Dyslipidemia and Stroke Flashcards
In general, when should anti lipids be started?
7.5% risk or greater of CV event
What meds can cause dyslipidemia
Steroids, thiazide diuretics, estrogen, anabolic steroids, cigarette smoking, alcohol
What diseases can cause dyslipidemia?
DM, hypothyroidism, nephrotic syndrome, ESRD, Cushing’s syndrome
Exam findings for dyslipidemia
Corneal arcus, xanthelasmas around eyes and tendons. Also check bruit
Labs for dyslipidemia?
Renal, LFTs, CK, TSH,
When to start high intensity treatment for dyslipidemia?
- Patients with atherosclerotic CV disease
2. patients with LDL > 190
When to start low intensity treatment for dyslipidemia?
- DM with LDL 70-189
2. No CVD or DM, but 10 year risk of 7.5% or greater
Statins: intensities, side effects, and caution and other medication
- Atorvastatin 40-80, low 10-20
- Rouvastatin (half of Atorvastatin dose)
- Decreases LDL, Trigly, increases HDL
- Myositis and LFTs
- Don’t use with gemfibrozil
Bile Acid Sequesterants- names, affect on lipids, and contraindications
- (chols)-Cholesytyramine, colesevelam
- Decrease LDL, incr HDL, Marginal effect on triglycerides
- Don’t use if trig >300
- Don’t give with other medications
Cholesterol absorption Inhibitor: name, action/result, drugs to monitor, and adverse effects
- Ezetimibe
- Decreaes LDL
- Monitor warfarin
- May increases LFTs x3
Omega 3 Fatty Acids
Decrease triglycerides
What might Niacin do, and contraindications?
- Hyperglycemia (Ok for A1C <7), hyperuricemia
- flushing- give ASA
- Contraindicated in PUD, GI disease, liver disease
Risk factors for Stroke?
Stress, no physical activity, high homocysteine, carotid artery stenosis, TIA, anterior MI, long term oral anticoagulants, aortic wall plaques
Assessment for Stroke?
Pregnancy, carotid bruit, heart sounds, valvular disorder
Differential diagnosis of stroke?
SAH, brain absess, pseudo tumor cerebri, carotid artery dissection, encephalitis, TIA, encephalitis, syncope, intoxication, conversion disorder, migraine, bell’s palsy
When do you treat carotid stenosis?
If there is > 50% blockage
What meds should patients be on after ischemic stroke?
Aspirin and plavix, smoking cessation
What additional labs can help with decisions on when to start lipid therapy?
CRP >2
CT Calcium Score > 300
Homocysteine level
Who do you refer familial hypercholesterolemia to?
Endocrinologist
What medication is a good alternative for patients who can’t handle high dose statins?
Pravastatin, it’s water soluble
What lab to not forget when starting someone on a statin?
Initial CK
How much does high and low intensity drop statins?
High = >50% Low= 30%
Side effects of statins? (x3)
Memory loss, increase risk of DM, myopathy and hepatic injury.
Metabolic syndrome, need 3 out of the 5
- Abdominal Obesity (men 40, women 35), 2.Tryglicerides >150
- Low HDL
- Hypertension- 135/85;
- Fasting glucose >110
When do you start screening for hyperlipidemia?
20 years old
When do you treat hypertriglyceridemia? And why?
When they are over 500, to prevent pancreatitis
What else can you use bile acid sequesterants for besides hyperlipidemia?
Parities from cholestatic disease or biliary obstruction
What medication should you give with statins and why?
Gemfibrozil- may increase risk for rhabomyolisis
