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CMN572 > U4: lipids > Flashcards

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
Q

pt w CYP3A4 drug interactions. what do you give?

A

Prava & Rosu

*“Pick Really Carefully”

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26
Q

hx of multiple major ASCVD events is considered a _______ risk conditiion (level)

A

VERY HIGH

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27
Q

hx of 1 major ASCVD event and multiple high risk conditions places is considered a _______ condition

A

VERY HIGH

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28
Q

“major CV events” include

A
  • ACS w/i 12m
  • hx MI or ischemic CVA
  • symptomatic PAD (claudication or ABI <0.85, previous revascularization)
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29
Q 
high risk conditions include: 
1. age \_\_\_\_+
2. hx previous \_\_\_\_\_\_ or \_\_\_\_\_
3. 
4. 
5. 
6. persistently elevated \_\_\_\_\_ despite \_\_\_\_\_\_
7.
A
  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
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30
Q

heart failure related to ischemic heart disease. what level statin?

A

MOD

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31
Q

ezetimibe may allow you to lower ____ dose.

A

statin

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32
Q

adults over 75 w LDL <190. you may initiate what level statin?

A

MOD

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33
Q

adults 76-80y w LDL <190. waht do you do?

A

measure CAC to reclassify those that can avoid statin therapy

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34
Q

CYP34A drug interactions to know

A
  • amio
  • amlodipine
  • azoles
  • dilt
  • verapamil
  • *RX PRAVA OR ROSU
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35
Q

10y or older with LDL persistently over _____ OR _____ w fam hx. what do you do?

A
  • 190 w/o fam hx
  • 160 w fam hx
  • lifestyle therapy x6m
  • if no response then statin
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36
Q

moderate hypertriglyceridemia range

A

175-499

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37
Q

severe hypertriglyceridemia range

A

500+

38
Q

> 20y w moderate trigs. what rx?

A

*address/tx lifestyle reccs and potential secondary factors (like meds)

39
Q

20-75 w moderate OR SEVERE trigs and ASCVD risk >7.5%. what do?

A
  • assess lifestyle & secondary factors
  • re-eval ASCVD risk
  • CONSIDER initiation or intensification of statin
40
Q

40-75 w severe trigs and ASCVD >7.5%. what do you do?

A
  • address reversible causes

* START STATIN

41
Q

adults w fasting trigs over 1000. what do you do?

A
  • address cause
  • BEGIN FIBRATE THERAPY (fenofibrate) to prevent pancreatitis
  • very low fat diet, add omega 3. NO refined carbs or ETOH
42
Q

true statin intolerance must occur when?

A

after initiating therapy

43
Q

true statin intolerance must improve when?

A

statin is dc’d

44
Q

true statin intolerance must reappear when?

A

reinitiating statin

45
Q

assess for statin intolerance how?

A
  • measure CK
  • evaluate RF intolerance
  • w/draw & rechallenge
46
Q

how to manage muscle symptoms of statin intolerance- switch from?

A

lipophilic to hydrophilic

47
Q

manage muscle s/s of statin intol without swiching meds. what do?

A
  • lower dose or frequency

* rechallenge w same med

48
Q

if statin rechallenge is tolerated how do you proceed?

A

titrate up slowly to achieve LDL goals w minimal muscle complaints

49
Q

pt cant tolerate statins on daily basis. what do you do?

A

alternate day or twice weekly dosing w ROSU or ATORV

50
Q

pt cant tolerate statins at all. what do you do?

A

*monotherapy w non-statins or add non-statins to max tolerated statin dose

51
Q

you start a patient on a high intensity statin. upon recheck- their LDL is <70. what do you do?

A

continue HIGH statin

52
Q

you start a patient on a high intensity statin. upon recheck their LDL is >70. what do you do?

A

add ezetimibe

53
Q

you have a pt on a high intensity statin and ezetimibe. upon recheck their LDL is <70. what do you do?

