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Clinical Prep > Hyperlipidemia and HTN > Flashcards

Hyperlipidemia and HTN Flashcards

1
Q

Most cholesterol is made in

A

Liver

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2
Q

LDLs do what?

A

Carry cholesterol from the Liver (where it’s made) to the body’s cells

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3
Q

HDL’s job

A

collect chol from bodys tissues and return it to the Liver

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4
Q

Chylomicrons

A

carry lipids from DIET

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5
Q

VLDLs carry

A

Triglycerides

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6
Q

Familial Hypercholesterolemia conditions

A

Tx w Statin

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7
Q

Secondary Hyperlipidemia

Risk factors

A 
DM
Exc Alcohol
Smoking
Obesity
Hypothyroid
CKD
Liver dz
Meds
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8
Q

What is more common- Secondary Hyperlipidemia or Inherited/genetic Hyperlipidemia?

A

Inherited

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9
Q

When to screen for High cholesterol?

A

9-11 YO
and again at
17-21 YO

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10
Q

When to screen lipids

A

age 9

age 17

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11
Q

Coronary Heart Dz Risk factors

A 
HTN >140/90
DM
Tobacco use
Obese
Hyperlipidemia
HDL <40
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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

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13
Q

Total cholesterol includes

A

HDL + LDL + Trig/5

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14
Q

Cholesterol, LDL, and HDL levels can be falsely low after what?

A

MI

Acute coronary event

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15
Q

Desirable LDL level

A

60-130

many sources say <100

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16
Q

Normal LDL level

A

<100

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17
Q

Desirable Total Cholesterol

A

<200

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18
Q

Desirable HDL level

A

> 60

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19
Q

Normal HDL level for female

A

> 50 (or equal to)

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20
Q

Normal HDL level for male

A

> 40 (or equal to)

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21
Q

Approach to Lipid mgmt

A

Diet
Exercise
Meds

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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
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23
Q

Benefits of DASH diet

A

Decrease BP
Decrease LDL
Decrease risk of CHD and Stroke

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24
Q

Exercise can increase HDL levels

A

3-4 sessions/week

40 min of mod-vigorous

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25
Q

What are Statins

A

HMG Co-A reductase inhibitors

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26
Q

How do Statins work

A

Stabilize vulnerable plaques and reduce underlying inflammation

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27
Q

Statin mechanism

A

Stop HMG-Co A Reductase enzyme from working in the Liver

This is the Rate limiting step in Cholesterol production

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28
Q

When should pts take Statins

A

Bedtime

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29
Q

SE/ risk of Statins

A

Liver toxic
Mild GI
Myalgia, Myositis, Myopathy –> RHABDO!!!!

muscle stuff

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30
Q

CONTRA to giving Statins

A

Pregnant

Active Liver dz

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31
Q

What labs do you need to take before starting a Statin?

A

Lipid panel
LFT (live fx)
Creatine kinase

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32
Q

How often to get labs after starting Statins?

A

every 4-12 wks at first

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33
Q

What Lipid med is Safe during Pregnancy

A

Bile Acid Seq

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34
Q

Synergistic w Statin

A

Bile Acid Seq

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35
Q

What is the bad thing about Bile Acid Seq?

A

Can increase Triglycerides

DO NOT USE if Trig are already >400, and caution use if they are >200

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36
Q

Niacin

A

increase HDl

SE: Flushing, liver damage, not rec to use w statin

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37
Q

Fibric Acid Derivative

  • Gemfibrozil
  • Fenofibrate
  • Bezafibrate
A

Best known for LOWERING TRIGLYCERIDES

raise HDL

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38
Q

Meds that affect Triglycerides

A

Fibric Acid: good bc they LOWER triglycerides

Bile Acid: bad bc they can increase triglycerides

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39
Q

Fibric Acid Deriv

contra

A

Pre-existing Gallstones

Don’t use w other statin, Myopathy risk (muscle)

