dyslipidemia Flashcards
for how long does a patient need to fast for a lipid panel?
9-12 hours
normal range for LDL
<100 optimal
100-129 near or above optimal
good range for HDL?
> =40 , >=60 high
normal TG level?
<150
normal TC level
<200
Friedewasl equation for LDL
LDL= TC - HDL - TG/5 but cannot use the forumula if TGs are > 400
what are hte CHD risk equivalents?
abdominal aortic aneurysm CAD (MI, ANgina) aortic artery disease peripheral arterial disease diabetes 10 year framingham risk of >20%
major risk factors for CHD? (one point each)
- men >= 45, Women >=55
- cigarette smoking
- > = 140/90 or on HTN meds
- HDL< 40
- First degree male relative with premature CHD < 55 yo, female relative < 65 yo
negative risk factor if HDL >= 60mg/dl
what lifestyle modifications to do for Therapeutic lifestyle changes?
a. Reduced intake of saturated fat (< 25
e. stop smoking
which is the drug of choice for lowering LDL?
statins
what is the drug of choice for inc HDL?
niacin, fenofibrates
DOC lowering TG
Fenofibrates or fish oils
when should you stop cholesterol lowering medications?
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
what is the MOA of Statins
inhibit HMG-CoA reductase which stops conversion of HMG-CoA to mevalonate, which is the rate limiting step in cholesterol synthesis
brand name of pravastatin
pravachol
contraindications of statins?
active liver disease (ie unexplained elevations in liver enzymes)
pregnancy
breast feeding
taking strong cyp3A4 inhibitors
what must you do if a patient has symptoms of muscle damage?
should be seen right away and get a CPK checked
may have statin tstopped or changed
factors that increase risk of myopathy?
higher doses & used of fibrates
age > 65
renal impairment
untreated hypothyroidism
main side effects of statins
myalgias, arthralgias, myopathy inc CPK, rhabdomyolysi cognitive impairment (mem loss confsuion) inc blood glucose, inc a1c inc LFTs
what Labs should you get if patient is starting statins?
LFts at baseline
pregnancy category for statins?
X
which statins can you take any time of the day?
crestor
lipitor
livalo
pravachol
when should you take simvastatin?
take at bedtime because that is when hormones are made
when should you lower doses for statins in renal impairment?
if clcr < 30ml/min
except lescol if <60ml/min
no dose adjustment for lipitor
which two statins have the most first pass CYP3A4 metabolism?
simvastatin and lovastatin
what is the dose of simvastatin that should not be used and why?
simvastatin 8mg /day dues to increased risk of myopathy
with which medications should you not exceed simvastatin 10mg?
verapamil
diltaizem
dronadarone
with which medications should you not exceed simvastatin 20mg ?
amiodarone
amlodipine
ranolazine
which medications are contraindicated with atorvastatin?
tipranavir plus ritonavir
telaprevir
cyclosporine
which medications are contraindicated with simvastatin and lovastatin (most common)
HIV protease inhibitors
cyclosporine
erytrhomycin
itraconazole/posa/keto/voriconazole
signs and symptoms of liver damage?
brown or dark colored urine pale stools tirnedess yellow eyes yellow skin
MOA of ezetemibe?
inhibits cholesterol abosorption in the small intestines
ezetemibe effect on cholesterol types
dec LDL 18-23%
inc HDL 1-3 %
dec TG 8-10%
side effects ezetemibe?
diarrhea
arthralgias/myalgias
pain in extermities
URTIs
DDI ezetimibe
cyclosporine (inc c level)
bile acid binding resins dec zetia sep by 4-6 hrs
moa of bile acid binding resins?
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
BABR effect on cholesterol types?
dec LDL 10-30%
inc HDL 3-5 %
no change or inc in TG! 5%
contraindications for colesevelam ?
bowel obstruciton
TG > 500mg/dl
hisytory of hypertriglyceridemia induced pancreatitis
side effects of BABR?
constipation (reduce dose or laxative ) dyspepsia abdomina pain crapmping , gas , bloating * less GI side effects with Welchol)
pregnancy category of welchol
B
pregnancy category of colestipol and cholestyramine?
C
which drugs should be taken 4 hours before welchol?
pheytoin
levothyroxine
glyburide
oral contraceptives E+P
how do you separate Niaspan from BABRs?
take niaspan 4-6 hours later
for questran or colestipol, when should you take all other meds?
all others can be taken 1 hour before BABRs or 4-6 hours after BABRs
which vitamins can you potentially be deficient with BABRs?
ADEK the fat soluble type
what is the MOA of Fibrates?
PPAR alpah activation which leads to decreased levels of VLDL. This causes a decrease in TGs and an increase in HDL
fibrates effect on types of cholesterol?
TG lowering 20-50%
ince HDL 15%
dec LDL 5-20% unless TG are high in which in that case LDL will actuall increcase
when are fibrrates contraindicated?
severe liver disease
severe renal disease
gallbladder disease
nursing modther
side effects of fibrates?
increase LFTs
incerase CPK, myopathy
abdomina pain, dyspepsia, constipation
hypothyroidism
pregnancy category of fibrates?
C
which is the only fenofibarre that has the indication to be used with a statin?
Trilipix
which is the only fibrate you need to take twice daily?
Lopid takes twice daily 30 minutes before breakfast and dinner
which fibrates brands require you take with food?
Fenoglide
lofibra
lipofen
once daily with food
what is the MOA of niacin
decrease the rate of synthesis of VLDL (which decreases TG) and LDL. May also increase removal of TG by chylomicrons
what are the three formulations of Niacin?
Niacor OTC immediate release
Niaspan Extended release niacin
Slo-niacin Sustained Release
Are the niacin formulations interchangeable?
no
what effect of niacin on different cholesterol types?
dec LDL 5-25%
inc HDL 15-35%
dec TG 20-50%
