recommendation for saturated fats, polyunsaturated fats, monounsaturated fats and total fat?
- Saturated <7% of total calories
- Poly up to 10% of calories
- Mono up to 20% of calories
- Total fat 25-35% of calories
What is the dietary recommendation for carbs, fiber, protein and cholesterol?
- Carbs 50-60% of calories
- Fiber 20-30grams/day
- Protein 15% of calories
- Cholesterol <200mg/day
What are the four main categories established for statin therapy for secondary prevention of ASCVD?
- Clinical ASCVD (or intervention)
- LDL > 190
- DM
- Equal or more than 7.5 estimated 10-year ASCVD risk
The dosage of statin therapy depends on what two factors?
- Which category
2. Ability to tolerate treatment
Moderate intensity statin therapy is composed of what and achieves what?
- 40 Atorvastatin
2. Approx 30-50% reduction in LDL
High intensity statin therapy includes what and achieves what?
- Atorvastatin 80 or 20 rosuvastatin
2. Approx over 50% reduction in LDL
Statin therapy in general reduces the risk of ASCVD across the spectrum for all those with LDL >
70
Explain MOA of statin and name some agents.
Inhibit the rate-limiting enzyme in the formation of cholesterol. Effect is to decrease LDL and TG while increasing HDL.
Agents include anything that ends in statin.
When a person is under 75 and has clinical ASCVD what kind of statin therapy should they receive?
High intensity
Over 75 or with contraindications to high-intensity therapy with ASCVD should receive?
Moderate intensity
What are four considerations for statin therapy for primary hyperlipidemia (without CVD)?
- Patients with LDL over or equal to 190
- Reduction of LDL by 39mg/dl reduces ASCVD by approx 20%.
- May require additional use of non-statin lipid lowering agents to achieve acceptable lipid reduction.
- Assess need for addressing elevated TG.
With diabetes when should someone get high intensity therapy?
When 10yr ASCVD risk over 7.5
What medication works by reducing the production of VLDLs, which reduces LDLs, reduce TGs and increases HDLs?
Nicotinic acid
What medication reduces the synthesis and increases the breakdown of VLDLs, effect is to reduce LDLs, decrease TG and increase HDLs?
Fibric acid derivatives including gemfibrozil, fenofibrate, clofibrate.
Which medication works by inhibiting cholesterol and phytosterol absorption from the brush border of the intestines?
Ezetimibe (zetia)
remember, no effect on absorption of fat soluble vitamins (ADEK), no effect on CYP450, only intended for COMBO use with statin.
When statins are given with ezetimibe what kind of a reduction do we see in LDL?
approx 25%
When statins are given with bile acid sequestrants what kind of a reduction do we see in LDL?
8-16%
What three considerations must be made with combination therapy fibric acid derivatives and statins?
- Primarily assist in decreasing TG
- Increased risk of myopathies
- Contraindicated with severe hepatic disease
What do we see with statins and niacin?
Increased risk of hepatic dysfunction
With lovastatin and simvastatin what kind of significant drug interactions do we see?
Issues with antifungals, antibiotics, gemfibrozil and grapefruit juice.
Myopathies are a side effect of statins which ones can it occur with and who is at risk?
- Can occur with any statin
2. Age over 80, small body frame and failty, impaired renal or hepatic system and alcohol abuse.
Which drug interactions with statins cause myopathies?
Niacin, gemfibrozil, cyclosporin, HIV protease inhibitors, verapamil and amiodarone.
What drugs should be avoided in pregnant and nursing women? What drug should they be on?
Avoid: Statins, ezetimibe, niacin and fibric acid derivatives.
Should be on: Bile acid-binding resins are the only lipid lowering medication safe for use in prego
