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92 Cards in this Set
- Front
- Back
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PRIMARY DYSLIPIDEMIA CAUSE
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DISTINCT GENETIC DISORDERS
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SECONDARY DYSLIPIDEMIA CAUSE
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LIFESTYLE
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DEFINITION OF DYSLIPIDEMIA
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ABNORMAL CIRCULATING LIPID LEVELS
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XANTHOMATOUS TENDONS
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NODULAR LIPID DEPOSITS (USUALLY IN ACHILLES)
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CORNEAL ARCUS
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AKA SENILE ARCUS- WHITE RINGA ROUND CORNEA CAUSED BY EXTREMELY HIGH LIPID LEVELS
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XANTHELASMA
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YELLOS PLAQUES ON EYEBROWS, ELBOWS, EARS, BACK OF NECK---CHOLESTEROL DEPOSITS
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MC SIGN OF PRIMARY DYSLIPIDEMIA
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XANTHELASMA
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SECONDARY DYSLIPIDEMIA DISORDERS
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OBESITY, UNCONTROLLED DM, HYPOTHYROIDISM, LIVER DISEASE, RENAL DISEASE, CORTICOSTEROIDS, PROGESTIN, ANABOLIC STEROIDS, ETHANOL USE/ABUSE
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PRIMARY FOCUS OF DYSLIPIDEMIA TREATMENT
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ELEVATED LOW DENSITY LIPOPROTEIN (BAD CHOLESTEROL)- LDL
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JOB OF HIGH DENSITY LIPOPROTEIN
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SCRUBS LDL OUT OF BLOODSTREAM AND PREVENTS ATHEROSCLEROTIC PLAQUES
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WHAT IS THE CLINICAL APPROACH TO DYSLIPIDEMIA BASED ON?
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ATP III GUIDELINES
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HOW IS THE LIPOPROTEIN LEVEL DETERMINED INITIALLY?
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DRAW BLOOD AFTER 12 HOUR FAST WHEN WELL HYDRATED AND TEST
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OPTIMAL LDL
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LESS THAN 100
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NEAR OPTIMAL OR ABOVE OPTIMAL LDL
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100-129
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BORDERLINE HIGH LDL
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130-159
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HIGH LDL
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160-189
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VERY HIGH LDL
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GREATER THAN 190
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DESIRED TOTAL CHOLESTEROL
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LESS THAN 200
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BORDERLINE HIGH TOTAL CHOLESTEROL
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200-239
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HIGH TOTAL CHOLESTEROL
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GREATER THAN 240
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MJOR RISK FACTORS THAT MODIFY LDL GOALS
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CIGARETTE SMOKING, HYPERTENSIVE, LOW HDL, FAMILY HX OF PREMATURE CHD (M=55, F=65) IN 1ST DEGREE RELATIVE, AGE (M=45, F=55)
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WHAT SIGNIFICANCE DOES AN HDL GREATER THAN 60 HAVE IN CALCULATING RISK?
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IT IS A NEGATIVE RISK FACTOR- SUBTRACT 1 FROM RISK NUMBER IF IT IS GREATER THAN 60
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HOW MANY RISK FACTORS IN THE ABSENCE OF CHD OR EQUIVALENT MUST THERE BE BEFORE YOU LOOK AT 10 YEAR RISK?
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2+ RISK FACTORS YOU WILL ASSESS THE 10 YEAR CHD EVENT RISK
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WHAT RISK DOES A PERSON HAVE IF THEY HAVE A CHD RISK EQUIVALENT OR CHD?
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GREATER THAN 20%
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LDL GOAL FOR PEOPLE WITH CHD OR CHD EQUIVALENTS (>20% RISK)
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LESS THAN 100
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LDL LEVEL WHERE WE INITIATE LIFESTYLE MODIFICATIONS FOR CHD/EQUIVALENT PATIENTS
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GREATER THAN 100
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LDL LEVEL WHERE WE CONSIDER DRUG THERAPY FOR PATIENTS WITH CHD/EQUIVALENTS
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GREATER THAN 130
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WHAT IS THE DRUG OPTIONAL RANGE FOR PATIENTS WITH CHD OR RISK EQUIVALENTS?
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BETWEEN 100 AND 129
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WHY IS 10 YEAR RISK ASSESSMENT NO NECESSARY FOR PEOPLE WITH 0 TO 1 RISK FACTOR?
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BECAUSE ALMOST ALL PEOPLE WITH 0-1 RISK FACTOR HAVE A 10 YEAR RISK LESS THAN 10%
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IF A PERSON HAS 2+ RISK FACTORS AND A RISK LESS THAN 20% WHAT IS THE LDL GOAL?
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LESS THAN 130
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CONSIDERED LOW HDL
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LESS THAN 40
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CONSIDERED HIGH HDL
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MORE THAN 60
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AFTER DETERMINING A PATIENT'S LIPOPROTEIN LEVELS, WHAT DO WE DO?
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IDENTIFY PRESENCE OF CLINICAL ATHEROSCLEROTIC DISEASE THAT CONFERS HIGH RISK FOR CHD EVENTS
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WHAT ARE THE CHD AND CHD RISK EQUIVALENTS?
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CLINICAL CHD, SYMPTOMATIC CAROTID ARTERY DISEASE (TIA, STORKE), PERIPHERAL ARTERY DISEASE, ABDOMINAL AORTIC ANEURYSM, AND DIABETES
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HOW DO YOU TREAT ALL CHD RISK EQUIVALENTS?
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AS IF THEY HAVE HAD A PREVIOUS MI
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WHAT IS INCLUDED IN CLINICAL CHD?
