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44 Cards in this Set

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5 Risk Factors for MI in the next 10 years:
1. M>45, F>55
2. MI/sudden death in dad/bro <55 or mom/sis <65
3. currently smoker
4. BP > 140/90 or on meds
5. HDL < 40
ATP III recommends a lipid panel how often?
Every 5 years beginning at age 20
What is the 1 Negative Risk Factor?
HDL > 60 mg/dL
What are the 6 CAD equivalents?
1. diabetes
2. symptomatic carotid artery dz like TIA/stroke
3. duh -- coronary artery disease
4. peripheral artery dz like ABI < 0.90
5. AAA
6. if you have a >20% 10-yr risk of MI
How do you calculate LDL?
total cholesterol - HDL - (TG/5)
What are the 5 parts, of which you need at least 3, to have Metabolic Syndrome?
1. male waist >40", female waist >35"
2. TG >150
3. male HDL <40, female HDL <50
4. BP > 130/85
5. fasting glu > 110
How do you tx Metabolic Syndrome?
1. wt loss/exercise
2. BP control
3. ASA for CAD pts
4. lower TGs & raise HDL
Whate are the Risk Groups?
1. 0-1 risk
2. 2,3,4,5 risks
3. CAD or equivalent
4. CAD with poorly controlled risk factors (smoking, DM) or acute coronary syndrome or metabolic syndrome
What is the LDL goal and cutoffs for TLC and meds in a 30 yo M who is a smoker but has no other risk factors?
This is a low-risk person.
LDL < 160
TLC start at LDL >160
meds start at LDL >190
What is the LDL goal/TLC/Med cutoffs for a 60 yo F smoker on HCTZ?
Mod-risk patient who has 3 risk factors and has 10-20% 10-yr risk of MI.
LDL <100
start TLC >130
start meds >130
What is the LDL goal/TLC/Med cutoffs for someone with only 2 risk factors?
Mod-risk person who has <10% 10-yr risk of MI.
LDL <130
start TLS >130
start meds >160
What are the LDL goals and treatment cutoffs for someone at high risk of 10-yr MI?
This would be someone who has CAD or an equivalent!
LDL <100
start TLC >100
start meds >100
What is the LDL goal for a very high risk patient?
<70
What are the therapeutic lifestyle changes?
wt loss/exercise
diet
stop smoking
What is the TLC diet?
1. < 30% of calories from fat
2. < 7% calories from sat fat
3. inc soluble fiber (10-25 g/day)
4. substitute in plant sterols
What are 5 2ndary casues of Hyperlipidemia?
1. DM
2. hypOthyroid
3. chronic renal failure
4. nephrotic syndrome!
5. obstructive liver dz
TGs > ___ are a/w acute pancreatitis?
TG >500 mg/dL
What are the most effective agents for lowering TGs?
1. gemfibrozil
2. niacin
3. atorvastatin is the best of the statins
What agents can worsen/raise TG levels?
BILE ACID sequestrants! Contraindicated if TG >200 and absolutely contraindicated if TG >400!
What %age do gemfibrozil and niacin reduce TGs?
20-50%
What should you do if a patient has TG >500?
1. FIRST lower TG to <500 to prevent pancreatitis! give fibrate or niacin, encourage low-fat diet and exercise
2. THEN focus on lowering LDL
3. AFTER THAT goal has been reached, focus on achieving non-HDL-C goal, which is 30+LDL goal
What things lower your HDL?
1. smoking!!!
2. sedentary lifestyle
3. obesity
4. beta blockers
5. anabolic steroids
What things increae your HDL?
1. exercise
2. weight loss
3. moderate EtOH use
What meds increase your HDL?
1. NIACIN!!!
2. fibrates
3. statins
What kind of drug is 1st line for lowering LDL?
STATINS.
When should you check LFTs in a patient who's going to be on a statin?
Check before you start statin, check 12 wks after you start, check 12 wks after you raise the dose, then semianually.
What should you tell patients to report when they start a statin?
1. muscle pain/tenderness
2. weakness
3. brown urine
What is an absolute contraindication to starting a statin?
active or chronic liver disease
What are some relative contraindications to starting a statin?
1. on macolide abx
2. on antifungals
3. on P-450 inhibitors
What is cholestyramine? What is an absolute contraindication? How should you instruct patients to take it with their other meds, like statins?
1. BILE ACID sequestrant
2. no if TG >400
3. dec absorption of other meds, so take the other meds either 1 hr before or 4 hrs after cholestyramine!
What side effects of cholestyramine?
1. GI distress
2. constipation
3. dec absorption of other meds
What is cholestyramine good for?
2nd line agent for lowering LDL -- after statins.
What is niacin good for?
Best at raising HDL and lowering TGs!
What is a common poorly tolerated side effect of niacin? What are other side effects of niacin?
1. flushing
2. raise glucose
3. raise uric acid
4. raise SGOT/PT
5. GI upset
What is an absolute contraindication to taking niacin?
1. severe gout
2. chronic liver dz
What side effects do you get with niacin + statin?
1. liver toxicity
2. myopathy

Get baseline LFTs then q3 mo!
What is gemfibrozil mainly used for?
lowering TGs when >500 (pancreatitis)
What are side effects of gemfibrozil and the other fibrates?
1. GI upset
2. gallstones
3. myopathy with statins
What is Zetia???
Ezetimibe -- cholesterol absorption inhibitor! Reduces LDL by 20-30% when used alone and with statin, respectively.
zocor
simvastatin
5/10/20/40/80mg
take 5-40mg PO qhs
lipitor
atorvastatin
10mg
take 10mg PO daily
questran
cholestyramine
4g packets
take 4-12g in water PO bid
nicolar
niacin
500mg
take 1-2g PO tid with food!
lopid
gemfibrozil
600mg
take 600mg PO bid before food