Dyslipidemia and Stroke

Question 1

In general, when should anti lipids be started?

Answer 1

7.5% risk or greater of CV event

Question 2

What meds can cause dyslipidemia

Answer 2

Steroids, thiazide diuretics, estrogen, anabolic steroids, cigarette smoking, alcohol

Question 3

What diseases can cause dyslipidemia?

Answer 3

DM, hypothyroidism, nephrotic syndrome, ESRD, Cushing’s syndrome

Question 4

Exam findings for dyslipidemia

Answer 4

Corneal arcus, xanthelasmas around eyes and tendons. Also check bruit

Question 5

Labs for dyslipidemia?

Answer 5

Renal, LFTs, CK, TSH,

Question 6

When to start high intensity treatment for dyslipidemia?

Answer 6

1. Patients with atherosclerotic CV disease

2. patients with LDL > 190

Question 7

When to start low intensity treatment for dyslipidemia?

Answer 7

1. DM with LDL 70-189

2. No CVD or DM, but 10 year risk of 7.5% or greater

Question 8

Statins: intensities, side effects, and caution and other medication

Answer 8

• Atorvastatin 40-80, low 10-20
• Rouvastatin (half of Atorvastatin dose)
• Decreases LDL, Trigly, increases HDL
• Myositis and LFTs
• Don’t use with gemfibrozil

Question 9

Bile Acid Sequesterants- names, affect on lipids, and contraindications

Answer 9

• (chols)-Cholesytyramine, colesevelam
• Decrease LDL, incr HDL, Marginal effect on triglycerides
• Don’t use if trig >300
• Don’t give with other medications

Question 10

Cholesterol absorption Inhibitor: name, action/result, drugs to monitor, and adverse effects

Answer 10

• Ezetimibe
• Decreaes LDL
• Monitor warfarin
• May increases LFTs x3

Question 11

Omega 3 Fatty Acids

Answer 11

Decrease triglycerides

Question 12

What might Niacin do, and contraindications?

Answer 12

• Hyperglycemia (Ok for A1C <7), hyperuricemia
• flushing- give ASA
• Contraindicated in PUD, GI disease, liver disease

Question 13

Risk factors for Stroke?

Answer 13

Stress, no physical activity, high homocysteine, carotid artery stenosis, TIA, anterior MI, long term oral anticoagulants, aortic wall plaques

Question 14

Assessment for Stroke?

Answer 14

Pregnancy, carotid bruit, heart sounds, valvular disorder

Question 15

Differential diagnosis of stroke?

Answer 15

SAH, brain absess, pseudo tumor cerebri, carotid artery dissection, encephalitis, TIA, encephalitis, syncope, intoxication, conversion disorder, migraine, bell’s palsy

Question 16

When do you treat carotid stenosis?

Answer 16

If there is > 50% blockage

Question 17

What meds should patients be on after ischemic stroke?

Answer 17

Aspirin and plavix, smoking cessation

Question 18

What additional labs can help with decisions on when to start lipid therapy?

Answer 18

CRP >2
CT Calcium Score > 300
Homocysteine level

Question 19

Who do you refer familial hypercholesterolemia to?

Answer 19

Endocrinologist

Question 20

What medication is a good alternative for patients who can’t handle high dose statins?

Answer 20

Pravastatin, it’s water soluble

Question 21

What lab to not forget when starting someone on a statin?

Answer 21

Initial CK

Question 22

How much does high and low intensity drop statins?

Answer 22

High = >50%
Low= 30%

Question 23

Side effects of statins? (x3)

Answer 23

Memory loss, increase risk of DM, myopathy and hepatic injury.

Question 24

Metabolic syndrome, need 3 out of the 5

Answer 24

1. Abdominal Obesity (men 40, women 35), 2.Tryglicerides >150
2. Low HDL
3. Hypertension- 135/85;
4. Fasting glucose >110

Question 25

When do you start screening for hyperlipidemia?

Answer 25

20 years old

Question 26

When do you treat hypertriglyceridemia? And why?

Answer 26

When they are over 500, to prevent pancreatitis

Question 27

What else can you use bile acid sequesterants for besides hyperlipidemia?

Answer 27

Parities from cholestatic disease or biliary obstruction

Question 28

What medication should you give with statins and why?

Answer 28

Gemfibrozil- may increase risk for rhabomyolisis