Lipid Lowering Drugs part 2 Flashcards
How long should a patient fast to determine the levels of LDL, HDL, and total cholesterol
about 9-10 hours
When a patient is at high risk what is the optimal level of LDL
should be below 100mg/dL
What is the near optimal level of LDL
from 100-129 mg/dL
What is the borderline high level of LDL
from 130-159 mg/dL
what is the high level of LDL,hint it will be a range
160-180 mg/dL
What is the very high level of LDL
any thing above 190mg/dL
For total cholesterol what is the desirable level
below 200mg/dL
For total cholesterol what is borderline high level
200-239 mg/dL
For high cholesterol what is range
anything equal or above 240 mg/dL
For HDL cholester what is the range. Why will it be higher for women than men.
it will be higher in women because of hormones
low is below 40mg/dL in men
and 50 mg/dL of women
Is it better for HDL to be high or low
high; because it gets rid of cholesterol in blood stream; if its high subtract one risk factor
What is a high range for HDL
anything above 60mg/dL
What is the next therapeutic step after the levels of lipoproteins have been determined
determine if the patient has atherosclerotic disease that puts them at risk for having coronary heart disease or its equivalents
What are the equivalents of coronary heart disease
symptomatic carotid artery disease
peripheral artery disease
abdominal aortic aneurysm
Explain carotid artery disease
in the fork between the anterior and posterior artery one irrigates the face the other the brain, b/c there is a fork there is a tendency to have artherosclerosis in this place– it can be dangerous for proper blood irrigation. Its a high risk level should be lowered
Explain peripheral artery disease also know as PAD
some plaque can form in lower extremities, will produce a stenosis and blood irrigation is decreased significantly–ischemia
Explain paradoxical redness and what disease is it related to
the patient will have redness of legs or feet, peripheral blood will increase near area that is block as the body tries to bring blood there
how ever if you tell the patient to bring the legs up or elevate the redness will go away
What is abdominal aortic aneurysm
the abdominal aorta wall becomes weak and thin, any added pressure and it can explode causing death
What is the third step in therapy
determine other risk factors except LDL
What is the Framingham Calculator
determines the 10 year risk factor for coronary heart disease leading to heart attack
What are some symptoms for peripheral artery disease
pain while walking, ischemia in the legs
what are some other risk factors except high LDL
cigarette smoking hypertension low hdl family history of premature coronary heart disease age
For the other risk factors, what range is hypertension
blood pressure is higher than 140/90
For the other risk factors, what is low HDL
anything below 40mg/dL
For the other risk factors,what is notable risk factor for family history
if dad or brothers had a heart attack before 55 yrs and patient is male
if your mother or sister had a heart attack before 65 yrs old you are female
At what age become a risk that requires the patients to set new LDL goals
if you are a male older than 45 years
if you are a female older than 55 years
What is the four step in therapy
Ignore the LDL levels and if the patient does not have a CHD risk or equivalent then determine if there are two or more risk factors. And then again assess the 10 year risk with Framingham table.
What is an above 20% risk on framhingham table
its a high risk
What is an intermediate risk on Framinham score
10-20%
What is a low risk framhingham score
below 10%
What are the treatment categories for LDL-c
CHD or equivalent/ above risk 2 risk factors-10 yr risk 10-20%, 10 yr risk below 10%/ anything below two risk factors
For CHD or equivalent what should be the LDL goal and at what point should the doctor consider drug therapy
LDL-c Goal should be: less than 100mg/dL
consider drug therapy @: equal to or greater than 130 mg/dL
For a patient with 2 risk factors that does not include CHD or an equivalent, but has a Framhingham score below 10%, what is the LDL-goal and at what point should a doctor consider drug therapy
LDL-c goal should be: less than 130 mg/dL
consider drug therapy @: equal to or greater than 160mg/dL
For a patient with 2 risk factors that does not include CHD or an equivalent, but with a Framhingham score above 10%, what is the LDL-c goal and at which point should you consider drug therapy
LDL-c levels should be: less than 130mg/dL
consider drug therapy @: equal to or above 130mg/dL
What is the LDL-c goal and drug therapy start point for drug therapy
LDL-c should be below 160mg/dL
consider drug therapy @: equal or greater than 190mg/dL
After step five (determining LDL goal of therapy), what is step 6
initiate therapeutic lifestyle changes, when LDL is above goal
What are the three lifestyle changes patients with higher than goal LDL should do
altering total cholesterol in the diet
weight management
increasing physical activity
Explain the total cholesterol changes that should be implemented in the diet
saturated fat should be less than 7% of the calories and cholesterol should be less than 200mg/day (equal to one egg yolk)
increase fiber 10-25g/day and plant sterols 2g day because it will compete with adsorption of cholesterol into body
How does weight management help with life style changes
it deals with other cardiovascular risk factors and helps overall health
How has physical activity been show to help the body
it increases HDL cholesterol
What is the seven step in LDL therapy
once you have determined the patients category, implemented life style changes, THEN consider drug therapy
If a patient is between what ranges for LDL-c and has a CHD or equivalent risk what should be done
the patient is in between 100-129mg/dL but that are at risk for CHD or equivalent then doctor can consider giving them total life changes, statin, niacin or fibrate therapy
After what period of not reaching goal should the doctor consider drug therapy
about three months, it enough time to see if other life style changes have impacted cholesterol levels
What is metabolic syndrome
it is a cluster of cardiovascular risk factors; that usually has to do with abdominal obesisty, diabetes/ pre diabetes, high blood pressure and low HDL level, patient may have high triglycerides and a higher risk for heart attack
If a patient has metabolic syndrome after 3 months of total life changes how can you treat it
treat underlying causes
and lipid/non lipid risk factors
How can you treat underlying causes
by intensifying weight management and physical activity
What lipid and non-lipid risk factors should be treated
- hypertension
- use aspirin for CHD patients to reduce blood clots
- treat triglycerides and low HDL
