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Advanced pharmacology > Dyslipidemia /HTN > Flashcards

Dyslipidemia /HTN Flashcards

1
Q

Dyslipidemia

A

Elevation of plasma chol , triglyceride or both or a low high density lipoprotein that contributes to the development of atherosclerosis

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2
Q

LDL

A

Bad cholesterol … want this to be low < 100 ( less than 70 w/ heart disease or DM)

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3
Q

HDL

A

Good cholesterol … want this to high

40-60

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4
Q

Goal total cholesterol

A

< 200 mg/dL

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5
Q

Goal triglycerides

A

< 150 mg/dL

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6
Q

Non-pharm treatment for Dys

A

Always first step prior to medication

Heart - healthy diet ( avacado, almonds and blueberry) , regular exercise, avoid tobacco or smoking , weight loss

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7
Q

Treatment for children and aldolesence

A

Initial : lifestyle changes

Statins 1 st line agent in 10 years and older

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8
Q

Treatment for preg/ lactation

A

Statin therapy CONtRAindicated

Zétia ( C)

Discouraged in lactation

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9
Q

Tx in older pt

A

Age not a factor, depends on how long you expect them to live

Limited lifespan = do NOT initiate therapy

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10
Q

Primary prevention

A

Reduces the risk of MI and HF decreases the need for coronary procedures and improves quality of life

( before an event)

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11
Q

Secondary prevention

A

Clinical atherosclerotic cardiac disease already present or prevention of a second attack

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12
Q

Corner stone therapy

A

Lifestyle modification through weight loss , aerobic exercise and eating diets low in saturated fats

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13
Q

CVD risk Schemes ( big difference between prior to 2013 and after 2013)

A

Fasting lipids assess adherence / therapeutic response ( non-statin therapy discouraged due to lack of evidence)

You want a percentage decreased not exacting aiming at a number

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14
Q

Treatment for secondary prevention pt with ASCVD

A

< 75 yrs old = high intensity statin

> 75 yrs old = moderate in intensity statin

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15
Q

Tx for primary prevention pt with LDL > 190

A

High intensity statin

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16
Q

Primary prevention pt wit dm ( age 40-75) LDL 70-189

A

Moderate intensity statin unless ASCVD risk > 7.5 %

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17
Q

Tx with primary prevention pt when you assess there ASCVD score

A

> 7.5 high intensity statin

> 5 <7.5 moderate intensity stain

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18
Q

Statins ( decrease LDL)

A

Crestor, Lipitor, zocor,

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19
Q

Fibrates

A

Decrease TG and increase HDL

Ticor

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20
Q

Bile acid sequestrants

A

Decrease LDL

Questran

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21
Q

Nicotinic Acid Derivates

A

Decreases TG

Niacin

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22
Q

Omega 3 fatty acids

A

Decrease TG , last line

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23
Q

Selective cholesterol absorption inhibitors

A

Decrease LDL, TG and increase HDL

Zetia

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24
Q

PCSK9 inhibitors

A

Decrease LDL ( last line due to injection)

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25
Q

Statins ( background)

A

Competitive inhibitors of HMG CoA reductase - the limiting step in cholesterol biosynthesis - thus removing LDL from the blood

Cholesterol synthesis occurs at nigh so take shorter half live statins at night ( take longer acting during day)

Adverse: muscle aches, myopathy, rhabdo, bloating

Monitor: CK, LFTS,

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26
Q

High intensity statin

A

Decrease LDL by > 50 %
Lipitor 40-80mg
Crestor 20-40

27
Q

Moderate intensity statin

A

Daily dose lowers LDL by 30-50 %

Lipitor 10-20 mg

28
Q

Low intensity statin

A

Daily dose lowers LDL by < 30 %

Simvastatin 10 mg

29
Q

Non statin therapy

A

Addition of non statin chol lowering agent when max intentsity agent who has less than anticipated response

Can use Niacin, BAS, omega 3

30
Q

Lowering dose criteria

A

LDL < 40 on 2 consective checks

31
Q

Statin big adverse effect

A

Muscle events

32
Q

Myalgia

A

Similar to influenza aches and pain, involves muscle discomfort, ( CK WNL)

33
Q

Myopathy

A

Muscle weakness not due to pain ( w/ or w/o CK elevation)

34
Q

Myositis

A

Muscle inflammation

35
Q

Myonecrosis

A

Elevation in muscle enzyme compared with baseline

36
Q

Clinical rhabdomyolysis

A

Myonecrosis w/ myoglobinuria or acute renal failure

37
Q

Management of statin associated myopathy

A

Stop statin and have CK go back to normal
( fluvastatin and pravastatin - lowest risk of statin myopathy )

