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Exam 4 > Lipids/CKD > Flashcards

Lipids/CKD Flashcards

1
Q

CKD is defined as ____ or more months of either kidney damage or eGFR < _____.

A

3, 60

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2
Q

Dominant risk factors for CKD

A

DM and HTN

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3
Q

Four interventions to reduce CKD progression

A

blood pressure control goal <130/80
use of ACE/ARB (not together) for albuminuria
DM control HgBA1C target <7%
correction of metabolic acidosis

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4
Q

eGFR Stages of CKD

A 
Stage 1- 90-100 normal
Stage 2- 60-89% mild
Stage 3- 30-59% moderate
Stage 4- 15-29% severe
Stage 5- 14% and less- failure
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5
Q

Which stage of CKD? eGFR 90-100%, asymptomatic, with health issues such as DM, HTN, and obesity

A

Stage 1

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6
Q

Modifiable risk factors for CKD

A

DM
HTN
frequent NSAID use
hx of AKI

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7
Q

Non-modifiable risk factors for CKD

A

family hx of CKD
age 60 or older
ethnicity- AA, Hispanic, Asian/PI, or American Indian

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8
Q

What lab tests are used to diagnose CKD?

A

eGFR

ACR- albumin to creatinine ratio, urine (kidney damage marker)

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9
Q

Normal UACR level

A

<30

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10
Q

Severe albuminuria UACR level

A

> 300

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11
Q

Urine dipstick proteinuria if level is > ____.

A

30

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12
Q

Especially avoid these medications in CKD

A 
NSAIDs
Bisphosphonates 
IV contrast
Metformin
RAAS blockers
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13
Q

Starting at stage 3 CKD these additional labs are needed

A

Serum albumin
phosphorus
calcium
intact parathyroid hormone (PTH)

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14
Q

At what stage should nephrology be consulted in patients with CKD

A

Stage 3 or eGFR <30

or persistent albuminuria UACR >300

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15
Q

Clinicians should not only check patients blood creatinine levels but also check their ______.

A

Urine- low pH, high specific gravity, protein, RBC/WBCs are early indicators of potential issues.

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16
Q

In order for erythropoiesis-stimulating agents (ESA) to be effective, this medication is needed

A

Iron supplementation

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17
Q

Sodium should be limited to ___g/day and phosphorus ___-____mg/day in patients with CKD

A

2

800-1000

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18
Q

Animal protein consumption should be reduced to

___-___g/kg/day in CKD patients

A

0.6-0.8

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19
Q

What stage of CKD do complications usually begin>

A

Stage 3 (anemia, bone/mineral issues, CV dz, low serum albumin)

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20
Q

Common meds that require dose reduction

A 
Allopurinol
Gabapentin
Reglan
Narcotics- methadone/fentanyl
Beta-blockers
Digoxin
Statins- lova, prava, simva, fluva, rosuva
Antimicrobials- sulfa, Macrobid, aminoglycosides
Lovenox
methotrexate
colchicine
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21
Q

Treatment of hyperkalemia in CKD

A

Stop NSAIDs and Cox-2 inhibitors
Stop K+ sparing diuretics (spironolactone)
Avoid salt substitutes

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22
Q

CKD increases the risk for ____ disease.

A

CV

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23
Q

Increased waist circumference, increased trigs, decreased HDL, increased BP, and increased fasting glucose are indicators of:

A

metabolic syndrome

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24
Q

How do ACE/ARBs help with CKD?

A

lowers BP and reduces hyperfiltration injury inpatients with limited nephrons

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25
Q

What is the primary intervention for metabolic syndrome?

A

lifestyle therapy

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26
Q

Statin intensity for clinical ASCVD

A

high intensity if <75y

mod-high if >75y

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27
Q

Statin intensity for age 40-75 with DM and LDL 70-189

A

moderate intensity, consider increase if multiple ASCVD risk factors

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28
Q

Severe primary hypercholesterolemia LDL >190 initiate ____ intensity statin without calculating ASCVD risk

A

high

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29
Q

Statin intensity for age 20-75 with LDL >190

A

high

30
Q

ASCVD risk enhancers

A 
family hx of premature ASCVD
persistently elevated LDL >160 or trigs >175
CKD
metabolic syndrome
preeclampsia, premature menopause 
Inflammatory disorders: RA, psoriasis, HIV
ethnicity (South Asian ancestry)
ABI <0.9
31
Q

Signs/Symptoms of Stage 2 CKD

A

eGFR 60-89%

protein leaking in urine <200mcg

32
Q

Signs/Symptoms of Stage 3 CKD

A 
eGFR 30-59%
Edema
Fatigue
Back pain 
Foamy, darker urine 
Microalbumin >200mcg 
Food restrictions: Na+ and phosphorus
33
Q

Signs/Symptoms of Stage 4 CKD

A 
eGFR 15-29% Stage 3 symptoms plus:
n/v
difficulty concentrating
tingling in fingers/toes
loss of appetite
sleep problems
dialysis need
renal dietician required
less dietary potassium intake
34
Q

Signs/Symptoms of Stage 5 CKD

A 
eGFR 0-14% Stage 4 symptoms plus:
fatigue/weakness
easy bruising/bleeding
anemia
thirst/cramps
skin color changes
making little to no urine
dialysis or transplant
35
Q

A daily dose of high-intensity statin can lower LDL by ____%

A

50

36
Q

A daily dose of moderate-intensity statin can lower LDL by ____%

A

30-49%

37
Q

A daily dose of low-intensity statin can lower LDL by ____%

A

<30%

38
Q

High-intensity statins have a longer _____-_____ and can be given any time of day. These medications are good for patients who have adherence problems.

