Dyslipidemia Cards Flashcards
The calculation for ASCVD score is based off of what factors?
Race, gender, age, total cholesterol, HDL level, systolic blood pressure, use on anti-hypertensive therapy, presence of diabetes, and smoking status.
Metabolic syndrome is characterized by which things
Abdominal obesity, glucose intolerance, insulin resistance, hyper insulinemia, dyslipidemia, and hypertension
Total cholesterol level should be below what number?
Less than 200
What is the normal range for triglycerides?
150-199 is normal
What is considered low for hdl? 
Less than 40
Which drugs can cause lipid abnormalities? Name some classes
Thiazide diuretics, corticosteroids, beta blockers, anti-HIV protease inhibitors, isotretinoin, and growth hormone
What are the two functions HDL lipoprotein has on the body?
It removes excess cholesterol from blood vessels and transports it back to the liver which is excreted through the bile.
And it blocks oxidation of LDL which inhibits atherogenesis
Atherogenesis is mediated by which lipoprotein?
LDL, small particles migrate to inflame regions of the blood vessel where they are oxidize inform fatty streaks and plaques.
On physical exam what may be present indicating dyslipidemia?
Yellow skin deposits of cholesterol called xanthomas around eyelids or a carotid bruit
Alcohol abuse can have what effect on triglycerides, HDL, and total cholesterol?
increase triglycerides, lower HDL, an increase total cholesterol
Having hypothyroidism affects total cholesterol and triglycerides how?
Both are increased
For a triglyceride level that’s 1000 what is the concern?
Pancreatitis, aggressively attempt to lower the triglyceride level to prevent that from happening
What is the physical exam sign for the eye that you may see in a patient with hypercholesterolmia?
Corneal arcus 
Eruptive xanthomas can occur where?
There a 6, name a few
Can occur on buttocks, back, tendons of hands, Achilles’ tendon, insertion of patellar tendons, skin around eyes
Orange Palmer creases is associated with what?
Hyperlipoproteinemia
What is a coronary artery calcium score?
Measurement of calcified plaque in coronary arteries as determined from cardiac CT scan
Measurement of calcified plaque in coronary arteries as determined from cardiac CT scan
If the coronary artery calcium score is from one to 99 what is the recommendation?
Score = 1 to 99: initiate statin therapy for patients aged 55 years or older
What elevation in a lipid panels is associated with pancreatitis?
Elevated triglyceride levels
High intensity statins reduce LDL-C levels by how much?
50% or more
Moderate intensity statins reduce LDL-C levels by how much?
Lower LDL-C levels by 30 to 49%
Low intensity stands lower LDL-C levels by how much?
Less than 30%
An LDL that is considered optimal is less than what?
Less than 100
Patients very high risk meaning they’ve already had a ASCVD event and have multiple high-risk conditions, they should be on a high intensity Statin and what other medication?
Ezetimibe 
What lab should be checked before starting a statin medication?
Measure baseline hepatic function or LFTs
In which patient situation should a moderate Statin be used instead of a high intensity Staten?
If patients have multiple or series comorbidities including impaired renal or hepatic function, history of previous Statin intolerance or muscle disorders, unexplained serum ALT elevations two more than three times the upper limit, use of drugs that affect certain metabolism, and older than 75 years old
Name a cholesterol absorption inhibitor drug
Ezetimibe
What is the mechanism of action of Ezetimibe?
Blocks intestinal absorption of cholesterol
What kind of pts should receive Ezetimibe?
It’s indicated for pts who are intolerant of statins, also in pts who require additional LDL-c lowering despite maximally tolerated statin therapy, those who have Sitosterolemia
What’s the standard dose for Ezetimibe?
10mg po daily
Cholestyramine, colestipol, colesevelam are apart of what class of medications?
Bile acid sequestrants
What is the mechanism of action of bile acid sequestrants?
Promotes LDL-c clearance from plasma
Gemfibrozil, Fenofibrate, lofibra are apart of what class of medications?
Fibric acid derivatives (fibrates)
Which fibric acid derivative should be avoided if a patient is already on a statin medication?
Gemfibrozil
Increase risk of myopathy
What is first line therapy for severe hypertriglyceridemia?
Fibric acid derivatives (fibrates)
For the physical activity recommendation, patient should engage in how many minutes per week of moderate intensity physical activity?
150 minutes per week
For the physical activity recommendation, patients should engage in how many minutes per week of vigorous intensity physical activity should be done?
75 minutes
For dietary changes, patient should replace saturated fat with what?
Polyunsaturated data as it can help lower risk of cv disease
What would be an indication to receive a LDL apheresis?
Coronary heart disease, severe hypercholesteremia, In an LDL-c above 200 despite maximum extent of drug therapy
For patients with diabetes at age 40 to 75 without ASCVD, what is the recommendation for statin use? 
Moderate intensity Statin
For patients with diabetes that have a known ASCVD, what is a recommendation for level of statin medication?
High intensity statin medication
For patients that are older than 75 years old with diabetes and have ASCVD that are intolerant of high intensity Statins, what is the recommendation?
Combination therapy of moderate statin (simvastatin) and Ezetimibe (cholesterol absorption inhibitor)
In adults ages 20-39 yrs, it’s reasonable to start moderate intensity statin therapy if any of the following exist:
Long duration of Diabetes (dmt1 for 20yrs, dmt2 for 10yrs)
Albuminuria (30mcg or more of albumin per mg creatinine)
EGFR less than 60
Retinopathy
Neuropathy
Ankle brachial index less than 0.9
What is the recommendation for pregnant patients when it comes to all lipid lowering therapy? 
