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Board Review > dyslipidemia > Flashcards

dyslipidemia Flashcards

1
Q

for how long does a patient need to fast for a lipid panel?

A

9-12 hours

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2
Q

normal range for LDL

A

<100 optimal

100-129 near or above optimal

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3
Q

good range for HDL?

A

> =40 , >=60 high

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4
Q

normal TG level?

A

<150

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5
Q

normal TC level

A

<200

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6
Q

Friedewasl equation for LDL

A

LDL= TC - HDL - TG/5 but cannot use the forumula if TGs are > 400

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7
Q

what are hte CHD risk equivalents?

A 
abdominal aortic aneurysm
CAD (MI, ANgina) 
aortic artery disease
peripheral arterial disease 
diabetes  
10 year framingham risk of >20%
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8
Q

major risk factors for CHD? (one point each)

A
  1. men >= 45, Women >=55
  2. cigarette smoking
  3. > = 140/90 or on HTN meds
  4. HDL< 40
  5. First degree male relative with premature CHD < 55 yo, female relative < 65 yo
    negative risk factor if HDL >= 60mg/dl
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9
Q

what lifestyle modifications to do for Therapeutic lifestyle changes?

A

a. Reduced intake of saturated fat (< 25

e. stop smoking

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10
Q

which is the drug of choice for lowering LDL?

A

statins

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11
Q

what is the drug of choice for inc HDL?

A

niacin, fenofibrates

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12
Q

DOC lowering TG

A

Fenofibrates or fish oils

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13
Q

when should you stop cholesterol lowering medications?

A

when the AST or the ALD become >3 times the upper limit of normal
Normal AST 10-35 unitls/ L
ALT 6-40 units/L

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14
Q

what is the MOA of Statins

A

inhibit HMG-CoA reductase which stops conversion of HMG-CoA to mevalonate, which is the rate limiting step in cholesterol synthesis

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15
Q

brand name of pravastatin

A

pravachol

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16
Q

contraindications of statins?

A

active liver disease (ie unexplained elevations in liver enzymes)
pregnancy
breast feeding
taking strong cyp3A4 inhibitors

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17
Q

what must you do if a patient has symptoms of muscle damage?

A

should be seen right away and get a CPK checked

may have statin tstopped or changed

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18
Q

factors that increase risk of myopathy?

A

higher doses & used of fibrates
age > 65
renal impairment
untreated hypothyroidism

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19
Q

main side effects of statins

A 
myalgias, arthralgias, myopathy
inc CPK, rhabdomyolysi
cognitive impairment (mem loss confsuion)
inc blood glucose, inc a1c 
inc LFTs
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20
Q

what Labs should you get if patient is starting statins?

A

LFts at baseline

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21
Q

pregnancy category for statins?

A

X

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22
Q

which statins can you take any time of the day?

A

crestor
lipitor
livalo
pravachol

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23
Q

when should you take simvastatin?

A

take at bedtime because that is when hormones are made

24
Q

when should you lower doses for statins in renal impairment?

A

if clcr < 30ml/min
except lescol if <60ml/min
no dose adjustment for lipitor

25
Q

which two statins have the most first pass CYP3A4 metabolism?

A

simvastatin and lovastatin

26
Q

what is the dose of simvastatin that should not be used and why?

A

simvastatin 8mg /day dues to increased risk of myopathy

27
Q

with which medications should you not exceed simvastatin 10mg?

A

verapamil
diltaizem
dronadarone

28
Q

with which medications should you not exceed simvastatin 20mg ?

A

amiodarone
amlodipine
ranolazine

29
Q

which medications are contraindicated with atorvastatin?

A

tipranavir plus ritonavir
telaprevir
cyclosporine

30
Q

which medications are contraindicated with simvastatin and lovastatin (most common)

A

HIV protease inhibitors
cyclosporine
erytrhomycin
itraconazole/posa/keto/voriconazole

31
Q

signs and symptoms of liver damage?

A 
brown or dark colored urine
pale stools 
tirnedess 
yellow eyes
yellow skin
32
Q

MOA of ezetemibe?

A

inhibits cholesterol abosorption in the small intestines

33
Q

ezetemibe effect on cholesterol types

A

dec LDL 18-23%
inc HDL 1-3 %
dec TG 8-10%

34
Q

side effects ezetemibe?

A

diarrhea
arthralgias/myalgias
pain in extermities
URTIs

35
Q

DDI ezetimibe

A

cyclosporine (inc c level)

bile acid binding resins dec zetia sep by 4-6 hrs

36
Q

moa of bile acid binding resins?

A

bind bile acids and form a complex that is excreted in the feces. SO the body has to make more blie acids which dec LDL

37
Q

BABR effect on cholesterol types?

A

dec LDL 10-30%
inc HDL 3-5 %
no change or inc in TG! 5%

38
Q

contraindications for colesevelam ?

A

bowel obstruciton
TG > 500mg/dl
hisytory of hypertriglyceridemia induced pancreatitis

39
Q

side effects of BABR?

A 
constipation (reduce dose or laxative )
dyspepsia
abdomina pain 
crapmping , gas , bloating
* less GI side effects with Welchol)
40
Q

pregnancy category of welchol

A

B

41
Q

pregnancy category of colestipol and cholestyramine?

A

C

42
Q

which drugs should be taken 4 hours before welchol?

A

pheytoin
levothyroxine
glyburide
oral contraceptives E+P

43
Q

how do you separate Niaspan from BABRs?

A

take niaspan 4-6 hours later

44
Q

for questran or colestipol, when should you take all other meds?

A

all others can be taken 1 hour before BABRs or 4-6 hours after BABRs

45
Q

which vitamins can you potentially be deficient with BABRs?

A

ADEK the fat soluble type

46
Q

what is the MOA of Fibrates?

A

PPAR alpah activation which leads to decreased levels of VLDL. This causes a decrease in TGs and an increase in HDL

47
Q

fibrates effect on types of cholesterol?

A

TG lowering 20-50%
ince HDL 15%
dec LDL 5-20% unless TG are high in which in that case LDL will actuall increcase

48
Q

when are fibrrates contraindicated?

A

severe liver disease
severe renal disease
gallbladder disease
nursing modther

49
Q

side effects of fibrates?

A

increase LFTs
incerase CPK, myopathy
abdomina pain, dyspepsia, constipation
hypothyroidism

50
Q

pregnancy category of fibrates?

A

C

51
Q

which is the only fenofibarre that has the indication to be used with a statin?

A

Trilipix

52
Q

which is the only fibrate you need to take twice daily?

A

Lopid takes twice daily 30 minutes before breakfast and dinner

53
Q

which fibrates brands require you take with food?

A

Fenoglide
lofibra
lipofen
once daily with food

54
Q

what is the MOA of niacin

A

decrease the rate of synthesis of VLDL (which decreases TG) and LDL. May also increase removal of TG by chylomicrons

55
Q

what are the three formulations of Niacin?

A

Niacor OTC immediate release
Niaspan Extended release niacin
Slo-niacin Sustained Release

56
Q

Are the niacin formulations interchangeable?

A

no

57
Q

what effect of niacin on different cholesterol types?

A

dec LDL 5-25%
inc HDL 15-35%
dec TG 20-50%

Board Review (65 decks)

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