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Theraputics Winter > Hyperlipidemia > Flashcards

Hyperlipidemia Flashcards

1
Q

Total cholesterol range

A

<200 good
200-239 - borderline high
+ 240 - high

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2
Q

LDL range

A

<100 - desirable
100-129 - near desirable
130-159 - borderline high
160-189 - high
+190 - very high

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3
Q

HDL range

A

<40 - low men
<50 - low women

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4
Q

TG ranges

A

<150 - normal
150-199 - borderline high
200-499 - high
+500 - very high

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5
Q

Risk factors for atherosclerosis

A

Smoking, HTN, Diabetes, lipo abnormalities, family CHD, Age and Race

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6
Q

CAC (coronary Artery Calcium) score for which pts

A

help detect calcium deposits
For pts with no DM LDL ≥ 70 to 189 mg/dl and ASCVD risk 7.5 - 20
0 none
1–99 minimal to mild
100 - 400 moderate
>400 severe

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7
Q

Non - pharm for hyperlipidemia

A

≥150 each week
200 -300 min each weak for wt loss
Aerobic is best ( other is not as effective)

Diet
DASH, Mediterranean and vegetarian
Supplements
Fiber - reduce just LDL
Red yeast rice (same active as lovastatin) - super variable so need good source

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8
Q

Clinical ASCVD flow chart

A
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9
Q

What counts as a ASCVD event and what guideline do we follow?

A

MI, coronary, stroke, peripheral arterial disease
Follow clinical ASCVD first statin guideline

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10
Q

What are high risk condition to start the flow chart of Clinical ASCVD?

A

Any heart event
65+
hetero familia hyerpercholesterolemia
bypass
DM
HTN
CKD 15-59
smoker
LDL -C >100
CHF

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11
Q

What are the high intensity statins?

A

Atorvastatin (Lipitor) 40-80 mg
Rosuvastatin (Crestor) 20-40 mg

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12
Q

Moderate intensity statins

A

Ato - 10 - 20 mg
Rosuvastatin - 5 - 10 mg
Simvastatin (Zocor) 20 - 40 mg
Pravastatin (Pravachol) 40 - 80 mg
Lovastatin (mevacor) 40 mg
Fluvasatin XL 80mg
Fliuvasatin (Lescol) 40mg BID
Pitavasatin ( Livalo) - 2- - 4 mg

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13
Q

Low intensity statins

A

Simva - 10
Prava 10 - 20
Lovastatin 20
Fluvastatin 20- 40
Pitavastatin 1 mg

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14
Q

What labs should be checked for statin

A

Fasting lipids 4- 12 weeks

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15
Q

Pros with Ezetimibe

A

LDL 10%-18% lower
34-61% lower in combo with statins
Additive therapy
No food required

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16
Q

Side effects of Ezetimibe (Zetia)

A

GI mainly like diarrhea

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17
Q

PCSK-9 drug and dosing

A

Alirocumab (praluent) - 75mg SC every 2 weeks max 150
Evolocumab ( repatha) - 140mg every 2 weeks max 420

LDL decrease 60% (in statin treated pts)

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18
Q

Adverse rxn of PCSK9

A

Injection site rxn
Flu-like symptoms
upper respiratory tract infection
Nasopharyngitis

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19
Q

What is the goal for LDL?

A

<70

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20
Q

Pros of Bile acid Sequestrants?

A

Lower A1c and safe in pregnacy

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21
Q

Colesevelam dosing

A

Welchol - 6 tablets QD or 3 t bid with meal and liquid (625)

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22
Q

Cholestyramine dosing

A

Questran - 8-16 grams QD over 2 doses

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23
Q

colestipol dosing

A

Colestid 2-16 grams QD in 1 -2 doses

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24
Q

Thirds statins benefits for Diabetes flow chart

A

Usually moderate unless additional risk

25
Q

What are risk enhancers for deciding statin for diabetes

A
26
Q

Inclisiran AD

A

Trial on goting so no place in therapy
injections site, bronchitis

27
Q

Bempedoic Acid AD

A

Trial so no place in therapy as of now
respiratory tract infection, muscle spasms, hyperuricemia (GOUT), back pain, abdominal pain, elevated LTF

28
Q

How do we increase HDL and do we need to?

