Hyperlipidemia and HTN Flashcards
1
Q
Most cholesterol is made in
A
Liver
2
Q
LDLs do what?
A
Carry cholesterol from the Liver (where it’s made) to the body’s cells
3
Q
HDL’s job
A
collect chol from bodys tissues and return it to the Liver
4
Q
Chylomicrons
A
carry lipids from DIET
5
Q
VLDLs carry
A
Triglycerides
6
Q
Familial Hypercholesterolemia conditions
A
Tx w Statin
7
Q
Secondary Hyperlipidemia
Risk factors
A
DM Exc Alcohol Smoking Obesity Hypothyroid CKD Liver dz Meds
8
Q
What is more common- Secondary Hyperlipidemia or Inherited/genetic Hyperlipidemia?
A
Inherited
9
Q
When to screen for High cholesterol?
A
9-11 YO
and again at
17-21 YO
10
Q
When to screen lipids
A
age 9
age 17
11
Q
Coronary Heart Dz Risk factors
A
HTN >140/90 DM Tobacco use Obese Hyperlipidemia HDL <40
12
Q
What is affected more by eating: cholesterol or Triglycerides?
A
Trig way more, and since they are taken at the same time, this is why the labs are supposed to be FASTING
13
Q
Total cholesterol includes
A
HDL + LDL + Trig/5
14
Q
Cholesterol, LDL, and HDL levels can be falsely low after what?
A
MI
Acute coronary event
15
Q
Desirable LDL level
A
60-130
many sources say <100
16
Q
Normal LDL level
A
<100
17
Q
Desirable Total Cholesterol
A
<200
18
Q
Desirable HDL level
A
> 60
19
Q
Normal HDL level for female
A
> 50 (or equal to)
20
Q
Normal HDL level for male
A
> 40 (or equal to)
21
Q
Approach to Lipid mgmt
A
Diet
Exercise
Meds
22
Q
Diet for Elevated Lipids:
DASH
“Dietary approaches to stop HTN”
A
Rich fruits and veggies Moderate in low fat dairy Low animal protein Plant source of protein Low sodium
23
Q
Benefits of DASH diet
A
Decrease BP
Decrease LDL
Decrease risk of CHD and Stroke
24
Q
Exercise can increase HDL levels
A
3-4 sessions/week
40 min of mod-vigorous
25
What are Statins
HMG Co-A reductase inhibitors
26
How do Statins work
Stabilize vulnerable plaques and reduce underlying inflammation
27
Statin mechanism
Stop HMG-Co A Reductase enzyme from working in the Liver
This is the Rate limiting step in Cholesterol production
28
When should pts take Statins
Bedtime
29
SE/ risk of Statins
Liver toxic
Mild GI
Myalgia, Myositis, Myopathy --> RHABDO!!!!
muscle stuff
30
CONTRA to giving Statins
Pregnant
| Active Liver dz
31
What labs do you need to take before starting a Statin?
Lipid panel
LFT (live fx)
Creatine kinase
32
How often to get labs after starting Statins?
every 4-12 wks at first
33
What Lipid med is Safe during Pregnancy
Bile Acid Seq
34
Synergistic w Statin
Bile Acid Seq
35
What is the bad thing about Bile Acid Seq?