A

half-life

39
Q

High-intensity statin list

A

Atorvastatin 40-80mg

Rosuvastatin 20-40mg

40
Q

Moderate-intensity statin list

A 
Atorvastatin 10-20mg
Rosuvastatin 5-10mg
Simvastatin 20-40mg 
Pravastatin 40-80mg
Lovastatin 40mg 
Fluvastatin XL 80mg
Fluvastatin 40mg BID
Pitavastatin 2-4mg
41
Q

Low-intensity statin list

A

Simvastatin 10mg
Pravastatin 20mg
Lovastatin 20mg
Fluvastatin 20-40mg

42
Q

If CAC score is > ____ or >_____ percentile, statin therapy is indicated unless patient refuses.

A

100, 75th

43
Q

After beginning the treatment plan, lipids should be repeated in ___ to ____ weeks and repeat every ___ to ___ months if needed to check for statin intolerance.

A

4-12 weeks

3-12 months

44
Q

If ASCVD risk <5% (low risk) the clinician should:

A

discuss risk and emphasize healthy lifestyle habits to reduce risk factors

45
Q

If ASCVD risk 5% to <7.5% (borderline risk) the clinician should:

A

If the patient has risk enhancing factors, consider mod-intensity statin. If the decision about statin remains uncertain it is reasonable to use a CAC score to withhold, postpone or initiate therapy.

46
Q

If ASCVD >7.5% to <20% (intermediate risk) the clinician should:

A

Consider mod-high intensity statin or a nonstatin for those who cannot tolerate statins. Consider requesting a CAC score.

47
Q

If ASCVD >20% (high risk) the clinician should:

A

High risk with multiple high-risk clinical factors, initiate statin therapy to reduce LDL by 50%

48
Q

If LDL remains >70 despite max tolerated statin therapy, the clinician should consider adding:

A

Zetia (add to moderate-intensity statin)

49
Q

Major ASCVD events

A

ACS in past 12months
hx of MI or ischemic stroke
symptomatic PAD ( hx of claudication with ABI <0.85 or previous revascularization or amputation)

50
Q

Bile sequestrants may increase ________.

A

triglycerides

51
Q

Patients with impaired renal function should be prescribed which statins?

A

Atorvastatin or fluvastatin. Caution use of Rosuvastatin in these patients.

52
Q

Patients with heart failure related to ischemic disease should be started on what intensity statin?

A

moderate

53
Q

Adults with severe hypertriglyceridemia (>1000) should begin statin therapy. If the level remains high, the clinician should also prescribe _______.

A

fibrate therapy (fenofibrate) to prevent acute pancreatitis. Dietary modifications are also needed: a very low-fat diet, no refined carbs or ETOH, add omega 3.

54
Q

To have a true statin intolerance, the symptoms must:

A

occur after initiating therapy, improve with statin DC, and reappear when reintroducing statin.

55
Q

True or False: Statins can be given during pregnancy

A

False. Statins are listed as category X

56
Q

LDL target for patients with very high risk CV disease is

A

50

57
Q

ALL patients should limit this in their dietary intake:

A

sat/trans fat, sweets, sugar-sweetened beverages, red meats

58
Q

Universal pediatric lipid screening is recommended at what ages?

A

ALL 9-11-year-olds

12-17-year-olds with new family hx, a parent with HLD, or other risk factors

ALL 17-21-year-olds

59
Q

In children and adolescents 10 years or older with an LDL persistently >190 or 160 with family hx, who do not respond adequately with __-__ months of lifestyle therapy it is reasonable to initiate statin.

A

3-6

60
Q

These statin medications have been approved for use in children beginning at age 8.

A

Rosuvastatin and Pravastatin

61
Q

Children with LDL 250 or greater and or trigs >500 should be referred to a _____ _________.

A

Lipid specialist

62
Q

Xanthomas are indicative of ________ _________.

A

Familial hyperlipidemia

63
Q

These non-statin medications may be added with statins to help further reduce LDL.

A

Ezetimibe
Bile sequestrants (Questran, Colestipol)
PCSK9 inhibitors
Niacin and Fibrates

64
Q

Statin associated side effects

A 
BILATERAL myalgias (most common)
hepatotoxicity
GI upset
cataracts
Rhabdomyolysis
Increased risk of DM
65
Q

Hydrophilic statins are _____ soluble and may be tolerated better due to less distribution into the body’s tissues.

A

water

66
Q

Lipophilic statins are _____ soluble and tend to cause more muscle-related adverse effects since they are distributed into the body’s fat.

A

fat

67
Q

Patients with complaints of myalgias would benefit from _______ statins.

A

Hydrophilic

68
Q

List hydrophilic statins

A

Rosuvastatin
Pravastatin
Fluvastatin
Pitavastatin (slightly hydrophilic)

69
Q

List lipophilic statins

A

Atorvastatin
Lovastatin
Simvastatin

70
Q

Patients on statin therapy should avoid this fruit.

A

Grapefruit

71
Q

Drug-drug interactions with statins (Simvastatin, Lovastatin, Atorvastatin) metabolized through CYP3A4

A 
Amiodarone
Amlodipine
Azole antifungals
Diltiazem 
Verapamil

Exam 4 (3 decks)

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