Check for drug interaction

Start on fluvastatin or pravastatin

38
Q

Hypertension definition

A

Based upon the average of 2+ readings at each of the two or more office visits after initial screening
( normal 120/80)

39
Q

Stage one HTN

A

130-139/ 80-89

40
Q

Stage two HTN

A

140-149/90

41
Q

Isolated systolic / diastolic HTN

A

> 130/ < 80

< 130/>80

42
Q

HTN emergency

A

Diastolic >110

43
Q

HTN risk factors

A

Age ( systolic BP)

Obesity, fam hx, race ( blacks), high sodium, alcohol consumption, dm and dyslipidemia

44
Q

Blood pressure goals ( general, >60, <60, CKD/DM, >18 w/ dm or CKD)

A

General : <140/90
> 60 : 150/90
CKD/DM : <130/80
>18 with dm or CKD < 140/90

45
Q

Drug treatment titration strategy

A
  1. Max first med before adding a second or ADD second med before reaching max dose of first med OR start with 2 medication classes or as a fixed dose combination
46
Q

JNC 8 initial drug recommendations

A

Non blacks : TD, ACEI, ARB, CCB ( alone or combined )

Blacks : TD or CCB

CKD pt : ACEI or ARB

NO beta blocker treatment

47
Q

Black population HTN treatment

A

Thiazide Diuretics and CCB’s are shown better efficacy as mono therapy

NO longer ACEI or ARBS - increases fluid overload

48
Q

Thiazide Diuretics

A

HCTZ, Metolazone,

Monitoring parameters: K ( decreases) Ca ( increases) NA ( decreases ) increased (Scr), increased glucose

Weight and blood pressure

Given once daily ( don’t give at night)

49
Q

Ace inhibitors

A

Lisinopril, captopril ( PRIL)

Monitoring : K increases Scr increases

  • check 1-2 week after initation
  • cough and angioedema, AKI
50
Q

Angiotensin receptor blockers ( ARBS)

A

Losartan, Valsartan (ARTAN)

Monitoring: increased K and Scr, angioedema (less)

51
Q

CCB

A

Dihydropyrodines (HTN)
- amlodipine (DIPINE)

Non-Dihydropyridines ( rate control )
- verapamil / diltiazem ( concern for heart black ) (don’t use in HF)

Monitoring: peripheral edema, reflex tachycardia, HA

52
Q

2nd line agents for HTN

A 
Potassium sparing diuretics 
Beta-blockers
Alpha 1 blockers
Central acting agents 
Direct vasodilators
53
Q

Potassium sparing diuretics

A

Spironolactone

Monitoring : increased K ( caution in dual use with ACEI/ARB arrthymias

Gynecomastia in men

54
Q

Beta blocker ( last line)

A 
Metoprolol succinate ( QD)
Metoprolol tartate (BID)

(LOL)

Uses : use with combined CHF or CVD, dresses HR > BP effects , caution for bronchospasm (COPD/ASTHMA)

Rebound HTN may happen with rapid d/c

55
Q

Alpha 1 blockers

A

Terazosin ( ZOSIN)

Use with cormorbid BPH
Adverse: orthostatsis, reflex tachy, dizziness, peripheral edema

56
Q

Centrally acting agents

A

Clonidine ( available in once a week patch called Catapres)

Adverse: rebound hypertension, sedation, dry mouth, impotence

57
Q

Direct Vasodilators

A

Hydralazine

Monitoring : reflex tachy , helps with HF and Minoxidil helps with getting rid of excess fluid

58
Q

Dose adjusting and monitoring

A

If BP not reached after 4 weeks of initation therapy —> increase dose of drug or add a second ( 1st line agent ) from a different class

If BP goal is not achieved with 2 agents —> dada 3rd recommended agent ( avoid ACEI/ARB combos)

If goal still not consider : patient adherence and dose optimization

Simplify regimens/reduce pill burden to avoid non adherence

59
Q

Resistant HTN

A

BP above goal with > agents from differing classes at optimal dose

Consider white coat hypertension ( most common)

Drug causes : (NSAIDS, stimulants, oral contraceptives,

Consider spironolactone therapy as add on agent

60
Q

Lifestyle modifications and SBP reduction range

A

Weight —> 5-20

DASH eating —> 8-14

61
Q

Treatment for children

A

Ace #1 or ARBS
TD, CCB
Beta blockers no recommended

62
Q

Treatment of HTN in preg

A

ACE and ARBD are CONtRAindicated die to renal abnormalities

Labetalol or Methyldopa

63
Q

Treatment for geriatrics in HTN

A

Therapy requires gently initiation ( risk of falls)

Progress towards goals help preserve cognitive function

Advanced pharmacology (12 decks)

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