Hyperlipidemia √ Flashcards
Total cholesterol range
<200 good
200-239 - borderline high
+ 240 - high
LDL range
<100 - desirable
100-129 - near desirable
130-159 - borderline high
160-189 - high
+190 - very high
HDL range
<40 - low men
<50 - low women
TG ranges
<150 - normal
150-199 - borderline high
200-499 - high
+500 - very high
Risk factors for atherosclerosis
Smoking, HTN, Diabetes, lipo abnormalities, family CHD, Age and Race
CAC (coronary Artery Calcium) score for which pts
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
Non - pharm for hyperlipidemia
≥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
Clinical ASCVD flow chart
What counts as a ASCVD event and what guideline do we follow?
MI, coronary, stroke, peripheral arterial disease
Follow clinical ASCVD first statin guideline
What are high risk condition to start the flow chart of Clinical ASCVD?
Any heart event
65+
hetero familia hyerpercholesterolemia
bypass
DM
HTN
CKD 15-59
smoker
LDL -C >100 despite treatment
CHF
What are the high intensity statins?
Atorvastatin (Lipitor) 40-80 mg
Rosuvastatin (Crestor) 20-40 mg
Moderate intensity statins
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
Low intensity statins
Simva - 10
Prava 10 - 20
Lovastatin 20
Fluvastatin 20- 40
Pitavastatin 1 mg
What labs should be checked for statin
Fasting lipids 4- 12 weeks
ALT/AST for initial starting
Pros with Ezetimibe
LDL 10%-18% lower
34-61% lower in combo with statins
Additive therapy
No food required
Side effects of Ezetimibe (Zetia)
GI mainly like diarrhea
PCSK-9 drug and dosing
Alirocumab (praluent) - 75mg SC every 2 weeks max 150 or 300 monthly
Evolocumab ( repatha) - 140mg every 2 weeks max 420 or 420 monthly
LDL decrease 60% (in statin treated pts)
4 adverse rxn of PCSK9
Injection site rxn
Flu-like symptoms
upper respiratory tract infection
Nasopharyngitis
What is the goal for LDL?
<70
Pros of Bile acid Sequestrants?
Lower A1c and safe in pregnacy
Colesevelam dosing
Welchol - 6 tablets QD or 3 t bid with meal and liquid (625mg Tabs)
Cholestyramine dosing
Questran - 8-16 grams QD over 2 doses
colestipol dosing
Colestid 2-16 grams QD in 1 -2 doses
Thirds statins benefits for Diabetes flow chart
Usually moderate unless additional risk
What are risk enhancers for deciding statin for diabetes
Inclisiran AD and indicaiton
FH heterozygous
injections site, bronchitis
Bempedoic Acid AD
Trial so no place in therapy as of now
respiratory tract infection, muscle spasms, hyperuricemia (GOUT), back pain, abdominal pain, elevated LTF
How do we increase HDL and do we need to?
Niacin and no just makes the numbers look pretty
NIACIN AD
Flushing - most common
Hepatotoxicty
Decreased uric acid secretion
Increase insulin resistance
management of hypertroglyceridemia flow chart
3 omega-3 fatty acids AD
Fishy breath
Increase risk of bleeding
GI
Dosing of Omega-3 acid ethyl esters
Lovaza - 4g QD
Dosing of Icsosapent ethyl
Vascepa
2G bid
How do you treat Heterozygous Familial Hypercholesterolemia
High intensity statins, PCSK9 inhibitors, Bempedoic Acid
How do we treat Homozygous Familial Hypercholesterolemia
Lipoproteins apheresis (removes chole from plasma), Evinacumab, lomitapide, Evolocumab
Statins too but minimal benefit
what does Familial hypercholesteremia present with
presents with: cutaneous Xanthomas (deposits in hand)
Premature CV disease
Evinacumab AD
Injection site
Nasopharygitis, rhinorrhea, dizzy, Nasea
Lomitapide AD
⭐️ BBW for liver toxicity
Diarrhea
NV abdominal pain
Vitamin deficiency
What should we consider with pt older that’s 75
Just consider might have to up dose bc more likely to be statin resistant and if on a statin just continue
What is the guideline for pregnancy and Hyperlipidemia?
safe to use however had a previous warning
Consider if keeping an ASCVD event or familial hyper
Consider hydro over lipo if need to use a statin
What med can be used without consideration in pregnancy for Hyperlipidemia
BAS
CKD and hemodialysis hyperlipidemia guidelines
CKD without hemo = still use primary prevention statin (3rd and 4th group) CKD w/ HEMO = do not initiate
Race and ethnicity for statins
CrCl doses for which statin meds
Simvastatin 5mg <30
Lovastatin 20mg <30
Pravastatin 10mg if impaired
Fluvastatin 40 mg
For all of above 30 use 20-80
Biomarkers
APO- B ≥ 130
Non-HDL > 190
LP (a) ≥ 50
hsCR - ≥2
How long do we fast before ordering a lipid panel
8 hrs
What drug should we avoid with Red Yeast rice
lovastatin bc very similar
What are the DDI for Simvastatin
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)
What amount of Sim cant we exceed and with which drugs
10 mg DNE for Verapamil and Diltiazem
20 mg DNE for amiodarone, Amlodipine and Ranolozine
Which statins are hydrophilic
Rosuvastatin and Pravastatin
Acute/liver disease can i uses statins
no unless they have chronic
Should I continue sim 80 if a pt has been on it for a year
yes if stable for a year+ do not change
When do we consider non-statin therapy in benefit group 1?
lifestyle first before non-statin but if needed for high risk look for, non-optimal response LDL ≥ 70, can’t take max statin, or statin unwilling
Goal for LDL for secondary statin group
50% or less than 100
When to absolutely avoid BAS
TG > 300
Side effects of BAS
Nasty GI effects
DDI of BAS and how to avoid
ADEK vitamins
Reduces bioavalibitly of warfarin, levothyroxine and phenytoin
1 hr before or 4 hrs after
Lomitapide BBW
requires REMS
liver toxic and hepatic stenosis
Group 4 Primary Prevention flow chart