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40
Q

Ezetimibe

A

Block absorption of cholesterol

ADJUNCT for Statin

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41
Q

Contra to Ezetimibe

A

Active Liver dz

Pregnancy

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42
Q

PCSK9 Inhib

  • Evolocumab
  • Alirocumab
A

EXPENSIVE, requires injections

but very effective at lowering LDL, increasing role as Adjunct tx to Statins

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43
Q

Things that can be used ADJUNCT as Statin Add-on

A

Bile Acid seq
Ezetimibe
PCSK9 inhib

44
Q

Cholestyramine
Colesevelam
Colestipol

are all:

A

Bile Acid seq

aka Resins

45
Q

Safe in pregnancy

A

Cholestyramine
Colesevelam
Colestipol

(bile acid seq/ resins)

46
Q

Bad things about Bile Acid Seq

A

Mess w Warfarin tx

Increase Triglyceride levels

47
Q

Bad thing about Bile Acid Seq

  • Cholestyramine
  • Colesevelam
  • Colestipol
A

Warfarin

Triglycerides

48
Q

Evolocumab

Alirocumab

A

PCSK9 inhibitors

Good adjunct
but expensive
injections

49
Q

NOT recommended to use with Statins

A

Niacin

Fibrates

50
Q

What med is good to use if pt has High Triglycerides?

A

Fibrates

  • Gemfibrozil
  • Fenofibrate
  • Bezafibrate

best at lowering trig

51
Q

Which med increases HDL

A

Nicotinic ACid (Niacin)

52
Q

Absolute CONTRA to taking Fibric Acid Deriv

Gemfibrozil, Fenofibrate, Bezafibrate

A

Taking Simvastatin

53
Q

What two drugs can mess with Warfarin use

A

Bile acid Seq (“chol”)

Fibric acid deriv (“gemfibrozil, fenofibrate, bezafibrate”) - relative contra

54
Q

4 Statin benefit groups.. aka Who should be on a Statin?

A

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
Q

What is a “High intensity Statin” regimen?

A

Atorvastatin 40-80 mg

Rosuvastatin 20-40 mg

56
Q

What conditions are considered Clinical ASCVD?

A

Acute coronary synd
Hx of heart attack
Sx PAD
Stroke/TIA

57
Q

4 Statin Benefit groups

A

Clinical ASCVD
LDL >190
DM 40-75 yo w LDL >70
Regular dude with LDL 70-189 but 10 yr risk >7.5%

58
Q

Use with Statin

A

Bile acid seq “chol”
Ezetimibe
PCSK9 “umab”

59
Q

PCSK9 inhib

A

Evolocumab

Aliocumab

60
Q

Tx used to lower Triglycerides

A

GemFIBrozil
FenoFIBrate
BezaFIBrate

(fibric acid derivatives)

61
Q

Med used to increase the healthy HDL

A

Niacin acid “Niacin”

62
Q

Person is 40-75 YO and has Diabetes, what level would be an indication to start Statin?

63
Q

What LDL level alone means person needs statin?

64
Q

Person doesn’t have ASCVD or DM, but they have these levels —-> need Statin

A

ASCVD risk >7.5%

LDL >70

65
Q

Stage 1 HTN

A

130-140 OR
80-89

only need one of those parameters

66
Q

Anytime diastolic is over 80

A

you are in one of the classifications of HTN

67
Q

Stage 2 HTN

68
Q

Primary HTN is the majority

Risk factors:

A 
Smoking
Eating unhealthily
Excess alcohol
Obesity
Sedentary
Dyslipidemia
69
Q

Secondary HTN

meaning it’s d/t another condition like:

A 
Kidney dz
Atherosclerosis
OSA
Thyroid dz
Coarc of Aorta (narrowing)
Hyperaldosterone
Cushings
Pheo
Med induced
70
Q

When to start screening for HTN

A

18 YO

no risk factors- annual
risk factors- semi-annual

71
Q

Gold standard to confirm HTN (out of office)

A

ABPM

Ambulatory Blood Pressure Monitor

72
Q

Lifestyle mgmt for HTN

A 
Lower sodium
DASH diet
Alcohol reduction
Exercise 3-4x/week
Healthy weight
Stop smoking
73
Q

4 first line medications for HTN

A

ACE-I
ARBs
Thiazide diuretics
CCBs

74
Q

What is considered Resistant HTN?

