Pharm 7 Dyslipidemia pt1

Question 1

__ are the best way to visualize clots.

Answer 1

Intravascular ultrasounds

Question 2

How to diagnose Dyslipidemia

Answer 2

Diagnosed using fasting lipoprotein profile, aka fasting cholesterol/lipid profile
Generally want people fasting “overnight”, 12 hours.

Question 3

Role of CETP

Answer 3

changes cholesterol’s particle size. (between HDL, VLDL, LDL)

Question 4

What’s the deal with LDL?

Answer 4

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)

Question 5

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?

Answer 5

The golf balls – more Apoproteins – atherogenic particles. Greater risk. The tennis balls had fewer atherogenic particles.

Question 6

When do we want to measure Apo B?

Answer 6

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’

Question 7

TC (total cholesterol): 212, LDL: 108, HDL: 102, TRIGS: 49

Assess!

Answer 7

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.

Question 8

According to ATP III-R, what is the Optimal LDL-C?

Answer 8

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.)

Question 9

How to read a lipid panel

Answer 9

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.

Question 10

*How to determine Non-HDL goal

Answer 10

LDL goal + 30

Question 11

What is the non-HDL goal in a high risk patient?

What about a non-high risk patient?

Answer 11

If LDL goal is <100: 130

Question 12

What do you do if a patient didn’t fast before having their lipid profile done?

Answer 12

you can just use non-HDL cholesterol.

Question 13

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?

Answer 13

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.

Question 14

*HDL levels by gender

Answer 14

Male: >40
Female: >45

Question 15

HDL, LDL control. Which is more important?

Answer 15

HDL increasing is more important than LDL decreasing.

Question 16

ATP III Changes HDL Classification

Answer 16

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

Question 17

1% decrease in LDL-C reduces CHD risk by

Answer 17

1%

Question 18

1% increase in HDL-C reduces CHD risk by (each gender)

Answer 18

3% in men, 2% in women

We have no drug that raises HDL well though

Question 19

What is a CRP level? What does it mean if it’s high or low?

Answer 19

C-reactive protein. A general marker of increased risk
Diseases & pregnancy make it increase
Being healthy and controlling BP, cholesterol, sugar makes it decrease

Question 20

Compare Angiograms vs. Intravascular Ultrasound

Answer 20

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

Question 21

What did the ASTEROID study reveal?

Answer 21

Statins can modestly reduce plaques, as well as improve LDL (greatly) and HDL (a little)

Question 22

“The Fab Five” of lipid lowering agents

What’s the only one with outcomes data?

Answer 22

BILE-ACID SEQUESTRANTS
STATINS - only one with outcomes data
FIBRATES
NIACIN
CHOLESTEROL ABSORPTION INHIBITORS

Question 23

HMG-CoA Reductase Inhibitors are also known as

Answer 23

Statins

Question 24

3 examples of Statins

Answer 24

Simvastatin
Atorvastatin
Rosuvastatin

Question 25

Rosuvastatin

Indications (4)

Answer 25

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)

Question 26

Rosuvastatin
Contraindications and Precautions (3)
1 side effect

Answer 26

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

Question 27

*Dosing statins in Asians

Answer 27

Starting statin starting dose is 50% of other ethnicities. 5 mg (instead of 10mg)