Pathophysiology and Evaluation of Dyslipidemia Flashcards by TheOneandOnly Ash

What is the pathogenic pathway of atheroscleorisis?

Endothelial injury
Inflammatory response
Macrophage Infiltration
Platelet Adhesion
Smooth Muscle Cell Proliferation
Extracellular Matrix Accumulation

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True or Fale: most patients with dyslipidemia experience many symptoms

False, most patients with dyslipidemia are asymptomatic until they are very progressed

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What are the signs of dyslipidemia?

-Pancreatitis
-Eruptive xanthomas (fatty deposits on skin)
-Peripheral polyneuropathy
-Increased BP
-Increased waist size
-Obesity

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What is LDL-P vs LDL-C?

LDL-P is the number of LDL particles in the body

LDL-C is the amount of cholesterol in LDL particles

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What is the lab value Apo-B used to indicate?

Number of atherogenic particles

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What is the Friedewald equation used to estimate?

LDL

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What is the goal TC/HDL?

< or = 5:1

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What is the first-line treatment for dyslipidemia?

Non-Pharm Options!!!

(diet, exercise)

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When on a DASH diet, what percent of calories should saturated fats be limited to?

5-6%

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When on a DASH diet, what should sodium intake be limited to?

< 1500 mg daily

*Or at least reduce by 1000mg/day for most adults

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How much exercise should be recommended to patients as treatment for dyslipidemia?

90-150mins a week

*Divide into 3-4 sessions/week for 40 mins/session

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How many calories are there in 1 gram of fat?

9kcal/1 gram

*no conversion needed between kcal and cal

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What are some Therapeutic Lifestyle Changes that can be made to help treat dyslipidemia?

-Increase soluble fiber intake
-Increase plant stanol and sterol intake
-Weight reduction
Increase physical activity
-Smoking cessation

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If a patient is overweight, how much weight reduction is recommended to help treat dylipidemia?

10% weight loss

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What are omega-3 fatty acids used for?

To lower triglycerides

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What is a major side effect of omega-3 fatty acids?

Increase LDL by 4-49%

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What do the REDUCE-IT, OMEMI, and STRENGTH trials show?

People taking omega-3 fatty acids have increased rates of atrial fibrillation

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What are the 2 high intensity statins?

Atorvastatin

Rosuvastatin

What is the high-intensity dose of atorvastatin?

40-80mg

What is the high-intensity dose of rosuvastatin?

20-40mg

What are the 2 hydrophilic statins?

Rosuvastatin

Pravastatin

Which statin should absolutely be taken at night?

Simvastatin

(has a short half life of 6 hours, most cholesterol is made at night)

What did the SEARCH trial show?

Increased risk of ADR (myopathy and rhabdomyalgia) when taking simvastatin 80mg vs other doses

*Do not use simvastatin 80mg in patients unless they have been on it for > or = 12 months

What is an important consideration when prescribing 80mg simvastatin?

DO NOT PRESCRIBE 80 mg SIMVASTATIN TO NEW PATIENTS

-only keep prescribing in patients who have been on it for a year or more

let this med die out

How often should LFT's (liver function tests) be collected when a patient is on statins?

-At baseline -When clinically indicated

At what LFT (liver function test) should statins be discontinued?

3 x upper limit of normal

When taking a statin, what is the mount of grapefruit intake per day that should be avoided?

>1 quart daily

What are the contraindications associated with statins?

-Pregnancy -Women who may become pregnant (must demonstrate low risk of becoming pregnant if they want to start a statin) -Breastfeeding -Acute Liver Disease -Unexplained persistent elevations of serum transaminases

At what age should be consider taking patients off of statins?

> 75 years old (risk outweighs benefit)

If a patient experiences muscle symptoms or fatigue while on a statin, what should we do?

-Discontinue statin and evaluate for rhabdomyolysis -Evaluate for exacerbating conditions -Restart same or lower dose after symptoms recede

What drugs are contraindicated with simvastatin?

"conazole" "romycin" HIV protease inhibitors Nefazodone Gemfibrozil Cyclosporine Danazol

With what drugs should simvastatin not exceed 10 mg with?

-Verapamil -Diltiazem

With what drugs should simvastatin not exceed 20 mg with?

Amiodarone Amlodipine Ranolazine

What do the JUPITER and PROVE-IT TIMI 22 trials show?

Statins increase blood sugar and increase risk for diabetes *risks still outweigh benefits, should keep patients on them

How often should FLP's (lipid panels) be taken when a patient is on a statin?

-At baseline -4-12 weeks following initiation -Every 3-12 months as indicated

What are the 2 disadvantages of bile acid resins?

-May increase TG -Must take other meds 1 hour before or 4 hours after

Why do we typically not recommend that patients take niacin?

*Content is not federally regulated in the US

What are the 2 big side effects of niacin?

Prostaglandin mediated: -Flushing -Itching

What can we do to avoid he side effects associated with niacin?

Administer aspirin 325mg 30 minutes before taking

By how much can ezetimibe decrease LDL when added onto statin therapy?

12-20%

What are the side effects of ezetimibe?

-Fatigue -Diarrhea -GI upset

What is the active ingredient in Red Yeast Rice?

Lovastatin

What boxed warning is associated with Iomitapide (Juxtapid)?

Risk of hepaotoxicity