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U4: lipids Flashcards

1
Q

ASCVD risk <5% is considered what risk? (low, medium, etc…)

A

low risk

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2
Q

ASCVD risk 5%-7.4% is considered what level risk?

A

borderline

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3
Q

ASCVD risk 7.5-19% is considered what risk?

A

intermediate

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4
Q

ASCVD risk 20%+ is considered what risk?

A

high risk

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5
Q

if risk decision is uncertain, you may elect to measure a ?

A

CAC (calcium artery score)

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6
Q

if CAC is zero how do you proceed?

A
  • acknowledge that risk is lower & pt may not need statin BUT
  • reconsider risk factors like: DM, fam hx premature CHD, or current smoker
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7
Q

if CAC score is 1-99 how do you proceed?/

A

start statin, especially if pt >55y

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8
Q

CAC score 100+ OR 75+ percentile

A

start statin therapy

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9
Q

PRIMARY PREVENTION:

NON DM adults 40-75 with BORDERLINE RISK and LDL <190. what do you do?

A

risk discussion.

*MOD statin for + risk enhancers

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10
Q

PRIMARY PREVENTION:

NON DM adults 40-75 with INTERMEDIATE RISK and LDL <190. what do you do?

A

risk discussion

*MOD statin for + risk factors to reduce LDL by 30-49%

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11
Q

PRIMARY PREVENTION:

NON DM adults 40-75 with HIGH RISK and LDL <190. what do you do?

A
  • risk discussion

* HIGH statin to reduce LDL by 50%

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12
Q

check ____ before starting meds

A

liver panel (LFTs)

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13
Q

high intensity statins lower LDL by ??`

A

50+%

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14
Q

moderate intensity statins lower LDL by ??

A

30-49%

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15
Q

low intensity statins lower LDL by??

A

<30%

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16
Q

clinical ASCVD pts get ______ intensity statin if under 75y

A

HIGH

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17
Q

clinical ASCVD pts get ______ intensity statin if OVER 75y?

A

mod-high

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18
Q

20-75y w LDL 190+. statin?

A

HIGH bc high lifetime risk

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19
Q

DM age 40-75. LDL <190. statin?

A

MOD. consider high in pts w mult. ascvd RFs

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20
Q

DM age 40-75. LDL <190. multiple RF for ASCVD. statin?

A

HIGH

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21
Q

for preggos in need of a statin give?

A

STATIN IS CAT X. DO NOT GIVE. give “RESINS” (cholestryramine)

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22
Q

for adherence issues with statins what would you Rx?

A

*atorv and rosu bc they have a longer half life

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23
Q

impaired renal function pt needs a statin. what do you give?

A

Ator or Fluv

“As iF i would want to make their kidneys worse!”

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24
Q

pt w previous myalgias on statin therapy. what do you give?

