Hyperlipidemia * + HTN *** Flashcards
Framingham risk factors
Sex
Age
Total Cholesterol
HDL
Systolic Blood Pressure
Smoking Status
Diabetes
Blood Pressure Medication Use
What LDL and total cholesterol do you aim for?
LDL <2.0 or >50% Reduction in LDL
Total Cholesterol <4
Meds that lower lipids + examples of each
Statins (simvastatin)
Bile Acid Sequestrants (cholestyramine - only lipid lowering drug safe in pregnancy)
Nicotinic Acid (Niacin)
Fibrates (clofibrate - used for lowering TG)
Cholesterol Absorption Inhibitors (ezetimibe)
PCSK9 Inhibitors (alirocumab, evolocumab)
RF
Increasing age
Male
Smoking
DM
Erectile dysfunction
Family history
Obesity
Secondary causes of raised LDL
Meds: diuretics, steroids, amiodarone, retinoids
Biliary obstruction
Nephrotic syndrome
Hypothyroidism
Anorexia
pregnancy
Secondary causes of raised TG
Meds: estrogen, steroids, BB, thiazides, tamoxifen, APs, retinoids,
Nephrotic syndrome
Hypothyroidism
Obesity
Pregnancy
Alcohol
Screening for hyperlipidemia
40-75 y/o = non fasting lipids q5yr, earlier if RF present
a1c, eGFR, Lp(a), fasting lipids if TG >4.5
Risk satisfy w/ FRS
Lifestyle recommendations to lower cholesterol
Alcohol use
Physical activity
Wt loss
Smoking cessation
Sufficient sleep
Diet (Mediterranean, Portfolio, DASH)
Target lipid levels + management for low, med + high risk
Low risk (FRS <10%) - lifestyle changes
Moderate risk (FRS 10-19%) - mod intensity statin, expect LDL <30%. Add ezetimibe if LDL >2
High risk (FRS >20%) - high intensity statin, expect LDL <50%, ezetimibe if LDL >2
How to manage LDL >5, pts with DM or CKD + pts w/ ASCVD
LDL >5 or FH = high intensity statin, expect LDL <50%, add ezetimibe if not in target
DM or CKD = mod intensity statin, expect LDL <2, add ezetimibe if LDL >2
ASCVD (MI, ACS, angina, CAD, CVA, TIA, PAD, claudication) = high intensity statin, expect LDL <1.8, add ezetimibe if LDL >1.8, add PCSK9 if LDL >2.2
Screening for HTN
ABPM > HBPM > AOBP > OBPM
Annual AOBP >40 y/o or w/ RF
q5yrs for adults 18-39 y/o
BP technique for office + home
Technique:
Bladder cuff width 40% arm circumference + length >80%
Non dominant arm
Quiet, rest 5 mins, empty bladder, arm at heart height, back supported, feet flat
Home: 7 days, before meds, 2 readings before breakfast + 2 readings after dinner, average days 2-7
Types of HTN
White coat HTN: increased BP in office but normal at home
Uncontrolled HTN: increased BP in office + home
Masked HTN: normal BP in office, high at home
Induced: NSAIDs, steroids, OCP, SSRIs, decongestants, cocaine, alcohol, caffiene
Secondary: renovascular, primary hyperaldosteronism, hyperthyroidism, Cushings, pheochromoctyoma, OSA, coarctation of aorta
RF for HTN
> 55
Male
Fam hx
LVH
PAD
CVA/ TIA
DM
Obesity
Smoking
Stress
Ix for HTN
Urinalysis, lytes, Cr, a1c, lipids
ECG
Urinary albumin if diabetic
Complications of HTN
Cardio: LVH, CHF, CAD, MI
Cerebrovascular: TIA, ischemic/ hemorrhagic CVA, SAH, dementia
Retinopathy
Renal: CKD
PAD
Emergency: HTN encephalopathy, aortic dissection, LVF, ACS, AKI, ICH, CVS
In a young pt needing multiple meds, what cause of secondary HTN would you be concerned for + what investigation would you order?
renovascular - renal scan, CTA
Monitoring for HTN - when pursuing lifestyle measures only vs on meds
Lifestyle only - q6 months
On pharmacotherapy - q1 month until readings on target then q6 months
Rx for HTN when systolic <160
Lifestyle changes:
Exercise 30 mins moderate 5/7
Wt loss
Reduce alcohol
DASH diet (fruits, veg, whole grain)
Reduce salt
Stress reduction
Stop smoking, maintain healthy weight
What are the target BPs?
Target BPs:
<140/90 or <130/80 if DM or <120 if CKD or CVD
Hypertensive emergencies
Decompensation of organ function d/t BP
High BP + MI, encephalopathy, LV failure, aortic dissection
Encephalopathy sx + rx
Sx: papilledema, HA, visual changes, N/V, neuro deficit, sz, coma
Rx: IV labetalol infusion
Pulmonary edema sx + rx
Sx: SOB, pink sputum, CP
Rx: nitro infusion, IV enalapril, SL captopril
Aortic dissection sx + rx
Sx: sharp, tearing CP + back pain
Rx: nitroprusside or esmolol infusion, labetalol infusion
CVA sx + rx
Sx: unilateral weakness, aphasic, impaired gait
Rx: use labetalol to lower BP if needed