Pharm 7 Dyslipidemia pt1 Flashcards
__ are the best way to visualize clots.
Intravascular ultrasounds
How to diagnose Dyslipidemia
Diagnosed using fasting lipoprotein profile, aka fasting cholesterol/lipid profile
Generally want people fasting “overnight”, 12 hours.
Role of CETP
changes cholesterol’s particle size. (between HDL, VLDL, LDL)
What’s the deal with LDL?
Apo B is the particle that is atherogenic. Attaches to LDL typically on a 1:1 relationship (every typical LDL has 1 Apo B on it)
Golf ball, tennis ball cholesterol scenario:
If 2 patients have = cholesterol VOLUME, but one’s is entirely golf balls (Apoproteins), and the other’s is entirely tennis balls. Are they at equal risk?
The golf balls – more Apoproteins – atherogenic particles. Greater risk. The tennis balls had fewer atherogenic particles.
When do we want to measure Apo B?
not on everybody (it’s $200), but you take a patient’s history and find out parents had their first MI in late 40’s. This patient’s LDL is within normal. So you decide to check Apo-B and realize it’s 140 (high). So you realize this person’s cholesterol are ‘golf balls’, not ‘tennis balls’
TC (total cholesterol): 212, LDL: 108, HDL: 102, TRIGS: 49
Assess!
hdl is so high it’s very protective. Trigs are normal. This is a very good cholesterol panel, excluding LDL which is a little higher than he’d like.
According to ATP III-R, what is the Optimal LDL-C?
Below 100 mg/dL; or
Below 70 in patients with high risk
(High risk = Coronary Heart Disease risk equivalents – Diabetes (if you have Diabetes, you have heart disease), Stroke, MI, AAA, Coronary Stenosis.)
How to read a lipid panel
First look at LDL, then Trigs.
If Trigs are high, don’t calculate non-HDL, don’t bother. If it’s normal then calculate it.
*How to determine Non-HDL goal
LDL goal + 30
What is the non-HDL goal in a high risk patient?
What about a non-high risk patient?
If LDL goal is <100: 130
What do you do if a patient didn’t fast before having their lipid profile done?
you can just use non-HDL cholesterol.
71-year-old male, hypertensive, smoker, overweight, with a family history for CHD
LDL: 145; HDL: 38; TRIG: 290.
Assess according to ATP III #1 thing to change about this patient?
At this point don’t bother make him stop smoking. Maybe exercise.
Want LDL40, TRIG <150
Tx: Drug and target lifestyle changes
Recognize that Trigs 290 means LDL# is not normal, must calculate Non-HDL cholesterol.
*HDL levels by gender
Male: >40
Female: >45
HDL, LDL control. Which is more important?
HDL increasing is more important than LDL decreasing.
ATP III Changes HDL Classification
Low HDL-C now a risk factor & treatment target
Modest increases in HDL-C = CHD risk reduction
Low HDL-C strongly associated with CHD
High HDL-C reduces risk
1% decrease in LDL-C reduces CHD risk by
1%
1% increase in HDL-C reduces CHD risk by (each gender)
3% in men, 2% in women
We have no drug that raises HDL well though
What is a CRP level? What does it mean if it’s high or low?
C-reactive protein. A general marker of increased risk
Diseases & pregnancy make it increase
Being healthy and controlling BP, cholesterol, sugar makes it decrease
Compare Angiograms vs. Intravascular Ultrasound
Angiograms are not perfect, b/c they don’t really see it in 3 dimensions. It’ll look nice and wide from one view, but from another it’s absolutely flat.
IVUS - This is the Gold Standard
What did the ASTEROID study reveal?
Statins can modestly reduce plaques, as well as improve LDL (greatly) and HDL (a little)
“The Fab Five” of lipid lowering agents
What’s the only one with outcomes data?
BILE-ACID SEQUESTRANTS STATINS - only one with outcomes data FIBRATES NIACIN CHOLESTEROL ABSORPTION INHIBITORS
HMG-CoA Reductase Inhibitors are also known as
Statins
3 examples of Statins
Simvastatin
Atorvastatin
Rosuvastatin
Rosuvastatin
Indications (4)
Adjust to diet in Hyperlipidemia/Mixed Dyslipidemia to reduce total-c, LDL, apo B, non-HDL-C, and TG
Adjuct to diet in HyperTG
Adjunct with other lipid-lowering agents in homozygous familial hypercholesterolemias
Adjunct to diet to slow progression of atherosclerosis (this doesn’t require elevated cholesterol. Means it’s FDA approved for use in ppl with normal cholesterol too)
Rosuvastatin
Contraindications and Precautions (3)
1 side effect
Monitor LFTs prior to Rx, at 12 weeks and then every 6 months or symptomatic
Stop if serum transaminase levels (LFT’S) > 3x normal lvl
Discontinue if myopathy or CK levels > 10 x ULN (10x the upper range of normal)
Side effect: muscle aches in thighs
*Dosing statins in Asians
Starting statin starting dose is 50% of other ethnicities. 5 mg (instead of 10mg)
