Pharmacology and Pharmoctherapy of Lipid Drugs and Disorders Flashcards
Uncontrolled hyperlipidemia significantly increases risk of what coronary heart diseases
Coronary artery disease, cerebovascular disease, peripheral vascular disease
What are non-modifiable cardiovascular risk factors
Increased age, male sex, first degree relative family history, Race
What are modifiable cardiovascular risk factors
Cigarette smoking, hypertension, obesity, diabetes, physical inavtivity, high LDL, poor diet
T/F: Lipid panels should start being done at 20
True
T/F: LDL is calculated and cannot be calculated if triglyceride levels are greater than 300
False: LDL is calculated and cannot be calculated if triglyceride levels are greater than 400
What is optimal LDL levels, high LDL levels, very high LDL levels
less than 100, 160-189, greater than 190
What is a high level for HDL
greater than 160
What is a very high reading for serum triglycerides
Greater than 500
What are the ASCVD risk groups
Clinical ASCVD, Severe hypercholesterolemia, Diabetes, Primary Prevention
What is primary prevention
Therapy aimed to prevent first ASCVD event
What is secondary prevention
Therapy aimed to prevent a subsequent event
T/F: Patients who are part of the secondary prevention are considered to have clinical ASCVD
True
What is ASCVD
Atherosclerotic cardiovascular disease
History of what diseases would make someone be diagnosed with ASCVD
Myocardial Infarction, Stable or unstable angina, Coronary or other aterial vascularization
What current diseases would a patient have in order to be diagnosed with ASCVD
Acute coronary syndrome, Stroke or transient ischemic attack, peripheral arterial disease
What are secondary causes of dyslipidemia
Medication-related, uncontrolled diabetes mellitus, alcohol, malnutrition, liver disease
What are the two determinants on if a patient is considerd high-risk for future ASCVD events if they are in the Clinical ASCVD group
History of multiple major ASCVD events, 1 major event and multiple high-risk conditions
What are major ASCVD events
Recent Acute coronary syndrome, history of myocardial infarction, history of ischemic stroke, symptomatic peripheral arterial disease
What are high risk conditions for ASCVD events
Age greater than 65, diabetes mellitus, hypertension, CKD (eGFR 15-59ml/min/1.73m2), current smoking, persistent LDL-C elevation (greater than 101) despite max statin and ezetimibe , history of congestive heart failure
T/F: If someone is in the Clinical ASCVD group they should be assessed to either be on a high intensity statin or a low intentisty statin
False: Everyone in the Clinical ASCVD group should be on a high intensity statin whether very high risk or not
If a patient is in the clinical ASCVD group and is on a max tolerated statin with LDL greater than 70 what medication would it be reasonable to add
Ezetimibe
If a patient is in the clinical ASCVD group an is very high risk, on a statin, and on ezetimibe and their LDL is greater than 70 what medication would it be reasonable to add
PCSK9 inhibitor
What is a baseline LDL for someone in the severe hypercholesterolemia group
Baseline LDL greater than 190 mg/dL
T/F: Patients in the severe hypercholesterolemia group have high lifetime ASCVD risk
True
What medication should all severe hypercholesterolemia patients be on
Maximally tolerated statin
When is adding ezetimibe reasonable for a patient who is in the severe hypercholesterolemia group
There is a less than 50% reduction in LDL with statin
When is adding a PCSK9 reasonable for a patient who is in the severe hypercholesterolemia group
If the patient is on a statin and ezetimibe with LDL greater than 130 mg/dL
When a patient is in the diabetes group what is their risk of ASCVD events
Intermediate to high-risk
What is medication is required if a patient is in the diabetes group
At least a moderate intensity statin
When would it be appropriate to give someone a high intensity statin if the patient is in the diabetes group
If the patient has multiple ASCVD risk factors or risk modifiers
What are the diabetic specfic risk modifiers
DM1 greater than 20 years or DM2 greater than 10 years, Albuminuria, eGFR less than 60ml/min/1.73m2, retinopathy, neuropathy, ankle brachial index less than 0.9
When would it be reasonable to add ezetimibe to statin therapy for a patient in the diabetes group
ASCVD risk is greater than 20%
What is the goal LDL reduction for patients in the diabetic group
Reduce LDL by 50%
If a patient is in the primary prevention risk and has an ASCVD risk of of less than 5% (low risk) what is the therapy
Lifestyle changes only
If a patient is in the primary prevention risk and has an ASCVD risk of 5% to 7% (borderline risk) what is the therapy
Lifestyle changes, consider a moderate intensity statin if risk enhancers are present
If a patient is in the primary prevention risk and has an ASCVD risk 7.5% to 20% (intermediate risk) what is the therapy
Lifestyle changes, moderate intensity statin if risk enhancers are present
T/F: Patients in the primary prevention with intermediate risk can be considered for a hgih intesnsity statin and addition of ezetimibe if the high intensity statin is not tolerated
True
If a patient is in the primary prevention risk and has an ASCVD risk greater than or equal to 20% (high risk) what is the risk
Lifestyle changes and a high intensity statin
What is the goal for patients in the primary prevention group with intermediate risk, high risk
30% to 49%, 50%
What are the risk enhancers for patients in the primary prevention group
Persistently elevated LDL greater than 160 mg/dl, persistently elevated triglycerides greater than 175 mg/dl, metabolic syndrome
