HTN, dyslipidemia, and obesity Flashcards
when to refer for hypertension and dyslipidemia
- no formal diagnosis
- no visit to PCP in last year
- nonadherence to medications
- perception that Rx medications are ineffective
- use of dietary supplements without PCP knowledge
- concurrent medication
medications that can worsen HTN
amphetamines, decongestants, erythropoietin, estrogen derivatives, nicotine, NSAIDs, corticosteroids, venlafaxine
lifestyle habits that can worsen HTN
increased caffeine, sodium, alcohol intake, decreased physical activity, and tobacco use
DASH diet reduces systolic by
8-14 mmHg
reducing weight reduces systolic by
5-20 mmHg
increase in physical activity reduces systolic by
4-9 mmHg
reduce intake of dietary sodium reduces systolic by
2-8 mmHg
consuming alcohol in moderation reduces systolic by
2-4 mmHg
non pharm treatment for pts w dyslipidemia
exercise, diet, smoking cessation, and limiting alcohol consumption
who should not be doing home cholesterol tests
excessive bleeding from a finger stick can occur in patients who have coagulation disorders or use anticoagulants, do not recommend for pt who have health insurance or see PCP annually
who benefits from home cholesterol tests
more beneficial for those who don’t have insurance, those who don’t see PCP annually, or who have high cost or no lab coverage
fish oil MOA
reduce intestinal absorption of cholesterol and inhibit VLDL –> reduction of TG synthesis in liver –> reduce concentration of TG
fish oil therapeutic uses
lower TG levels (25-50%), hyperlipidemia, CAD, HTN, and inflammatory conditions
dosing of fish oil
1-2g per day, for TG lowering 2-4g per day
common AE of fish oil
fishy smell, fishy burps, and/or upset stomach
doses of fish oil up to ______ considered safe in patients with anticoags
3g/day
therapeutic use of red yeast rice
mainly lowers LDL with some effect on TG, improves indigestion and blood circulation
MOA of red yeast rice
composed of monacolins which inhibit HMGCoA reductase
dosing of red yeast rice
1.2 to 2.4g/day in two divided doses with food
ADE of red yeast rice
allergic reactions, headache, and GI upset
red yeast rice may cause
elevated liver enzymes or rhabdomyolysis similar to statins
alcohol > 2 drinks/day and red yeast rice
increased risk of hepatotoxicity
pregnancy and red yeast rice
category X
therapeutic uses for niacin
dyslipidemia, hypertriglyceridemia
MOA of niacin
inhibits mobilization of FFA from fat tissue to the liver –> reduce VLDL –> reduction in LDL and TG levels and increase HDL levels
dosing of niacin
1-3 g/day typically divided; start at lower dose and titrate
side effects of niacin
Flushing (IR > ER > SR)
hyperglycemia (SR > ER > IR)
hepatotoxicity (SR > ER > IR)
GI symptoms
contraindications of niacin
liver disease, active peptic ulcer
co-enzyme Q10 therapeutic use
heart failure, cardiomyopathy, HTN, antioxidant, statin-related myopathy
MOA of Q10
involved in many energy production functions. also involved with regeneration of antioxidants such as vitamin E, stabilizes membranes and may have vasodilator and inotropic effects
typical dosage of coQ10
100mg dosed 1-3 times daily
side effects of coQ10
nausea, GI upset, headache
BMI
< 18.5
underweight
BMI
18.5-24.9
normal
BMI
25.0-29.9
overweight
BMI
30.0-34.9
class I obesity
BMI
35.0-39.9
class II obesity
BMI
40 or higher
class III obesity
exclusions for obesity
- BMI 40 or higher
- pregnancy or breast-feeding
- < 18 y/o OR > 65 y/o
- CV disease, diabetes, hypertension, dyslipidemia
- eating disorders
non pharm treatment for obesity
caloric restriction, dietary changes, altered proportions of food groups/diets, commercial weight loss-programs, exercise
alli moa
reversible lipase inhibitor
- inhibits 25% absorption of dietary fat intake
alli dosage
60 mg capsule > 18 y/o (take one capsule TID)
alli ADE
flatulence with oily spotting/leakage, oily diarrhea, fecal urgency
MVI and alli
one time daily at bedtime or at least 2 hours AFTER alli
alli contraindications
- organ transplant OR taking cyclosporine
- pregnant or breast feeding
- chronic malabsorption syndrome
- cholestasis
stimulants, energy boosters, thermogenic aids
increase basal metabolism, increase energy, counteract fatigue
(bitter orange, caffeine)
fat and carb modulators
alter fat or carbohydrate metabolism, resulting in decreased body mass and increased lean muscle mass
(green tea, chromium, carcinia)
appetite suppressants and satiety promoters
reduce caloric intake by suppressing appetite or promoting satiety
(guar gum, glucomannan, psyllium)
fat absorption blockers
block intestinal absorption of dietary fats
chitosan, green coffee, raspberry ketones
cortisol blockers
block stress-induced release of cortisol to avoid cortisol-induced increased appetite and fat storage
(beta-sitosterol, phosphatidylserine, theanine)
carbohydrate absorption blockers
block intestinal absorption of dietary carbohydrates
kidney bean extract, mung bean extract
laxatives
promote weight loss by increasing fecal loss
cascara Sagrada, psyllium
Diuretics
promote weight loss by increasing urination and fluid loss
dandelion, caffeine
