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Dermatology > Hpyperlipodemia > Flashcards

Hpyperlipodemia Flashcards

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Dermatology Board Prep flashcards
1
Q

Triglycerides and cholesterol are two most common lipids

A

Transported in blood stream
Elevated cholesterol leads to antherosclerosis
elevated triglycerides leads to pancreatitis.

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2
Q

LDL

A

the bad guys. have holes where cholesterol leaks out into the blood stream.

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3
Q

HDL

A

the good guys- smaller, more compact, tend to accept cholesterol as opposed to giving it up.

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4
Q

VLDL

A

major carrier of endogenousee triglycerides

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5
Q

In patients with diabetes, CAD or occlusive arterial disease simvastatin use ato 40 mg/day reduced MI, stroke and death by 25%

A

WOW

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6
Q

Bile Acid Resins

A

bind bile acids in the small intestine and are excreted.

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7
Q

Bile Acid resins

A

Other drugs must be taken 1 hour before or 4-6 hours after bile sequestrants. May bause deficiency of fat soluble vitamins.

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8
Q

HMG-CoA reductase Inhibitors-statins

A

block an enzyme in the cholesterol synthesis pathway. Contraindicated in pregnancy because women need cholesterol for fetal growth.

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9
Q

Anti-fungals are contraindicated because of drug -drug interaction

A

This is through the CYP450 system.

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10
Q

Elderly and anti fungals

A

If an elder requests and antifungal for nail fungus, look at other options.

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11
Q

Fibric Acid derivatives-gemfibrozil-fenofibrate

A

Alter rate of sythesis of specific lipoproteins. They are used to lower triglycerides. Raises HDL, little effect on LDL

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12
Q

Zocor- Simvastatin

A

Black box warning for more than 80 mg. Causes rhabdomyolosis

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13
Q

Cholesterol absorption inhibitors

A

Ezetimibe (zetia) inhibits absorption of cholesterol in small intestine.

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14
Q

Omega 3 fatty acids

A

little impact on LDL, but lowers triglcerides. Must contain EPA and DHA. No problems unless fish allergy

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15
Q

May 2012

A

check LF at beginning of therapy and then again only if client is symptomatic

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16
Q

Nicotinic Acid derivates

A

No longer used to improve cardiac outcomes

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17
Q

Lipid changes

A

Lifestyle first

but increasing emphasis on pharmacology.

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18
Q

Price differential of statins

A

Rosuvastatin (crestor) is most efficacious but not in generic form yet. Atorvastatin (lipitor) is high effective and now generic.

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19
Q

If simvastatin at 40 mg is not effective switch to a different pill.

A

Atorvastatin or rosuvastatin (crestor)

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20
Q

Statins-1st line tx

A

Do not use if active or chronic liver disease. Could cause myopathy or increased liver enzymes

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21
Q

Bile acid resins-2nd line tx

A

can cause gastrointestinal distress, constipation. Do not take with Dysbetalipoproteinem is TG>400 mg/dl

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22
Q

Nicotinic Acid

A

Would not start a client on this.. Causes flushing and hyperglycemia. Do not take with liver disease or gout

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23
Q

Fibric Acids-Gemfibrozil-3rd line

A

Causes gallstones and do not take with renal disease

24
Q

Selective Intestinal Cholesterol absorption inhibitor-3rd line tx

A

Check on contraindications

25
Q

If myopathy

A

lower dose
change the statin to fluvastatin, pravastatin or low dose rosuvastatin
check for drug interactions
suggest alternate day dosing
Correct Vitamin D levels and assess hypothyroidism
Some cardiologists recommend CoQ10 100-200 mg/day

26
Q

Hypertriglyceridemia

A

Trglycerides over >200 associated with metabolic syndrome. Genetic predisposition, sedentary lifestyle, type II diabetes, high CHO intake, smoking, and excessive ETOH

27
Q

Greater than >500 triglycerides with low HDL and normal LDL are treated with fish oil

A

DHA and EPA and fibrates. Two prescriptions, vascepa & lovaza take at 4g/d. Statins can reduce triglycerides up to 30% if the lcient has elevated LDL. Start with a statin if Triglycerides are less than 500.

28
Q

Statins and fibrates are not combined

A

adverse effects could be intensified.