Can increase Triglycerides
DO NOT USE if Trig are already >400, and caution use if they are >200
36
Niacin
increase HDl
| SE: Flushing, liver damage, not rec to use w statin
37
Fibric Acid Derivative
- Gemfibrozil
- Fenofibrate
- Bezafibrate
Best known for LOWERING TRIGLYCERIDES
| raise HDL
38
Meds that affect Triglycerides
Fibric Acid: good bc they LOWER triglycerides
Bile Acid: bad bc they can increase triglycerides
39
Fibric Acid Deriv
contra
Pre-existing Gallstones
Don't use w other statin, Myopathy risk (muscle)
40
Ezetimibe
Block absorption of cholesterol
ADJUNCT for Statin
41
Contra to Ezetimibe
Active Liver dz
| Pregnancy
42
PCSK9 Inhib
- Evolocumab
- Alirocumab
EXPENSIVE, requires injections
but very effective at lowering LDL, increasing role as Adjunct tx to Statins
43
Things that can be used ADJUNCT as Statin Add-on
Bile Acid seq
Ezetimibe
PCSK9 inhib
44
Cholestyramine
Colesevelam
Colestipol
are all:
Bile Acid seq
aka Resins
45
Safe in pregnancy
Cholestyramine
Colesevelam
Colestipol
(bile acid seq/ resins)
46
Bad things about Bile Acid Seq
Mess w Warfarin tx
| Increase Triglyceride levels
47
Bad thing about Bile Acid Seq
- Cholestyramine
- Colesevelam
- Colestipol
Warfarin
| Triglycerides
48
Evolocumab
| Alirocumab
PCSK9 inhibitors
Good adjunct
but expensive
injections
49
NOT recommended to use with Statins
Niacin
| Fibrates
50
What med is good to use if pt has High Triglycerides?
Fibrates
- Gemfibrozil
- Fenofibrate
- Bezafibrate
best at lowering trig
51
Which med increases HDL
Nicotinic ACid (Niacin)
52
Absolute CONTRA to taking Fibric Acid Deriv
| Gemfibrozil, Fenofibrate, Bezafibrate
Taking Simvastatin
53
What two drugs can mess with Warfarin use
Bile acid Seq ("chol")
Fibric acid deriv ("gemfibrozil, fenofibrate, bezafibrate") - relative contra
54
4 Statin benefit groups.. aka Who should be on a Statin?
Clinical ASCVD
LDL>190
DM age 40-75 with LDL >70
Don't have ASVCD or DM but LDL 70-189 and 10 year risk >7.5%
55
What is a "High intensity Statin" regimen?
Atorvastatin 40-80 mg
| Rosuvastatin 20-40 mg
56
What conditions are considered Clinical ASCVD?
Acute coronary synd
Hx of heart attack
Sx PAD
Stroke/TIA
57
4 Statin Benefit groups
Clinical ASCVD
LDL >190
DM 40-75 yo w LDL >70
Regular dude with LDL 70-189 but 10 yr risk >7.5%
58
Use with Statin
Bile acid seq "chol"
Ezetimibe
PCSK9 "umab"
59
PCSK9 inhib
Evolocumab
| Aliocumab
60
Tx used to lower Triglycerides
GemFIBrozil
FenoFIBrate
BezaFIBrate
(fibric acid derivatives)
61
Med used to increase the healthy HDL
Niacin acid "Niacin"
62
Person is 40-75 YO and has Diabetes, what level would be an indication to start Statin?
LDL >70
63
What LDL level alone means person needs statin?
>190
64
Person doesn't have ASCVD or DM, but they have these levels ----> need Statin
ASCVD risk >7.5%
LDL >70
65
Stage 1 HTN
130-140 OR
80-89
only need one of those parameters
66
Anytime diastolic is over 80
you are in one of the classifications of HTN
67
Stage 2 HTN
>140
OR
>90
68
Primary HTN is the majority
Risk factors:
```
Smoking
Eating unhealthily
Excess alcohol
Obesity
Sedentary
Dyslipidemia
```
69
Secondary HTN
meaning it's d/t another condition like:
```
Kidney dz
Atherosclerosis
OSA
Thyroid dz
Coarc of Aorta (narrowing)
Hyperaldosterone
Cushings
Pheo
Med induced
```
70
When to start screening for HTN
18 YO
no risk factors- annual
risk factors- semi-annual
71
Gold standard to confirm HTN (out of office)
ABPM
| Ambulatory Blood Pressure Monitor
72
Lifestyle mgmt for HTN
```
Lower sodium
DASH diet
Alcohol reduction
Exercise 3-4x/week
Healthy weight
Stop smoking
```
73
4 first line medications for HTN
ACE-I
ARBs
Thiazide diuretics
CCBs
74
What is considered Resistant HTN?