A

Still not controlled with 3 meds

OR

Requiring 4 meds

75
Q

Threshold goal for most people with HTN

76
Q

CONTRA to prescribing Thiazide and Loop diuretics

A

Allergy/hypersensitive to Sulfa

77
Q

SE of ACE-I

“prils”

A

cough
hyperkalemia
ANGIOEDEMA
acute kidney failure

78
Q

CONTRA to ACE-I

A

Pregnant
Angioedema
Kidney artery stenosis

79
Q

Can you combine ACE-I and ARBs?

A

NO

too hard on the kidney

80
Q

ARBs

“sartans”

A

CONTRA
pregnant
Kidney artery stenosis

81
Q

CCBs broken down into 2 groups

A

Non-dihydro

  • Verapamil
  • Diltiazem

Dihydro

  • Amlodipine
  • Felodipine
  • Isradipine
  • Nicardipine
  • Nifedipine
  • Nisoldipine
82
Q

Verapamil and Diltiazem are Non-Dihydro, meaning

A

More of a cardiac depressant effect

83
Q

Dihydro CCBs have more of a

A

Vasodilator effect

less cardiac

84
Q

Best tx for HTN post MI

A

ACE-I

B blocker

85
Q

When you see ___dipines, it is a

A

CCB, Dihydro type meaning it has a more vasodilatory effect

86
Q

CCBs with more of a Cardiac effect (Non-dihydro)

A

Verapamil

Diltiazem (Cardizem)

87
Q

When to avoid Non-dihydro CCBs (more cardiac effect ones)

A

With B-blocker use

HFrEF

88
Q

Avoid all CCBs in

89
Q

Cardioselective B-blockers are those that are

A

B1 receptors

90
Q

HTN and BPH

A

a1 blockers

91
Q

African American with HTN

A

Thiazide

CCBs

92
Q

HTN in HF pts

A

ACE-I
ARB
B-blocker
Diuretic

basically, just don’t use CCBs

93
Q

B-blocker CONTRA

A

ASTHMA
bronchospastic dz
conduction abn
acute decomp of CHF

94
Q

What to use if Pregnant

A

Methylodopa

Also, B-blockers are often used in pregnancy

95
Q

Alpha blockers to use if BPH and HTN

A

Prazosin (minipress)
Terazosin
Doxazosin

96
Q

What to use if you have Gout and HTN

A 
CCBs
or Losartan (the only ARB that doesnt inc uric acid)
97
Q

Avoid abrupt cessation of

A

B-blockers
Methyldopa

(both of these are the ones used in pregnancy also)

98
Q

HTN Urgency

A

DIASTOLIC (the bottom number) is >120

no evidence of end organ damage

99
Q

HTN EMERGENCY!!

A

Diastolic >120 WITH evidence of end organ damage

100
Q

BP reduction goal in HTN Urgency (no end organ damage)

A

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
Q

HTN EMERGENCY!! signs of end organ damage

A

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
Q

What to use in HTN emergency

A

IV Nitrate
CCB
Adrenergic blockers
Hydralazine

103
Q

CONTRA in HTN emergency

A

Sublingual Nifedipine (CCB) can cause ACS

104
Q

Orthostatic Hypotension

A

Supine for 5 min
Then stand

> 20 fall in systolic
10 fall in diastolic

105
Q

Causes of Orthostatic Hypotension

A

Parkinson
DM
Volume depletion- dehydrated d/t vomiting, hemorrhage, etc
Meds (too much Anti-HTN meds in elderly)

106
Q

What to consider ordering if pt has Orthostatic Hypotension

A

CBC
CMP
EKG

detailed history
review med list
neuro hx/exam

107
Q

Often one of the first signs of shock

A

HYPOTENSION, low BP

Clinical Prep (41 decks)

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