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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

LDL is the main cause
South Asian higher risk
Family history of CHD
App B >= 130mg

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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 or ASCVD equal or above 20

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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

Pros\ of statins

A

Pro
LDL 18% - 55% decrease (most important)
non - HDL 15-51% decrease
TG - 7% -30 % decrease
HDL - 5-15 %

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15
Q

Cons of statins

A

SAMS
Elevated ALT
New-onset Diabetes (outweighs risk of ASCVD)
Acute/active liver disease ( chronic okay)
Pregnancy maybe
Breastfeeding
SIMVASTATIN

grapefruit, DNE 10mg with verapamil or diltiazem, DNE 20mg w/ amiodarone, amplodipine and ranolazine

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16
Q

What labs should be checked for statin

A

Fasting lipids 4- 12 weeks

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17
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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18
Q

Cons of ezetimibe (Zetia)

A

GI mainly like diarrhea

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19
Q

Pros of PCSK9 and the drugs

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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20
Q

Cons of PCSK9

A

Injection site rxn
Flu like sysmtoms

21
Q

what is the goal for LDL?

A

50% reeducation or <100

22
Q

Pros of Bile acid Sequestrants?

A

Not systemically absorbed
Used as a failure after ezetimibe with fasting TG ≤300
LDL 15-26% LDL reduction
A1c .5 reduction

23
Q

Cons of BA

A

Bowel obstruction
History of hypertrglyceridemia-induced pancreatitis

24
Q

Colesevelam dosing

A

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

25
Q

Cholestyramine dosing

A

8-16 grams QD over 2 doses

26
Q

colestipol dosing

A

2-16 grams QD in 1 -2 doses

27
Q

Thirds statins benefits for Diabetes flow chart

A

Usually moderate unless additional risk

28
Q

What are risk enhancers for deciding statin for diabetes

A
29
Q

Fourth statin benefit for primary prevention

A

Pts that never had a ASCVD event
With ASCVD >20 start high intensity statin

30
Q

Inclisiran pros and cons

A

Pro - 50% drop in LDL
Cons - injections site, bronchitis

31
Q

ACL Pros and cons

A

Pro - 17-18 % reduction with combo w/ statin
38% drops with ezetimibe and statin for LDL
Cons - repiratory tract infection, muscle spasms, hyperuriecemia, back pain, abdominal pain, elevated LTF

32
Q

How do we increase HDL?

A

Niacin

33
Q

Pros and cons of NIACIN

A

Pros - TG lower 20-50%
LDL-C lower 5-20%
HDL-C increase 5-30%
Only drug to increase HDL
CONS
Flushing - most common
Hepatotoxicty
Decreased uric acid
Increase insulin resistance

34
Q

management of hypertroglyceridemia flow chart

A
35
Q

pros and cons of Omega-3 fatty acids

A

Icosapent ethyl main one we use (Vascepa)
Pros. TG down 27-45%
TC down 7-10%
VLDL down 20-42%
HDL up 8-14%
LDL variable
CONS
GI
Fishy breath
Increase risk of breathing

36
Q

Dosing of Omega-3 acid ethyl esters

A

Lovaza - 4g QD or
Vascepa 2G BID

37
Q

Dosing of Icsosapent ethyl

A

Vascepa
2G bid

38
Q

Where do you use Fibrates in cholesterol management

A

≥ 20 yr and TG ≥ 500

39
Q

How do you treat Hereozygous Familial Hypercholesterolemia

A

High intensity statins, PCSK9 inhibitors, Bempedoic Acid

40
Q

How do we treat Homozygous Familial Hypercholesterolemia

A

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

41
Q

What is defective in Familial Hyperscholesterolemia and what does it present with`

A

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

Defective
LDL receptor
PCSK9
ApoB
LDLRAP1

42
Q

Pros and Cons of Evinacumab

A

Pro - LDL- C ⬇️ 49%
TC ⬇️ 48%
Apo B ⬇️ 37%
Non-HDL ⬇️ 52%
HDL ⬇️ 30%

CONS
Injection site
Nasopharygitis, rhinorrhea, dizzy, Nasea

43
Q

Pros and Cons of Lomitapide

A

PROS
LDL- C ⬇️ 40%
TC - ⬇️ 30%
Apo B ⬇️39%
Non-HDL ⬇️40%

CONS
⭐️ BBW for liver toxicity
Diarrhea
NV abdominal pain
Vitamin deficiency

44
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

45
Q

What is the guideline for pregnancy and Hyperlipidemia?

A

Continue bc benefits outweigh the risks
-pt with high risk or event continue ( hypdophillic over lipophilic like pravastatin)
-pt just on it for prevention can DC
⭐️ BAS are safe for pregnancy

46
Q

What med can be used without consideration in pregnancy for Hyperlipidemia

A

BAS

47
Q

CKD and hemodialysis hyperlipidemia guidelines

A

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

48
Q

Race and ethnicity for statins

A
49
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

Theraputics Winter (12 decks)

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