Still not controlled with 3 meds
OR
Requiring 4 meds
75
Threshold goal for most people with HTN
<130/80
76
CONTRA to prescribing Thiazide and Loop diuretics
Allergy/hypersensitive to Sulfa
77
SE of ACE-I
| "prils"
cough
hyperkalemia
ANGIOEDEMA
acute kidney failure
78
CONTRA to ACE-I
Pregnant
Angioedema
Kidney artery stenosis
79
Can you combine ACE-I and ARBs?
NO
too hard on the kidney
80
ARBs
| "sartans"
CONTRA
pregnant
Kidney artery stenosis
81
CCBs broken down into 2 groups
Non-dihydro
- Verapamil
- Diltiazem
Dihydro
- Amlodipine
- Felodipine
- Isradipine
- Nicardipine
- Nifedipine
- Nisoldipine
82
Verapamil and Diltiazem are Non-Dihydro, meaning
More of a cardiac depressant effect
83
Dihydro CCBs have more of a
Vasodilator effect
less cardiac
84
Best tx for HTN post MI
ACE-I
| B blocker
85
When you see ___dipines, it is a
CCB, Dihydro type meaning it has a more vasodilatory effect
86
CCBs with more of a Cardiac effect (Non-dihydro)
Verapamil
| Diltiazem (Cardizem)
87
When to avoid Non-dihydro CCBs (more cardiac effect ones)
With B-blocker use
| HFrEF
88
Avoid all CCBs in
HFrEF
89
Cardioselective B-blockers are those that are
B1 receptors
90
HTN and BPH
a1 blockers
91
African American with HTN
Thiazide
| CCBs
92
HTN in HF pts
ACE-I
ARB
B-blocker
Diuretic
basically, just don't use CCBs
93
B-blocker CONTRA
ASTHMA
bronchospastic dz
conduction abn
acute decomp of CHF
94
What to use if Pregnant
Methylodopa
Also, B-blockers are often used in pregnancy
95
Alpha blockers to use if BPH and HTN
Prazosin (minipress)
Terazosin
Doxazosin
96
What to use if you have Gout and HTN
```
CCBs
or Losartan (the only ARB that doesnt inc uric acid)
```
97
Avoid abrupt cessation of
B-blockers
Methyldopa
(both of these are the ones used in pregnancy also)
98
HTN Urgency
DIASTOLIC (the bottom number) is >120
no evidence of end organ damage
99
HTN EMERGENCY!!
Diastolic >120 WITH evidence of end organ damage
100
BP reduction goal in HTN Urgency (no end organ damage)
reduce to <160/120 over hours to days
```
rest in quiet room
increase current meds
add another med
Na restriction
Make sure not to overcorrect
```
101
HTN EMERGENCY!! signs of end organ damage
ICU admission
Address underlying cause
Reduce BP no more than 25% in min-hour
160/110 over 2-6 hours
If stable, decrease to normal BP in 1-2 days
102
What to use in HTN emergency
IV Nitrate
CCB
Adrenergic blockers
Hydralazine
103
CONTRA in HTN emergency
Sublingual Nifedipine (CCB) can cause ACS
104
Orthostatic Hypotension
Supine for 5 min
Then stand
>20 fall in systolic
>10 fall in diastolic
105
Causes of Orthostatic Hypotension
Parkinson
DM
Volume depletion- dehydrated d/t vomiting, hemorrhage, etc
Meds (too much Anti-HTN meds in elderly)
106
What to consider ordering if pt has Orthostatic Hypotension
CBC
CMP
EKG
detailed history
review med list
neuro hx/exam
107
Often one of the first signs of shock
HYPOTENSION, low BP
