Hyperlipidemia Flashcards

1
Q

Normal TC, TG, LDL

A

TC < 200

TG < 150

LDL < 100

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2
Q

ASCVD Group Tx

A
  1. Very High Risk

-High intensity statin
-Ezetimibe (if LDL still 70+)
-PCSK9i

  1. 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

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3
Q

ASCVD Group Classification

A

Any cardio event
-ACS
-MI
-IS
-PAD

High risk conditions
-65+
-Hetero fam hc
-CABG, PCI
-Diabetes
-HTN
-CKD
-Smoking
-CHF

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4
Q

High vs Low Intensity Statins

A

High
-A 40-80
-R 20-40

Low
-Sim 10
-Prava 10-20
-Lova 20
-Fluva 20-40
-Pita 1

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5
Q

Statins: AEs

A

-SAMS, myopathy, myalgias, rhabdo
-Elevated TAs (ALT, AST)
-New onset diabetes

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6
Q

Statins: CI

A

-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

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7
Q

Ezetimibe: dose, AE

A

Zetia

10 mg PO QD

AE: diarrhea

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8
Q

PCSK9i: dose, AE

A

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

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9
Q

Severe Hypercholesterolemia Group Tx

A

LDL 190+

  1. Max tolerated statin
  2. Ezetimibe
  3. Bild acid sequestrate

Can add PCSK9i if baseline LDL > 220 and > 130 on statin

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10
Q

BAS: chol, cols

A

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

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11
Q

Diabetes Group Tx

A
  1. Age 20-39
    -Mod statin
  2. Age 40-75
    -High statin (if ASCVD risk factors, 50+)
    -If not then mod
    -Then add ezetimibe
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12
Q

Prevention Group Tx

A
  1. 0-19 age
    -lifestyle
    -familial HC = statin
  2. 20-39 age
    -statin if family hx, premature ACSVD, LDL > 160
  3. 40-75 age w/o diabetes (LDL 70-190)
    -<5: lifestyle
    -5-7.5: mod statin
    -7.5-20: mod statin
    -20+: statin
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13
Q

Inclisiran

A

AE:
-Injection site rxn
-Bronchitis

284 mg SQ 3 mo, then Q 6 mo

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14
Q

Bempedoic Acid

A

AE: LUMI180
-Resp tract infections
-Muscle spasms, back pain
-High UA
-High LFTs

180 mg QD

combo with ezetimibe 180/10 QD

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15
Q

Niacin

A

For HDL improvement

AE: LUFI
-Flushing
-Liver tox
-High UA
-Insulin resistance

No CV benefit

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16
Q

Hypertriglyceridemia Tx

A

150-499 TGs

  1. Max statin
  2. Icosapent ethyl
17
Q

Omega 3 FAs

A

AE:
-GI
-Bleeding
-Fishy breath

EE, Lovaza 4 g QD

Ico ethyl 2 g QD

18
Q

Fibrates

A

Consider for 20+ yo with TG 500+

-GI
-Gallstones
-Myopathies

Gem 600 mg BID

19
Q

Familial Hypercholesterolemia

A

HeFH (hetero)
-Statins
-PCSK9i
-Bempedoic acid

HoFH (homo)
-Evinacumab
-Lomitapide
-Evolocumab
-Statins

SPB ELES

20
Q

Lomitapide

A

AE:
-Liver tx (BBW/REMS)
-GI (NV, AP)
-Vitamin deficiency

LV is G

21
Q

Pregnancy Tx

A

-BAS (cols) are safe in pregnancy
-Hydrophilic statins preferred if needed (pravastatin, rosuvastatin, fluvastatin)