A

hydrophilic statin

  • Rosu or Prava
  • “so they quit gRiPing about it”
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25
pt w CYP3A4 drug interactions. what do you give?
Prava & Rosu | *"Pick Really Carefully"
26
hx of multiple major ASCVD events is considered a _______ risk conditiion (level)
VERY HIGH
27
hx of 1 major ASCVD event and multiple high risk conditions places is considered a _______ condition
VERY HIGH
28
"major CV events" include
* ACS w/i 12m * hx MI or ischemic CVA * symptomatic PAD (claudication or ABI <0.85, previous revascularization)
29
``` high risk conditions include: 1. age ____+ 2. hx previous ______ or _____ 3. 4. 5. 6. persistently elevated _____ despite ______ 7. ```
1. age >65y 2. hx previous CABG or PCI (outside major ASCVD events) 3. DM 4. HTN 5. CKD w eGFR <60 6. elevated LDL >100 despite max tol'd statin AND EZETIMIBE 7. CHF
30
heart failure related to ischemic heart disease. what level statin?
MOD
31
ezetimibe may allow you to lower ____ dose.
statin
32
adults over 75 w LDL <190. you may initiate what level statin?
MOD
33
adults 76-80y w LDL <190. waht do you do?
measure CAC to reclassify those that can avoid statin therapy
34
CYP34A drug interactions to know
* amio * amlodipine * azoles * dilt * verapamil * *RX PRAVA OR ROSU
35
10y or older with LDL persistently over _____ OR _____ w fam hx. what do you do?
* 190 w/o fam hx * 160 w fam hx * lifestyle therapy x6m * if no response then statin
36
moderate hypertriglyceridemia range
175-499
37
severe hypertriglyceridemia range
500+
38
>20y w moderate trigs. what rx?
*address/tx lifestyle reccs and potential secondary factors (like meds)
39
20-75 w moderate OR SEVERE trigs and ASCVD risk >7.5%. what do?
* assess lifestyle & secondary factors * re-eval ASCVD risk * CONSIDER initiation or intensification of statin
40
40-75 w severe trigs and ASCVD >7.5%. what do you do?
* address reversible causes | * START STATIN
41
adults w fasting trigs over 1000. what do you do?
* address cause * BEGIN FIBRATE THERAPY (fenofibrate) to prevent pancreatitis * very low fat diet, add omega 3. NO refined carbs or ETOH
42
true statin intolerance must occur when?
after initiating therapy
43
true statin intolerance must improve when?
statin is dc'd
44
true statin intolerance must reappear when?
reinitiating statin
45
assess for statin intolerance how?
* measure CK * evaluate RF intolerance * w/draw & rechallenge
46
how to manage muscle symptoms of statin intolerance- switch from?
lipophilic to hydrophilic
47
manage muscle s/s of statin intol without swiching meds. what do?
* lower dose or frequency | * rechallenge w same med
48
if statin rechallenge is tolerated how do you proceed?
titrate up slowly to achieve LDL goals w minimal muscle complaints
49
pt cant tolerate statins on daily basis. what do you do?
alternate day or twice weekly dosing w ROSU or ATORV
50
pt cant tolerate statins at all. what do you do?
*monotherapy w non-statins or add non-statins to max tolerated statin dose
51
you start a patient on a high intensity statin. upon recheck- their LDL is <70. what do you do?
continue HIGH statin
52
you start a patient on a high intensity statin. upon recheck their LDL is >70. what do you do?
add ezetimibe
53
you have a pt on a high intensity statin and ezetimibe. upon recheck their LDL is <70. what do you do?
continue regimen
54
you have a pt on a high intensity statin and ezetimibe. upon recheck their LDL is >70. what do you do?
*add PCSK9
55
what is the LDL target for VERY HIGH RISK CVD pts
<50. lower is better
56
what age is the third lipid screening? what labs?
*18-21y *nonfasting non-HDL OR FLP
57
at what age range is the second lipid screening completed? what labs?
* 12-17y | * FLP IF FH newly positive (??), parent w dyslipidemia, any other RF or high-risk condition
58
at what age does is the first lipid screening? what labs are drawn?
*9-11y *non-fasting non-HDL OR *FLP
59
fam x of premature ASCVD
risk enhancing factor
60
persistently elevated LDL 160+
risk enhancing factor
61
metabolic syndrome
risk enhancing factor
62
CKD
risk enhancing factor
63
hx of preeclampisa OR premature menopause (<40y)
risk enhancing factor (prob HTN and low estrogen = CV RF?
64
chronic inflammatory disorders such as?
RA psoriasis chronic HIV *risk enhancing factor
65
ethnic group: south asian
risk enhancing factor
66
persistent trigs 175+
risk enhanginc factor
67
apolipoprotein B 130+
risk enhancing factor
68
high sensitivity CRP 2.0
risk enhancing factor
69
ABI <0.9
risk ehancing factor
70
lipoprotein (a) 50+
risk enhancing factor
71
secondary causes of hypercholesterolemia = (5)(HORND)
* Hypothyroidism * Obstructive liver disease * Renal disease * Nephrosis * Dietary/Med hx
72
statin induced muscle strain wil be bilateral or unilateral?
bilateral myalgia
73
statin induced muscle strain will involve proximal or distal muscles?
proximal (shoulder, pelvic girdle, arms, legs)
74
pts w liver disease can take a statin. true or false?
TRUE IF chronic and stable
75
can pts w NAFL take a statin?
yes please
76
routine measurements of CK and transaminase levels drawn on a pt on statin therapy is accurate. true or false
false. not useful. im assuming they're higher when on therapy but no time to look up
77
bile acid sequestrants lower LDL by?
15-30% | *dose dependent
78
bile sequestrant SE
GI complaints (constipation)
79
bile sequestrant adverse effect
can cause moderate hypertrigs to increase to severe hypertrigs
80
ezetimibe lowers LDL by?
13-20%
81
PCSK9 inhibitors lower LDL by?
43-64%
82
The National Lipid Association (NLA) defines statin intolerance:
: inability to tolerate at least two statins [one at the lowest starting daily dose and another at any daily dose] either due to objectionable symptoms (real or perceived) or abnormal laboratory analysis, temporally related to statin treatment, reversible upon statin
83
The NLA recently updated the classification of SAMS as (4 M's)
myalgia, myopathy, myositis, myonecrosis (rhabdo most extreme)
84
Myopathy
muscle weakness [not attributed to pain] and is not necessarily associated with elevation in CK levels
85
myositis
: muscle inflammation associated with pain and tenderness to palpation
86
myonecrosis
: increased CK levels varying from mild [>3-fold than baseline CK] to severe [≥ 50- fold] adjusted for age, race, and sex, with or without pain
87
myonecrosis or rhabdo?
If myoglobinuria and/or increase in serum creatinine >0.5 mg/dL are present: diagnosis is rhabdomyolysis [most severe form of myonecrosis]
88
measure ?? immediately for intolerable pain
CK
89
vitamin D and co Q10 help prevent or reduce muscle symptoms ST statin use? true or false
false. no evidence.
90
avoid using _____ w statins due to risk for myopathy
gemfibrozil

CMN572 (13 decks)

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