A

Niacin and no just makes the numbers look pretty

29
Q

NIACIN AD

A

Flushing - most common
Hepatotoxicty
Decreased uric acid
Increase insulin resistance

30
Q

management of hypertroglyceridemia flow chart

A
31
Q

omega-3 fatty acids AD

A

Fishy breath
Increase risk of breathing

32
Q

Dosing of Omega-3 acid ethyl esters

A

Lovaza - 4g QD

33
Q

Dosing of Icsosapent ethyl

A

Vascepa
2G bid

34
Q

How do you treat Hereozygous Familial Hypercholesterolemia

A

High intensity statins, PCSK9 inhibitors, Bempedoic Acid

35
Q

How do we treat Homozygous Familial Hypercholesterolemia

A

Lipoproteins apheresis (removes chole from plasma), Evinacumab, lomitapide, Evolocumab
Statins too but minimal benefit

36
Q

what does Familial hypercholesteremia present with

A

presents with: cutaneous Xanthomas (deposits in hand)
Premature CV disease

37
Q

Evinacumab AD

A

Injection site
Nasopharygitis, rhinorrhea, dizzy, Nasea

38
Q

Lomitapide AD

A

⭐️ BBW for liver toxicity
Diarrhea
NV abdominal pain
Vitamin deficiency

39
Q

What should we consider with pt older that’s 75

A

Just consider might have to up dose bc more likely to be statin resistant and if on a statin just continue

40
Q

What is the guideline for pregnancy and Hyperlipidemia?

A

same to use however had a previous warning
Consider keeping an ASCVD event or familial hyper
Consider hydro over lipo if need to use a statin

41
Q

What med can be used without consideration in pregnancy for Hyperlipidemia

A

BAS

42
Q

CKD and hemodialysis hyperlipidemia guidelines

A

CKD without hemo = still use statin (3rd and 4th group) CKD w/ HEMO = do not initiate

43
Q

Race and ethnicity for statins

A
44
Q

CrCl doses for which statin meds

A

Simvastatin 5mg <30
Lovastatin 20mg <30
Pravastatin 10mg if impaired
Fluvastatin 40 mg
For all of above 30 use 20-80

45
Q

Biomarkers

A

APO- B ≥ 130
Non-HDL > 190
LP (a) ≥ 50
hsCR - ≥2

46
Q

How long do we fast before ordering a lipid panel

A

8 hrs

47
Q

What drug should we avoid with Red Yeast rice

A

lovastatin bc very similar

48
Q

What are the DDI for Simvastatin

A

SICK FOLKS”

S – Similar statins (other statins like atorvastatin, lovastatin)
I – Itraconazole (azole antifungals)
C – Clarithromycin (macrolide antibiotics)
K – Ketoconazole (azole antifungals)
F – Fibric acid derivatives (e.g., gemfibrozil, increases risk of muscle issues)
O – Omeprazole (proton pump inhibitors, though less common, may increase statin levels)
L – Lopinavir (protease inhibitors, e.g., ritonavir, indinavir)
K – Ketoconazole (again, highlighting CYP3A4 inhibitors)
S – Starvation/low-fat diet (can increase the risk of muscle toxicity)

49
Q

What amount of Sim cant we exceed and with which drugs

A

10 mg DNE for Verapamil and Diltiazem
20 mg DNE for amiodarone, Amlodipine and Ranolozine

50
Q

Which statins are hydrophilic

A

Rosuvastatin and Pravastatin

51
Q

Acute/liver disease can i uses statins

A

no unless they have chronic

52
Q

Should I continue sim 80 if a pt has been on it for a year

A

yes if stable for a year+ do not change

53
Q

When do we consider non-statin therapy in benefit group 1?

A

lifestyle first before non-statin but if needed for high risk look for, non-optimal response LDL ≥ 70, can take max statin, or statin unwilling

54
Q

Goal for LDL for secondary statin group

A

50% or less than 100

55
Q

When to absolutely avoid BAS

A

TG > 300

56
Q

Side effects of BAS

A

Nasty GI effects

57
Q

DDI of BAS and how to avoid

A

ADEK vitamins
Reduces bioavalibitly of warfarin, levothyroxine and phenytoin

1 hr before and 4 hrs after

58
Q

Lomitapide BBW

A

requires REMS
liver toxic and hepatic stenosis

Theraputics Winter (12 decks)

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