Advised to discontinue all lipid lowering medications except bile acid sequestrants immediately
For patients are planning to be pregnant when should they discontinue lipid lowering drugs with the exception of bile acid sequestrants?
At least one month and preferably three months before attempting to become pregnant
When can patients resume Statin therapy and Ezetimibe therapy after pregnancy?
After patients stop breast-feeding they can resume Statin and Ezetimibe therapy
What is the recommendation to measure a lipid profile after initiating Statin therapy?
Measure a lipid profile 4 to 12 weeks
What is the recommendation to measure a lipid profile after a patient has been on it for a while?
Every 3 to 12 months there after
The American College of cardiology/American heart Association recommend screening how often after age 20 as part of overall Cardiac risk assessment?
Once every 4 to 6 years after age 20
How often should you screen patients with diabetes and male and female patient older than 65?
Annually screen
For a patient with an LDL-C greater than 190, and over the age of 21, What level of Statin therapy should the patient get?
High intensity Statin 
In a diabetic patient that is age 40 to 75 years of age and has an LDL between 70 to 189, what level of statin therapy should this patient get?
Moderate intensity statin
In a diabetes patient that is age 40 to 75 years and has an LDL of 72 189 with an estimated ASCVD score of 7.5%, What is the recommended Statin therapy?
High intensity statin therapy
In patient that has no diabetes, aged 40 to 75 years of age and an LDL level of 70 to 189, what is the recommended treatment if ASCVD score is less than 7.5%, what is the recommendation?
Not receiving statin, estimate risk every 4-6 years
Statin therapy is not routinely recommended for individuals with NYHA, what type of heart failure?
In class 2–4 heart failure or who are receiving maintenance hemodialysis
In patient that has no diabetes and has an LDL level greater than 190, what is the recommended treatment?
High intensity Statin
In adult’s older than 21 years of age with a primary LDL greater than 190, do they need a ASCVD risk test before starting statin therapy? What type of statin?
Use high intensity Statin therapy unless contraindicated. 10 yr ASCVD risk estimation is not required.
Is it reasonable to offer treatment with a moderate intensity stand to adults 40 to 75 years of age, with an LDL of 70 to 189 without clinical ASCVD or diabetes and an estimated 10 year ASCVD risk score 5%- (less than) 7.5%?
Yes
Are there any recommendations regarding the initiation or discontinuation of statins in patients with NYHA a class 2 to 4 ischemic Systolic heart failure or in the maintenance hemodialysis?
There is no recommendation.
What type of medication’s increase LDL levels?
Diuretics, cyclosporine, glucocorticoids, amiodarone.
What lab should not be routine he measured individual receiving Statin therapy?
Creatinine kinase (CK)
It is reasonable to test for individuals believed to be at increased risk adverse muscle events because of personal or family history of stone intolerance or muscle disease, anything that might increase the risk of myopathy. It is reasonable to measure Secane individual of muscle symptoms including pain, tenderness, stiffness, cramping, weakness or generalized fatigue
What liver test should be performed before initiating Statin therapy?
ALT (hepatic transaminase)
If 2 consecutive values of LDL levels are lower than 40, what should the practitioner consider doing if a patient is on Statin therapy?
Decreasing the statin dose should be considered
What are the four labs involved in initial evaluation for statin initiation?
Fasting lipid panel
ALT
Hemoglobin A1c
CK
If unexplained severe muscle symptoms or fatigue develop during Statin therapy, what should you do?
Discontinue Statin, address possibility of rhabdomyolysis and evaluate CK and creatinine and perform urinalysis for myglobinuria
If there is a mild to moderate muscle symptoms of a patient that is on Statin therapy, What is the next step?
Discontinue the Statin until symptoms can be evaluated, evaluate for other possible conditions, if muscle symptoms resolve and no contraindication exists give the patient the original or a lower dose of the same Statin to establish a casual relationship between the muscle symptoms and Statin therapy. If a casual relationship exists discontinue the original Statin once muscle symptoms resolved use a low-dose or a different one. Once a low-dose of a statin is tolerated, gradually increase the dose as tolerated.
The lipid guidelines apply to patients what of age?
Age 21 years or older
What are the four questions to help identify patients who are eligible to receive stands?
1.) Does a patient have clinical ASCVD including any of the following acute coronary syndrome, history of MI, Stable/unstable angina, coronary revascularization, stroke, TIA, PAD.
2. Does the patient have an LDL level greater than or equal to 190 without treatment?
- ) Is the patient 40 to 75 years of age? Do they have diabetes?
- ) Is a patient 40 to 75 years of age? Is the patient’s ten-year risk of CV events greater than or equal to 7.5%?
What are the two high intensity statins? Doses?
Atorvastatin 40-80 mg
Rosuvastatin 40 mg
If after quantitative risk assessment, a risk based treatment decision is uncertain, assessment of one or more of the following may be considered to inform treatment decision making, what are the four?
Family history, high sensitivity CRP, CAC (calcium) score, or ankle brachial index
What is the greatest endorsement to utilize after quantitative risk assessment provides uncertainty? 
The greatest endorsement is for calcium score.
What is the CRP cut point?
It is 2 mg/L
The calcium score cut point is what? Remember it is in Agatston units
The calcium score cut point is 300 agatston units 
What do they recommend against for measurement in intermediate risk tiebreakers?
They recommend against carotid intima-medial thickness
