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Primary care > Hyperlipidemia > Flashcards

Hyperlipidemia Flashcards

1
Q

Screening guidelines
NIH
ATP III

Criteria to perform Fasting full lipid panel:

A

NIH (2011) recommends screening all ages 9-11 and again at 17-21 years

Screen at age 20 and then every 5 years
Non-fasting Total Cholesterol with HDL

No Cardiac Risk Factors: 
Total-C >240 mg/dl
Cardiac Risk Factors: 
Total-C >200 mg/dl 
HDL
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2
Q

Screening guidelines
NIH
ATP III

Criteria to perform Fasting full lipid panel:

A

NIH (2011) recommends screening all ages 9-11 and again at 17-21 years

Screen at age 20 and then every 5 years
Non-fasting Total Cholesterol with HDL

No Cardiac Risk Factors: 
Total-C >240 mg/dl
Cardiac Risk Factors: 
Total-C >200 mg/dl 
HDL
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3
Q

LDL

Total cholesterol

HDL

A

LDL 190 very high

Total cholesterol 240 high

HDL 40-60

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4
Q

Triglyceride levels

A
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5
Q

LDL

A
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6
Q

LDL level if CVD

A

70

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7
Q

new medication choice strategy

A

not based on ldl goal

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8
Q

LDL measurement with statin therapy

when to decrease intensity

A

-monitor high risk, adherence, and to see if too low

Adherence confirmation in patients who do not have an appropriate drop or an increase in cholesterol levels

Decrease the intensity of therapy in patients whose LDL

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9
Q

Moderate intensity statins

A 
Lovastatin 40 mg
Pravastatin 40 - 80 mg
Simvastatin 20 - 40 mg
Atorvastatin 10 - 20 mg
Rosuvastatin 5 - 10 mg
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10
Q

High intensity statins

A

Atorvastatin 40 to 80 mg

Rosuvastatin 20 to 40 mg

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11
Q

Patients with >25% 10 year risk treat with…

A

high intensity

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12
Q

Treat with mod-high intensity statin instead of

A

LDL goal

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13
Q

Cardiac risk factors

A

Age Men >45 Women >55 (normal onset menopause) >45 (early menopause)
Tobacco Use Current or w/i 5 years
HTN BP >140/90 Antihypertensive med
Hyperlipidemia LDL >130 HDL

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14
Q

LDL

Total cholesterol

HDL

A

LDL 190 very high

Total cholesterol 240 high

HDL 40-60

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15
Q

Triglyceride levels

A
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16
Q

Estimating 10 year risk aka
Low
mod
high

A

aka framingham risk score

low

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17
Q

LDL level if CVD

A

70

18
Q

new medication choice strategy

A

not based on ldl goal

19
Q

LDL measurement with statin therapy

when to decrease intensity

A

-monitor high risk, adherence, and to see if too low

Adherence confirmation in patients who do not have an appropriate drop or an increase in cholesterol levels

Decrease the intensity of therapy in patients whose LDL

20
Q

Moderate intensity statins

A 
Lovastatin 40 mg
Pravastatin 40 - 80 mg
Simvastatin 20 - 40 mg
Atorvastatin 10 - 20 mg
Rosuvastatin 5 - 10 mg
21
Q

High intensity statins

A

Atorvastatin 40 to 80 mg

Rosuvastatin 20 to 40 mg

22
Q

Patients with >25% 10 year risk treat with…

A

high intensity

23
Q

Treat with mod-high intensity statin instead of

A

LDL goal

24
Q

Cardiac risk factors

A

Age Men >45 Women >55 (normal onset menopause) >45 (early menopause)
Tobacco Use Current or w/i 5 years
HTN BP >140/90 Antihypertensive med
Hyperlipidemia LDL >130 HDL

25
Q
A

GOAL 160- low fat diet
>190- antihyperlipidemic

if desirable- q 5 years
borderline- 1 year
elevated 3-6 months

26
Q

> 2 cardiac risk factors (LDL goal and mgt)

monitoring:
desirable
borderline
elevated

A

LDL goal 130- low fat diet and hyperlipidemic agent if LDL >130 with FRS 20% or >160

desirable: 1-2 years
borderline: repeat 6 months
elevated: every 2-3 months

27
Q 
Management CAD (DM FRS 20% or higher AAA PVD carotid disease) 
Goal LDL and management

monitoring
desirable:
borderline:
elevated:

A

goal ldl then low fat diet plus hyperlipidemic for LDL>130

desirable: every 6-12 months
borderline: every 2-3 months
elevated: every 6 weeks

28
Q

Primary prevention is for those without CVD
age___ to ____ without known CVD and LDL ___ to ____

with DM

without DM

A

40-75 without known CVD LDL 70-189

with DM: at least mod, >7.5% then HIGH

without DM: 5-7.5 mod and >7.5 mod to high

29
Q

Secondary prevention for those with

A

CAD cerebrovascular peripheral disease

10 year risk >20, CKD and GFR

30
Q

Previous MI 20x risk of

A

death from CAD

31
Q

Adjunct tx with statins?

A

not recommended unless trig> 500 or statins not tolerated

32
Q

Statins >75?

A

continue tx if CAD, high coronary calcium or ankle brachial index

33
Q

HIgh intensity

A

LDL>190
CVD
DM age 40-50 esp >7.5

34
Q

Moderate intensity

A

10 year >7.5

DM age

35
Q

Weight loss amount rec.

biggest effect on

A

24 lb

trig

36
Q

Complementary therapies

A

Garlic
Plant Sterols (e.g. Benecol, Promise Activ)
Fish oils (Omega-3 Fatty Acids)
Lowers Triglycerides (4%: 1 g/day, 10-40%: 2-4g/day) marg. effect HDL, raises LDL
Soluble Dietary Fiber (Lowers LDL Cholesterol 7% for 10 grams of fiber)
Dietary Soy Proteins 25 grams per day (4% lowering)
Unsaturated fat nuts
Glucophage (Metformin)
Rosiglitazone or Pioglitazone
Red-yeast rice(Contains natural HMG-CoA reductase agent)
Currently unregulated and dose not standardized

37
Q

HDL risk factor if

A

35
increase: gemfibrozil, niacin, mod etoh, aerobic exercise, weight loss
decreaseL tobacco, DM, high trig, menopause, obesity, steroids, liver disease, progestins

38
Q

LDL risk factor level

increases LDL:

A
39
Q

triglycerides level

level risk factor for CVD

A

500

>300 and HDL

40
Q 
triglyceride mgt 
150-199 borderline
200-499 high
500 very high*
1000 highest
A

borderline- lifestyle
high- + LDL 1st + fibrate, poss fish oil
(**very high- first line is fibrate (tricor, gemfibrozil) do not worry about LDL at this point) second line is niacin
>1000 agg weight loss, lowww fat diet, ? secondary cause

41
Q

Statins lab

A

baseline ALT aminotransferase

baseline CK may be useful

42
Q

Least likely statins to cause myalgias

A

pravastatin fluvastatin

Primary care (16 decks)

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