Amb Care - Hyperlipidemia

Front 1

5 Risk Factors for MI in the next 10 years:

Back 1

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

Front 2

ATP III recommends a lipid panel how often?

Back 2

Every 5 years beginning at age 20

Front 3

What is the 1 Negative Risk Factor?

Back 3

HDL > 60 mg/dL

Front 4

What are the 6 CAD equivalents?

Back 4

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

Front 5

How do you calculate LDL?

Back 5

total cholesterol - HDL - (TG/5)

Front 6

What are the 5 parts, of which you need at least 3, to have Metabolic Syndrome?

Back 6

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

Front 7

How do you tx Metabolic Syndrome?

Back 7

1. wt loss/exercise
2. BP control
3. ASA for CAD pts
4. lower TGs & raise HDL

Front 8

Whate are the Risk Groups?

Back 8

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

Front 9

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?

Back 9

This is a low-risk person.
LDL < 160
TLC start at LDL >160
meds start at LDL >190

Front 10

What is the LDL goal/TLC/Med cutoffs for a 60 yo F smoker on HCTZ?

Back 10

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

Front 11

What is the LDL goal/TLC/Med cutoffs for someone with only 2 risk factors?

Back 11

Mod-risk person who has <10% 10-yr risk of MI.
LDL <130
start TLS >130
start meds >160

Front 12

What are the LDL goals and treatment cutoffs for someone at high risk of 10-yr MI?

Back 12

This would be someone who has CAD or an equivalent!
LDL <100
start TLC >100
start meds >100

Front 13

What is the LDL goal for a very high risk patient?

Back 13

<70

Front 14

What are the therapeutic lifestyle changes?

Back 14

wt loss/exercise
diet
stop smoking

Front 15

What is the TLC diet?

Back 15

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

Front 16

What are 5 2ndary casues of Hyperlipidemia?

Back 16

1. DM
2. hypOthyroid
3. chronic renal failure
4. nephrotic syndrome!
5. obstructive liver dz

Front 17

TGs > ___ are a/w acute pancreatitis?

Back 17

TG >500 mg/dL

Front 18

What are the most effective agents for lowering TGs?

Back 18

1. gemfibrozil
2. niacin
3. atorvastatin is the best of the statins

Front 19

What agents can worsen/raise TG levels?

Back 19

BILE ACID sequestrants! Contraindicated if TG >200 and absolutely contraindicated if TG >400!

Front 20

What %age do gemfibrozil and niacin reduce TGs?

Back 20

20-50%

Front 21

What should you do if a patient has TG >500?

Back 21

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

Front 22

What things lower your HDL?

Back 22

1. smoking!!!
2. sedentary lifestyle
3. obesity
4. beta blockers
5. anabolic steroids

Front 23

What things increae your HDL?

Back 23

1. exercise
2. weight loss
3. moderate EtOH use

Front 24

What meds increase your HDL?

Back 24

1. NIACIN!!!
2. fibrates
3. statins

Front 25

What kind of drug is 1st line for lowering LDL?

Back 25

STATINS.

Front 26

When should you check LFTs in a patient who's going to be on a statin?

Back 26

Check before you start statin, check 12 wks after you start, check 12 wks after you raise the dose, then semianually.

Front 27

What should you tell patients to report when they start a statin?

Back 27

1. muscle pain/tenderness
2. weakness
3. brown urine

Front 28

What is an absolute contraindication to starting a statin?

Back 28

active or chronic liver disease

Front 29

What are some relative contraindications to starting a statin?

Back 29

1. on macolide abx
2. on antifungals
3. on P-450 inhibitors

Front 30

What is cholestyramine? What is an absolute contraindication? How should you instruct patients to take it with their other meds, like statins?

Back 30

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!

Front 31

What side effects of cholestyramine?

Back 31

1. GI distress
2. constipation
3. dec absorption of other meds

Front 32

What is cholestyramine good for?

Back 32

2nd line agent for lowering LDL -- after statins.

Front 33

What is niacin good for?

Back 33

Best at raising HDL and lowering TGs!

Front 34

What is a common poorly tolerated side effect of niacin? What are other side effects of niacin?

Back 34

1. flushing
2. raise glucose
3. raise uric acid
4. raise SGOT/PT
5. GI upset

Front 35

What is an absolute contraindication to taking niacin?

Back 35

1. severe gout
2. chronic liver dz

Front 36

What side effects do you get with niacin + statin?

Back 36

1. liver toxicity
2. myopathy

Get baseline LFTs then q3 mo!

Front 37

What is gemfibrozil mainly used for?

Back 37

lowering TGs when >500 (pancreatitis)

Front 38

What are side effects of gemfibrozil and the other fibrates?

Back 38

1. GI upset
2. gallstones
3. myopathy with statins

Front 39

What is Zetia???

Back 39

Ezetimibe -- cholesterol absorption inhibitor! Reduces LDL by 20-30% when used alone and with statin, respectively.

Front 40

zocor

Back 40

simvastatin
5/10/20/40/80mg
take 5-40mg PO qhs

Front 41

lipitor

Back 41

atorvastatin
10mg
take 10mg PO daily

Front 42

questran

Back 42

cholestyramine
4g packets
take 4-12g in water PO bid

Front 43

nicolar

Back 43

niacin
500mg
take 1-2g PO tid with food!

Front 44

lopid

Back 44

gemfibrozil
600mg
take 600mg PO bid before food