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Pharm Spring 2014 > Lipids > Flashcards

Lipids Flashcards

1
Q

Who gets statins for secondary prevention of ASCVD?

A

1) Those with ASCVD
2) LDL > 190
3) DM
4) >7.5% of 10 year ASCVD risk

Intensity of statin therapy depends on what category you fall into

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2
Q

What are HMG co-A reductase inhibitors also known as?

A

Statins

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3
Q

Yo mamma’s so fat!

How fat is she??

A

That she qualifies for high intensity statin therapy!

ohhhhh!!!!!!!

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4
Q

Statin therapy for those with primary HLD

A

For patients with LDL > 190
Results in LDL reduction by 39 points
Reduces ASCVD risk by 20%
May need additional lipid lowering agent that isn’t a statin

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5
Q

Do you automatically qualify for statin therapy if you have DM?

A

Yes

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6
Q

Statin therapy for those with DM

A

Ok to give moderate intensity
For patients 40-75 y/o with DM (I or II)
Have significant benefit from statin therapy
Give high intensity if 10 year risk is >7.5%

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7
Q

Who should you do an 10 year ASCVD risk for?

A

For people without existing ASCVD, without DM, and LDL t obviously need statins

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8
Q

Statins will reduce ASCVD risk across ____ LDL levels

A

all

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9
Q

When to treat triglycerides?

A

If TG > 200 and LDL is already under control, then add another agent for TGs.

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10
Q

What about statins and HDL?

A

Treat with statins if HDL < 40

Remember that statins will decrease TG and LDL and increase HDL.

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11
Q

How do bile acid sequestrants work?

A

The bind bile acid in the intestines, forcing the liver to use cholesterol to produce more bile acids.

This can cause oily BMs. Fun!

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12
Q

Effect of a statin plus niacin

A

Risk of hepatic dysfunction

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13
Q

What are cholesterol and triglycerides needed for?

A

TG- essential energy source

Cholesterol- Cell membranes, bile acids, steroid hormones

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14
Q

S/S of HLD

A

Xanthelasma (fatty deposits in skin and eyes)
Circumferential arcus
PVD (shiny extremities, hairlessness, skin discoloration- redness)
Thickened achilles
HTN or DM (these ppl usually have HLD)

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15
Q

If you get a lipid panel and the person forgot to fast, you can still use these values

A 
Total Cholesterol (TC)
HDL

Even if they forgot to fast and their TC > 200 or HDL is <40, bitch-slep them, tell them to fast this time, and then retest.

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16
Q

What do we care about more? Your LDL level or overall ASCVD risk?

A

ASCVD risk

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17
Q

TC and TG levels in someone with Primary (familial) HLD

A

TC > 200

TG > 500

18
Q

Secondary HLD can be caused by

A 
DM
CRF
Hypothyroidism
Obstructive liver disease
Medications that increase LDL and decrease HDL (corticosteroids, progestins, and anabolic steroids-->all types of steroids!)
Many other disease processes as well
19
Q

Effect of alcohol on lipid panel

A

Increase in TG

Increase in HDL

20
Q

What is the overall goal of the newest ACC/AHA guidelines?

A

Relative reduction of ASCVD risk by using statins

21
Q

What should people get screened for every 4-6 years starting at age 20?

A

Lipid profile (TC, TG, LDL, HDL)
ALT CK, HbA1c, 10 year ASCVD assessment
Herpes

22
Q

What is primary HLD prevention?

A 
Lifestyle changes (reduced dietary saturated fats and cholesterol, exercise, and weight control)
Recommended for all patients regardless of state of health
23
Q

Dietary influences on HDL and LDL

A

HDL

  • Elevated by alcohol, weight loss, and saturated fats
  • Lowered by low fat diet, sugar, excess calories, and excess polyunsaturated fats

LDL

  • Elevated by saturated fat, trans-fatty acids, and cholesterol
  • Lowered by monounsaturated fatty acids, complex carbs (fiber!), and soy

Saturated fats elevate both kinds.

24
Q

Four main categories established as candidates for statin therapy

A

Clinical ASCVD
10 year ASCVD risk > 7.5%
LDL > 190
DM

Intensity of the therapy depends on what category you fall into

25
Q

Statin therapy will reduce ASCVD risk for anyone with an LDL level over

A

70

26
Q

These are the two high-intensity statin meds

A

Atorvastatin 80mg

Rosuvastatin 20mg

27
Q

How do statins work?

A

The inhibit HMG Co-A reductase, which is the rate limiting enzyme in the production of cholesterol.

28
Q

Statins for people with ASCVD

A

If < 75, give high intensity

If > 75 or if high-intensity therapy is contraindicated, give moderate therapy.

29
Q

A reduction of LDL by ____ will decrease the risk of ASCVD by _____

A

39 mg/dL

20%

30
Q

Statin therapy for those with DM

A

If age 40-75 and LDL 7.5%, then give high-intensity.

31
Q

Does the data support statin use as a primary therapy?

A

Yes.

32
Q

How can you identify a bile acid sequestrant?

A

The names begin with chole/cole –> Referring to bile!

33
Q

How does nicotinic acid (Niacin) work?

A

By reducing the production of VLDLs

34
Q

Form of nicotinic acid (niacin) that is sustained release

A

Niaspan

35
Q

How do fibric acid derivatives work?

A

They reduce the synthesis of and increase the destruction of VLDLs

36
Q

How can you identify a fibric acid derivative?

A

“Fibr” will be hidden in the name somewhere.

The most common one is Gemfibrozil (Lopid)

37
Q

How does Ezetimibe (Zetia) work?

A

Preventing the absorption of cholesterol and phytosterol at the brush border of the intestines. Despite this, it has no effect on the absorption of fat soluble vitamins.

38
Q

Ezetimibe (Zeta) is supposed to be prescribed with

A

A statin.

39
Q

This is a potential SE of any statin

A

Myopathies. People especially at risk include age >80, small body frame/frail people, impaired hepatorenal function, ETOH abuse)

40
Q

Things to know about Statin/Fibric Acid Derivative combo therapy

A

Primarily assists in decreasing TGs
Increased risk of myopathies
Contraindicated in severe hepatic disease

41
Q

What is the only lipid lowering agent you can take during pregnancy?

A

Bile-acid sequestrants. Yay pregnancy! Yay oily poops!

Pharm Spring 2014 (13 decks)

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