Hyperlipidemia Flashcards
Normal TC, TG, LDL
TC < 200
TG < 150
LDL < 100
ASCVD Group Tx
- Very High Risk
-High intensity statin
-Ezetimibe (if LDL still 70+)
-PCSK9i
- Not High Risk
<= 75 yr old
-High intensity statin (to reduce LDL 50%)
-Mod intensity statin if high is not tolerated
-Ezetimibe
> 75
-Mod or high statin
ASCVD Group Classification
Any cardio event
-ACS
-MI
-IS
-PAD
High risk conditions
-65+
-Hetero fam hc
-CABG, PCI
-Diabetes
-HTN
-CKD
-Smoking
-CHF
High vs Low Intensity Statins
High
-A 40-80
-R 20-40
Low
-Sim 10
-Prava 10-20
-Lova 20
-Fluva 20-40
-Pita 1
Statins: AEs
-SAMS, myopathy, myalgias, rhabdo
-Elevated TAs (ALT, AST)
-New onset diabetes
Statins: CI
-Active liver disease
-Pregnancy, BF
Simvastatin 80 should only be continued in pts who have tolerated dose for 12+ months, NO NEW STARTS
-Avoid GFJ, >1 Q daily
Ezetimibe: dose, AE
Zetia
10 mg PO QD
AE: diarrhea
PCSK9i: dose, AE
Ali 75 mg to 150 mg SC every 2 weeks
Evolo 140 mg to 420 mg SC every 2 weeks or 420 mg monthly
AE:
-Injection site rxn
-Flu like sx, nasopharyngitis, respiratory tract infections
Severe Hypercholesterolemia Group Tx
LDL 190+
- Max tolerated statin
- Ezetimibe
- Bild acid sequestrate
Can add PCSK9i if baseline LDL > 220 and > 130 on statin
BAS: chol, cols
AE:
-GI, constipation, bloating, nausea, flatulence
Many DDIs
-Vitamin ADEK
-Warfarin, levothyroxine, phenytoin
*Take 1 hr before or 4 hrs after BAS
CI:
-Bowel obs
-Hx of hypertriglyceridemia-induced pancreatitis
Diabetes Group Tx
- Age 20-39
-Mod statin - Age 40-75
-High statin (if ASCVD risk factors, 50+)
-If not then mod
-Then add ezetimibe
Prevention Group Tx
- 0-19 age
-lifestyle
-familial HC = statin - 20-39 age
-statin if family hx, premature ACSVD, LDL > 160 - 40-75 age w/o diabetes (LDL 70-190)
-<5: lifestyle
-5-7.5: mod statin
-7.5-20: mod statin
-20+: statin
Inclisiran
AE:
-Injection site rxn
-Bronchitis
284 mg SQ 3 mo, then Q 6 mo
Bempedoic Acid
AE: LUMI180
-Resp tract infections
-Muscle spasms, back pain
-High UA
-High LFTs
180 mg QD
combo with ezetimibe 180/10 QD
Niacin
For HDL improvement
AE: LUFI
-Flushing
-Liver tox
-High UA
-Insulin resistance
No CV benefit