Pharmacotherapy: Dyslpidemia and HTN in DM Flashcards
What is the leading cause of morbidity and mortality for pt’s with DM2?
ASCVD
What is dyslipidemia in DM typically composed of?
Elevated TG and decreased HDL-C, with LDL elevations comparable to those without DM; however, particle size of LDL in pt’s with DM tends to be smaller/denser which can increase atherogenicity
What may be a good predictor of CHD?
HDL-C (reverse cholesterol transporter)
What is typically the lipid lowering agent of choice for pt’s with DM?
HMG-CoA reductase inhibitors (statin)
Lowers LDL-C and non HDL-C with secondary benefits of decreased TG and increased HDL-C
True or false: Statins are safe for women who are pregnant or BF
Who should they be used w/ caution in?
False; statins are contraindicated in pregnancy and BF–> used w/ caution for those with significantly impaired renal or hepatic function
Why might Niacin cause hyperglycemia?
niacin known to inhibit release of insulin for the beta cell, esp for those with new dx DM2 and pre-DM
What is the primary lipoprotein target for treating dyslipidemia?
LDL-C; however indication to treat is not based solely on LDLC but also. ASCVD risk.
True or false: Moderate intensity statin therapy is indicated in nearly all pt’s with DM
True; high intensity statin therapy reserved for pt’s with w/ clinical ASCVD or who have multiple ASCVD risk factors
How many stages in blood pressure classified into?
Four: Normal, elevated, stage 1 HTN and stage 2 HTN
What defines stage 1 and stage 2 HTN?
Stage 1: 130-139 mg/dL or 80-89 mg/dL
Stage 2: >140 or > 90 mg/dL
What are the four first line HTN treatments for pt’s with DM?
ACEIs, ARBs, thiazides and Ca channel blockers
What is the first line diuretic option for pt’s with uncomplicated HTN with concomitant DM?
Thiazide type diuretics
Why might a thiazide diuretic cause hyperglycemia?
Inhibit the release of insulin from the beta cell
What medication is typically used as a first line or preferred therapy for HTN and renal protection in pt’s with DM?
Angiotensin Coverting Enzyme Inhibitors (ACEI)
ACEI are often co formulated w/ low dose HCTZ (esp for African Americans) to enhance BP reduction and improve compliance with med regimen
Why are ARBs beneficial for pt’s with DM?
B/c they lower BP and have nephroprotective and cardioprotective effects; ARBs are traditionally prescribed with ACEi are not tolerated ; however, now considered an alternative to ACEi therapy for initial BP lowering
ACEi and ARB combo therapy is NOT rec’d for pt’s with DM
