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Hpyperlipodemia 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
If myopathy
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
Hypertriglyceridemia
Trglycerides over >200 associated with metabolic syndrome. Genetic predisposition, sedentary lifestyle, type II diabetes, high CHO intake, smoking, and excessive ETOH
27
Greater than >500 triglycerides with low HDL and normal LDL are treated with fish oil
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
Statins and fibrates are not combined
adverse effects could be intensified.
29
Bile acids are used to treat Cholestasis in pregnancy
Fibric acids lower triglycerides and incrase HDL-C but may increase LDL in clients with elevated TG
30
Secondary stroke prevention
``` A= Antiaggregants (aspirin, clopidogrel B= blood pressure-lowering medications C=Cessation of cigaretts D=Diet E=Exercise ```
31
Warfarin
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
Anticoagulation in pregnancy
Heparin-less likely to transfer to fetus
33
Warfarin
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
Plavix
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
Warfarin
If INR over 10 hold the warfarin and give oral Vitamin K.
36
Angina in the outpatient
Nitrates-relax smooth muscle. They decrease myocardial oxygen demand by reducing preload and end diastolic volume
37
Nitroglycerine
a dose of 0.3-0.4 may be repeated three times at 5 inute intervals in acute attackes. Replace every six months
38
Beta blockers
Used for angina. They reduce contractility, blood pressure, and heart rate. Helpful after an MI and for exercise-induced angina
39
Calcium channel blockers
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
Heparin in pregnancy
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
Warfarin VS Pradaxa
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
New Chest guidelines
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
Anti-arrhythmic drugs
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
goals of anti-arrhythmic drugs
establish sinus rhythm, relieve irregular rhythm or prevent additional episodes
45
Actions of drugs for anti-arrhythmic drugs
decrease conduction velocity alter excitability of cardiac cells by changing refractory period suppress abnormal automaticity
46
4 classes of anti-arrhythmic drugs
``` Choice is based on- the specific arrythmia overall risk to health underlying structural heart disease symtoms experienced by client ```
47
Amiodarone-Class III drug
widely used, but potential side effects.
48
Side affects for amiodarone
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
heart failure
caused by hypertension, CAD, odiopathic cardiomyopathy, MI, PE, sepsis
50
Heart failure Stage A
high risk without structural disease-ACEI or ARBs started.
51
Heart failure-Stage B
Structural disease without S/S of HF. | beta blockers added and possible defibrillators may be initiated
52
Stage C heart failure
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
Heart failure Stage D
Refractory HF that requires specialized interventions. Extraordinary measures-heart transplant, chronic inotropes, other drugs
54
Heart failure
Avoid NSAIDS, antiarrhythmics and CCB's
55
For heart failure
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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