29
Q

Bile acids are used to treat Cholestasis in pregnancy

A

Fibric acids lower triglycerides and incrase HDL-C but may increase LDL in clients with elevated TG

30
Q

Secondary stroke prevention

A 
A= Antiaggregants (aspirin, clopidogrel
B= blood pressure-lowering medications
C=Cessation of cigaretts
D=Diet
E=Exercise
31
Q

Warfarin

A

Prevents blot formation after a-fib, valve replacement, post-op
INR should be between 2-3
Dosage lowered in those with CHF, Malnourished and the elderly

32
Q

Anticoagulation in pregnancy

A

Heparin-less likely to transfer to fetus

33
Q

Warfarin

A

Monitor every 3 days until appropriate level is reached
Monitor liver function
watch for drug-drug interaction
Watch for changes in INR
Patient should avoid-brocolli, greens and other vitamin K sources, don’t use an electric razor, no ASA or NSAIDS, monitor bleeding, wear bracelet

34
Q

Plavix

A

Added to aspirin therapy but evidence does not support its efficacy over taking aspirin without clopidogrel. Very expensive and metabolized through the CYP 450 system so poor metobolizers will see little benefit.

35
Q

Warfarin

A

If INR over 10 hold the warfarin and give oral Vitamin K.

36
Q

Angina in the outpatient

A

Nitrates-relax smooth muscle. They decrease myocardial oxygen demand by reducing preload and end diastolic volume

37
Q

Nitroglycerine

A

a dose of 0.3-0.4 may be repeated three times at 5 inute intervals in acute attackes. Replace every six months

38
Q

Beta blockers

A

Used for angina. They reduce contractility, blood pressure, and heart rate. Helpful after an MI and for exercise-induced angina

39
Q

Calcium channel blockers

A

Promote artierial vasodilation, which decreases demand by decreasing afterload. They decrease vasospasm and enhance diastolic relaxation of the LV. They reduce symptoms, but not shown to reduce morbidity or mortality

40
Q

Heparin in pregnancy

A

Category C, Risks are more maternal and not fetal. Prevents VTE and DVT and PE
Intrapartum requires a anesthesia consult
Often warfarin will be started 6 weeks postpartum

41
Q

Warfarin VS Pradaxa

A

BID drug for hrombus formation. No INR needs to be done, gerat with a-fib, does not go through CPY450 system, great for lowering stroke.
No antidote and is very expensive

42
Q

New Chest guidelines

A

Brilinta (ticagrelor) over clopidogrel (plavix)
with ASA after acute coronary syndrome. More effective than Plavix. reduced bleeding risk. Take with 81 mg ASA.
Plavix will be generic soon and requires once a day dosing

43
Q

Anti-arrhythmic drugs

A

Arrhythmias are an abnormality in the impulse or a conduction problem or both. Conduction problems are caused by a block or reentry (most common)

44
Q

goals of anti-arrhythmic drugs

A

establish sinus rhythm, relieve irregular rhythm or prevent additional episodes

45
Q

Actions of drugs for anti-arrhythmic drugs

A

decrease conduction velocity
alter excitability of cardiac cells by changing refractory period
suppress abnormal automaticity

46
Q

4 classes of anti-arrhythmic drugs

A 
Choice is based on-
the specific arrythmia
overall risk to health
underlying structural heart disease
symtoms experienced by client
47
Q

Amiodarone-Class III drug

A

widely used, but potential side effects.

48
Q

Side affects for amiodarone

A

Hypothyroidism due to high iodine content-ck TSH
pulmonary toxicity-both as an acute reaction or pulmonary fibrosis development (this is the most lethal)
hepatotoxicity-montior LFTS
reversible slate blue of skin
photosensitivity-use sunblock
corneal deposits (does not affect vision)

49
Q

heart failure

A

caused by hypertension, CAD, odiopathic cardiomyopathy, MI, PE, sepsis

50
Q

Heart failure Stage A

A

high risk without structural disease-ACEI or ARBs started.

51
Q

Heart failure-Stage B

A

Structural disease without S/S of HF.

beta blockers added and possible defibrillators may be initiated

52
Q

Stage C heart failure

A

tructural with prior or current symtoms of HF.
Salt restriction, diuretics added to ACE and beta blockers. Also aldosteroine antagonists, ARBS, digital, hydralazine/nitrates

53
Q

Heart failure Stage D

A

Refractory HF that requires specialized interventions. Extraordinary measures-heart transplant, chronic inotropes, other drugs

54
Q

Heart failure

A

Avoid NSAIDS, antiarrhythmics and CCB’s

55
Q

For heart failure

A

Diuretics reduce edema through reduction of blood volume
Hydralazine (for preload and afterload)
Inotropic agents-restore organ perfusion and reduce congestion
antiplatelet agents-ASA, ticlopine, clopidogrel
beta blockers-for LVEF improvement, arrhythymia prevention
ACEIs/ARBs for vasodilation, and LVEF improvement
digoxin-canse cause sm. increase cardiac output

Dermatology (9 decks)

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