HTN + Dyslipidemia Flashcards

Question

HTN Tx Consideration in CKD

Answer 1

Target less than 130/80 Early Tx is key First line Tx: ACEi and ARB. Slows progression of CKD by decreasing glomerular pressure

Answer 2

Target less than 130/80 First Line: ACEi and ARB Caution: BB can mask the symptoms of hypoglycemia

Answer 3

First Line: Labetalol, alpha agonist methyldopa, CCB Nifedipine Contraindication: ACEi, ARB

Answer 4

First Line: ACEi

Answer 5

Umbrella term for lipid disorders e.g. familial hypercholesterolemia, hypertriglyceridemia, mixed hypercholesterolemia, diabetic dyslipidemia

Answer 6

Block effects of aldosterone, regulating sodium and water homeostasis and maintenance of intravascular volume

Answer 7

Complete lipid profile starting at age 20 (then every 5 years) Older than age 40 years, screen every 2-3 years Preexisting hyperlipidemia: screen annually or more frequently EXCEPTION: Homozygous Familial Hypertension (HoFH)

Answer 8

Primarily block the conversion of HMG-CoA to mevalonate, which is the rate-limiting step in the production of cholesterol in the liver. Maximum effects: usually are seen after 4 to 6 weeks of therapy. For this reason, dosage adjustments should not be made more frequently than q 4 weeks.

Answer 9

Good for HTN resistance or primary aldosteronism Spironolactone: Higher dose (150-300mg), androgen blocking effect. Eplerenone: Aldosterone antagonist wo anti-estrogen effect 25mg/d

Answer 10

Hyperkalemia, especially when combined with ACEi or ARB or in excessive diuresis CXN: Renal Impairment

Answer 11

Triglycerides: less than 150

Answer 12

Want LOW. Optimal: less than 100 mg/dL Less than 130 mg/dL for low-risk patients with fewer than two risk factors Very high: greater than 190 Heart disease or DM: less than 100

Answer 13

Want HIGH = Healthy for the HEART Men: Greater then 40 mg/dL Women: Greater than 50 mg/ dL

Answer 14

Action: primarily block the conversion of HMG-CoA to mevalonate, which is the rate-limiting step in producing cholesterol in the liver.

Answer 15

Individuals who have clinical ASCVD (highest risk group) Individuals who do not have ASCVD but have severe hyperlipidemia defined as LDL-C >190 and are 20-75 yrs old Individuals who are 40-75 yrs old with Type I or Type II DM and have LDL-C values of 70-189mg/dL Individuals who are 40-75 yrs old with LDL-C values of 70-189mg/dL and have a 10 year risk of ASCVD of 7.5% or more

Answer 16

Maximum effects are usually seen after 4-6 weeks of therapy. Dose adjustments made every 4 weeks

Answer 17

pregnant and lactating women active liver disease unexplained elevated aminotransferase levels heavy alcohol use. Adverse events: Well tolerated by most patients; myopathies, gastrointestinal (GI) complaints, headache may occur CXN: May increase blood sugar by inhibiting the efficacy of insulin

Answer 18

Acts on the brush border of the small intestine and inhibits the absorption of cholesterol, leading to a decrease in the delivery of intestinal cholesterol to the liver. This reduces hepatic cholesterol stores and increases clearance of cholesterol from the bloodstream Anticipated LDL-C reduction 15-20% (helpful adjunct)

Answer 19

pregnant lactating women active liver disease unexplained elevated aminotransferase levels heavy ETOH use

Answer 20

Receptors on our liver cells primarily sweep away excess cholesterol in our body, but a protein called “PCSK9” blocks this action by destroying the receptors on the liver cells, causing the cholesterol levels to go up. PCSK9 inhibitors attach to this protein and block their action. As a result, more receptors can continue to do their job and this lowers the amount of LDL CHL in the blood.

Answer 21

HA Diarrhea ABD Pain Combination therapy: Myopathy / Rhabdomyolysis

Answer 22

Additional LDL-C ~60% for patients already on an optimized statin therapy Blocking activity of PCSK9 with monoclonal antibodies reduces the degradation of LDL receptors and increases clearance of LDL cholesterol

Answer 23

Heterozygous familial hyperlipidemia or established ASCVD risk wo goal, max statin tolerated statin therapy

Answer 24

ACL enzyme upstream of HMG CoA reductase in CHL synthesis- Inhibition of ACL reduces CHL biosynthesis in the liver and decreases LDL Anticipated LDL-C reduction 18% (helpful adjunct)

Answer 25

LDL reduction of 38% when used maximally with statin

Answer 26

ADE Risk: Monitor uric acid levels /gout flare + tendon rupture risk (older, tendon damage history, concurrent or recent use of FQ).

Answer 27

Typically used as an adjunct to diet to treat adults with severe hypertriglyceridemia or to elevate high-density lipoprotein cholesterol (HDL-C)

Answer 28

Unclear stimulation of lipoprotein lipase, enhancing breakdown of VLDL to LDL CHL Multiple studies (per guidelines) have shown that if TG >500 and low HDL, despite dietary modifications then addition of fibrate to statin may trend toward less CVD events.

Answer 29

Contraindicated with h/o cholecystitis, cholelithiasis, and hepatic or renal disease No studies in pregnant women GI related (epigastric pain, N/V, dyspepsia, flatulence, constipation) Myopathy, Rhabdomyolysis Hepatotoxicity Cholestatic jaundice Anemia / thrombocytopenia

Answer 30

Decrease VLDL synthesis in the liver, inhibit lipolysis in adipose tissue, increase lipoprotein lipase activity. This decreases TG and LDL CHL in the bloodstream HDL may be increased by up to 35%

Answer 31

Hepatic dysfunction Severe Hypotension Persistent hyperglycemia Acute gout New onset AF Active peptic ulcers WORSEN GLUCOSE CONTROL

Answer 32

Pruritus Flushing of face and neck Increase uric acid Worsen glucose control GI side effects - not in pts with active ulcer Hepato-toxicity Acanthosis Nigricans (hyperpigmentation of the skin)