A

continue regimen

54
Q

you have a pt on a high intensity statin and ezetimibe. upon recheck their LDL is >70. what do you do?

A

*add PCSK9

55
Q

what is the LDL target for VERY HIGH RISK CVD pts

A

<50. lower is better

56
Q

what age is the third lipid screening? what labs?

A

*18-21y
*nonfasting non-HDL
OR
FLP

57
Q

at what age range is the second lipid screening completed? what labs?

A
  • 12-17y

* FLP IF FH newly positive (??), parent w dyslipidemia, any other RF or high-risk condition

58
Q

at what age does is the first lipid screening? what labs are drawn?

A

*9-11y
*non-fasting non-HDL
OR
*FLP

59
Q

fam x of premature ASCVD

A

risk enhancing factor

60
Q

persistently elevated LDL 160+

A

risk enhancing factor

61
Q

metabolic syndrome

A

risk enhancing factor

62
Q

CKD

A

risk enhancing factor

63
Q

hx of preeclampisa OR premature menopause (<40y)

A

risk enhancing factor (prob HTN and low estrogen = CV RF?

64
Q

chronic inflammatory disorders such as?

A

RA
psoriasis
chronic HIV
*risk enhancing factor

65
Q

ethnic group: south asian

A

risk enhancing factor

66
Q

persistent trigs 175+

A

risk enhanginc factor

67
Q

apolipoprotein B 130+

A

risk enhancing factor

68
Q

high sensitivity CRP 2.0

A

risk enhancing factor

69
Q

ABI <0.9

A

risk ehancing factor

70
Q

lipoprotein (a) 50+

A

risk enhancing factor

71
Q

secondary causes of hypercholesterolemia = (5)(HORND)

A
  • Hypothyroidism
  • Obstructive liver disease
  • Renal disease
  • Nephrosis
  • Dietary/Med hx
72
Q

statin induced muscle strain wil be bilateral or unilateral?

A

bilateral myalgia

73
Q

statin induced muscle strain will involve proximal or distal muscles?

A

proximal (shoulder, pelvic girdle, arms, legs)

74
Q

pts w liver disease can take a statin. true or false?

A

TRUE IF chronic and stable

75
Q

can pts w NAFL take a statin?

A

yes please

76
Q

routine measurements of CK and transaminase levels drawn on a pt on statin therapy is accurate. true or false

A

false. not useful. im assuming they’re higher when on therapy but no time to look up

77
Q

bile acid sequestrants lower LDL by?

A

15-30%

*dose dependent

78
Q

bile sequestrant SE

A

GI complaints (constipation)

79
Q

bile sequestrant adverse effect

A

can cause moderate hypertrigs to increase to severe hypertrigs

80
Q

ezetimibe lowers LDL by?

A

13-20%

81
Q

PCSK9 inhibitors lower LDL by?

A

43-64%

82
Q

The National Lipid Association (NLA) defines statin intolerance:

A

: 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
Q

The NLA recently updated the classification of SAMS as (4 M’s)

A

myalgia,
myopathy,
myositis,
myonecrosis (rhabdo most extreme)

84
Q

Myopathy

A

muscle weakness [not attributed to pain] and is not necessarily associated with
elevation in CK levels

85
Q

myositis

A

: muscle inflammation associated with pain and tenderness to palpation

86
Q

myonecrosis

A

: 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
Q

myonecrosis or rhabdo?

A

If myoglobinuria and/or increase in serum creatinine >0.5 mg/dL are present: diagnosis is
rhabdomyolysis [most severe form of myonecrosis]

88
Q

measure ?? immediately for intolerable pain

A

CK

89
Q

vitamin D and co Q10 help prevent or reduce muscle symptoms ST statin use? true or false

A

false. no evidence.

90
Q

avoid using _____ w statins due to risk for myopathy

A

gemfibrozil

CMN572 (13 decks)

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