Slide set 5 Flashcards
Major lipids transported by lipoproteins
Cholesterol and Triglycerides
Major Lipoproteins
LDL, VLDL, HDL, Chylomicrons
Dyslipidemia defined as
Abnormal circulating lipid levels
Primary Dyslipidemia is a result of
Genetics
Secondary Dyslipidemia is a result of
Lifestyle, DM, renal/thyroid DZ
Familial hypercholesterolemia mutation is at the
LDL receptor gene
Familial hypercholesterolemia is
Elevated cholesterol and premature CAD
Familial hypercholesterolemia pts may have what common S/S
Xanthomatous tendons FamHx hypercholesterolemia Elevated LDL in childhood
Familial Combined Hyperlipidemia is
Elevated LDL, Triglycerides and early CAD
Another name for HDL is
Apo-A1 lipoprotein
Another name for LDL is
Apo-B100 lipoprotein
Another name for Chylomicrons is
Apo-B-48 lipoprotein
Cholesterol screening recommendation is
Fasting lipid screening every 5 years >20yo
Calculate ASCVD risk when
Every 4-6y for those 40-75yo w/out DM/ASCVD and LDL 70-189 - not on statin
Predisposing statin Cis are
Multiple comorbidites Impaired Renal/Hepatic fx Hx of statin intolerance - muscle D/Os Unexplained ALT elevations >3x upper NL Taking drugs affecting statin metabolism >75yo
Cholesterol lab test contains
Total chol and HDL
What are the 4 statin benefit groups?
1.Pts with clinical ASCVD 2.Pts with primary elevations of LDL >190 3.Pts 40-75yo with DM and LDL 70-190 4.Pts 40-75yo with LDL 70-190 and >7.5%
ASCVD is defined as athersosclerotic origin of (3)
Acute coronary syndrome (MI, any angina) Revascularization Peripheral artery disease Stroke/TIA
What are the high intensity statins/doses
Atorvastatin 40-80mg Rosuvastatin 20mg
What are the low intensity statins/doses
Pravastatin 10-20mg Lovastatin 20mg
High intenstiy statin is expected to lower LDL by how much
> 50%
Mod intenstiy statin is expected to lower LDL by how much
30-50%
S/S of statin use
Pain, Tenderness, stiffness, cramping, weakness, fatigue
If pt has severe muscle S/S then
DC statin and perform a Rhabdomyolysis workup
Rhabdomyolysis workup consist of
CK, Creatininte, and UA for myoglobinuria
If pt has mild-mod muscle S/S then
DC and eval for hypothyroidism, renal-hepatic function, Vit-D deficency, primary muscle disease
If pt’s mild-mod muscle S/S resolve and no other CI can be determined whats next for statin therapy
Start pt back on SAME statin at the original or lower dose and monitor. If S/S reoccur DC current statin and start low dose of another statin
Can drugs such as estrogen replacement affect cardiovascular risk?
Yes (as a secondary cause)
Treatment of hypertryglyceridemia
<200 - lifestyle 200-500 - lifestyle and txt of DZ process >500 - req Rx txt to avoid pancreatitis
Meds to lower TG levels are
Fibrates, Nicotinic Acid, Omega 3’s
What fibrates are used to lower TG levels?
Fenofibrates and Gemfibrozil
How much can Omega 3s reduce TG levels
> 3gm per day can lower TG by 50%
What is metabolic syndrome
3 or more risk factors indicating health issues
TXT of metabolic syndrome
Lifestyle DM II prevention CV risk reduction Tob cessation Prevent/TXT HTN
90% of the time the HCP fails the patient in treating CV risks by
Wrong drug/dose Pt required combo TXT Patient is noncompliant due to Ses
Other drug choices for dyslipidemia
HMG-CoA reductase inhibitors Bile Acid-Binding agents Cholesterol Absorption inhibitors Niacin Fibrates
What is another name for Statins
HMG-CoA reductase inhibitors
MOA of HMG-CoA reductase inhibitors
Compete for HMG-CoA enz preventing cholesterol synthesis
MOA of Bile Acid-Binding agents
POS charged agent binds NEG charged bile acids preventing reabsorption
Bile Acid-Binding agents reduces what
LDL (difficult SEs however)
MOA of Cholesterol Absorption inhibitors
Inhibitor of cholesterol uptake in the small intestines and causes reduced Chylomicron production
Cholesterol Absorption inhibitors reduces what
LDL (works best in combo with statin)
Niacin MOA allow for what to happen
Increased HDL, inhibits fatty acid release
MOA of fibrates
Affects peroxisome proliferator receptor
Fibrates will cause what to happen
Lower triglycerides and elevate HDL
Ezetimbe is an example of what class of drug
Cholesterol Absorption inhibitors
What factors are used to determine metabolic syndrome (5)
Obesity at waist Triglycerides level >150 HDL cholesterol level BP >130/85 Fasting glucose >110
What are the waist circumferance criteria for M/F to determine metabolic syndrome?
M->40 in and F->35in
What are the HDL criteria for M/F to determine metabolic syndrome?
M-<40 and F-<50
What does ASCVD stand for
Atherosclerotic Cardiovascular DZ
Before starting statin therapy what labs should be run
Fasting Lipid ALT CK 2ndry issues ( >500TG, >190LDL, >ALT 3xNL)
What 3 statin benefit groups receive moderate intensty statins
Hx of clinical ASCVD and is >75yo DM 40-75yo with LDL 70-189 and <7.5% 40-75yo with LDL 70-189 and >7.5%
What 3 statin groups receive high intensity statins
Hx of clinical ASCVD and is <75yo LDL >190 DM 40-75yo with LDL 70-189 and >7.5%
