hyperlipidemia etc Flashcards
causes of hypercholesterolemia
hypothyroidism
pregnancy
kidney failure
cause of hypertriglyceridemia
DM
ETOH
obesity
steroids
estrogen
where do people commonly develop xanthomas
eyelids
Achilles tendon
what portion of people with xanthomas have normal lipid levels
2/3
hypertriglyceridemia can cause
pancreatitis
LDL goals for patients with CAD or equivalent
start drugs at > 130
LDL goal: < 100
optimal < 70
LDL goals for pts w no CAD but > 2 RF
start drugs at > 160
LDL goal < 130
LDL goals for everyone else (No CAD or equivalent or 1 or no RF)
start drugs at > 190
LDL goal < 160
tx for isolated LDL increase
statins
bile acid sequestrants
examples of bile acid sequestrants
Colestipal
Cholestyramine
Colesevelam
tx for isolated triglyceride incrase
fibrates
niacin (B3)
examples of fibrates
Fenofibrate
Fenofibric acid
Gemfibrozil
Clofibrate (not available in US)
tx to increase HDL
fibrates
niacin
tx for T2DM with hyperlipidemia
fibrates
statins
niacin may cause hyperglycemia so need to caution
what are the best class of meds to decrease LDL
statins
ADE statins
myositis
myalgias
rhabdo
hepatitis
contraindication statins
pregnancy
breast feeding
antibiotics and tetracyclines increase blood levels of statins
when is it best to take a statin
at bed time (when cholesterol synthesis is maximal)
what is the best drug to increase HDL
niacin/nicotonic acids (B3)
ADE niacin/nicotinic acids
flushing
headache
warm sensation
pruritus
hyperuricemia (may precipitate gout)
what can be taken prior to niacin to decrease flushing
Ibuprofen or aspirin
what is the best drug to decrease triglycerides
fibrates
ADE fibrates
increased LFTs
myositis
myalgias (esp w concomitant statin use)
increase bile acid lithogenicity (gallstones)
contraindications to fibrates
severe hepatobiliary disease
renal disease
what do bile acid sequestrants do to HDL, LDL, triglycerides
decreased LDL (increased w statins)
increase HDL
may increase TG (use in patients w normal TG)
what is the only hyperlipidemia drug that is safe to use in pregnancy
bile acid sequestrants
what else can bile acid sequestrants be used for
pruritus associated w biliary obstruction
ADE bile acid sequestrants
N/V
bloating
crampy abdominal pain
increased LFTs
increased TG
may impair absorption of digoxin, warfarin, fat soluble vitamins
what will you see on fundoycopic exam in advanced stage malignant HTN
papilledema
screening for hyperlipidemia
universal screening - once btwn 9 and 11 and again btwn 17 and 21
high risk - follow up 25-30 years or men and 30-35 years for women
low risk - follow up 35 men and 45 women
what things make someone “high risk” for hyperlipidemia
HTN
DM
cigarette use
what triglyceride levels are associated w pancreatitis
> 1000 mg/dL
who should receive a high intensity statin
anyone with LDL levels >/= 190
those with an estimated 10-year atherosclerotic cvd risk >/= 20%
who should receive a moderate intensity statin
pts w DM between 45-75 years and LDL of 70-189
those without DM and estimated 10-year atherosclerotic CVD risk > 7.5% but less than 20%
high intensity statin regimens aim to reduce LDL by
> /= 50%
moderate intensity statin regimens aim to reduce LDL by
30-50%
high intensity statin therapy options
atorvastatin 40-80 mg
rosuvastatin 20-40 mg
moderate intensity statin therapy options
atorvastatin 10-20 mg
rosuvastatin 5-10 mg
simvastatin 20-40 mg
pravastatin 40-80 mg
at what triglyceride level should patients receive tx for hypertriglyceridemia
> 500
metabolic syndrome
three or more
waist circumference greater than 102 cm in men or greater than 88 cm in women
triglyceride level greater than 150
HDL less than 40 in men and 50 in women
systolic BP greater than 130 or diastolic greater than 85
fasting plasma glucose level greater than 100
being on medical therapy for any also meets criteria
recommended cholesterol parameters
Total < 200
LDL < 100
HDL > 60
TG < 150