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PREVIOUS STRESS TEST, STROKE, POST MI
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WHEN DETERMINING PRESENCE OF CLINICAL ATHEROSCLEROTIC DISEASE OR EQUIVALENTS HOW WILL YOU CLASSIFY PATIENTS?
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AS CAD, EXCESS RISK FACTORS, OR W/O RISK FACTORS
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MOST COMMONLY USED STATIN (HMG COA REDUCTASE INHIBITOR)
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SIMVOSTATIN
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EFFECT OF STATINS ON LDL, HDL, AND TG
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LOWERS LDL, RAISES HDL, AND LOWERS TG
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MOST COMMON SIDE EFFECTS OF STATINS
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MYALGIAS (MC), MYOPATHY, INCREASED LIVER ENZYMES
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ABSOLUTE INDICATION FOR NOT USING STATIN
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ABSOLUTE NON WORKING LIVER
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WHEN CAN YOU USE ATORVASTATIN?
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CAN JUSTIFY PRESCRIBING TO PATIENT THAT FAILS ON SIMVASTATIN
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MOST EFFECTIVE STATIN
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LIPITOR OR ATORVASTATIN
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WHAT STATIN IS ALWAYS USED IN MI PATIENTS?
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LIPITOR
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WHAT IS THE ONLY STATIN WITH RENAL SIDE EFFECTS AT LARGE DOSES?
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RICUVISTATIN
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HOW MUCH ELEVATION WOULD YOU HAVE IN A BASELINE LFT BEFORE YOU DISCONTINUED USING IT?
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3X
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HOW OFTEN DO YOU MONITOR LFT'S IN STATIN USE?
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EVERY 3 MONTHS FOR THE FIRST YEAR AND ANNUALLY AFTER THAT
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IF A PATIENT ON STATINS COMPLAINS OF MYALGIA, WHAT DO YOU DO?
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CHECK CK LEVELS---IF NOT ELEVATED, DON'T STOP IT--DISCONTINUE WHEN THEY TRULY CAN'T TOLERATE OR WHEN THERE IS ACTUAL EVIDENCE OF MUSCLE DAMAGE
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MAIN PURPOSE FOR FIBRIC ACID
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DECREASES TG BY UP TO 50%
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SECOND MOST COMMONLY USED DYSLIPIDEMIA MED?
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FIBRIC ACIDS
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CLOFIBRATE, FENOFIBRATE, AND GEMFIRBOZIL ARE WHAT TYPE OF DRUGS?
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FIBRIC ACID
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SIDE EFFECTS OF FIBRIC ACIDS
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DYSPEPSIA, GALLSTONES**, MYOPATHY
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ABSOLUTE CONTRAINDICATIONS TO FIBRIC ACID
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SEVERE RENAL DISEASE, SEVERE HEPATIC DISEASE
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FIBRIC ACID USED WITH OTHER MEDS INCREASES THE RISK OF WHAT?
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RHABDO
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WHY CAN YOU NOT USE BIEL ACID SEQUESTRANTS IN GERD OR GI PATIENTS?
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IT CAUSES SIGNIFICANT DYSPEPSIA
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SIDE EFFECTS OF BILE ACID SEQUESTRANTS
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GI DISTRESS, CONSTIPATION, AND DECREASED ABSORPTION OF OTHER DRUGS
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USE FOR BILE ACID SEQUESTRANTS
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USED FOR STATIN FAILURE AND PEDIATRICS
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CHOLESTYRAMINE, COLESTIPOL, AND COLESEVELAM ARE WHAT CLASS OF MEDS?
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BILE ACID SEQUESTRANTS
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WHAT IS EFFECT OF BILE ACID SEQUESTRANTS ON LDL, HDL, AND TG?
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DECREASES LDL, INCREASES HDL ONLY UP TO 5%, AND CAUSES NO CHANGE OR AN INCREASE IN TG
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ABSOLUTE CONTRAINDICATIONS FOR NOT USING BILE ACID SEQUESTRANTS
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DYSBETA LIPOPROTINEMIA; TG OVER 400 (RELATIVE- TG OVER 200)
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BEST TOLERATED NICOTINIC ACID
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SUSTAINED RELEASE (ALSO COMES IN IMMEDIATE RELEASE ABD EXTENDED RELEASE)
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EFFECT OF NIACIN ON LDL, HDL, AND TG
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SLIGHTLY DECREASES LDL, GOOD INCREASE IN HDL AND GOOD DECREASE IN TG
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SIDE EFFECTS OF NIACIN
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FLUSHING, HYPERGLYCEMIA, GOUT, HYPERURICEMIA
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ABSOLUTE CONTRAINDICATION TO NIACIN
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CHRONIC LIVER DISEASE, SEVERE GOUT
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RELATIVE CONTRAINDICATION TO NIACIN
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DIABETES, HYPERURICEMIA, AND PEPTIC ULCER DISEASE
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WHY DO WE GIVE NIACIN PATIENTS ASPIRIN AND TELL THEM TO TAKE IT BEFORE BED?
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B/C IT WILL CAUSE ITCHING AND MAKE THEN FEEL LIKE THEY ARE GOING TO PASS OUT
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UPON DIAGNOSIS OF METABOLIC SYNDROME, WHAT DO ALL OF THESE PATIENTS START TAKING?
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ASPIRIN A DAY
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RISK FACTORS (MUST HAVE 3 OF 5) FOR METABOLIC SYNDROME
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ABDOMINAL OBESITY (WAIST >40M AND 35F; TRIGLYCERIDES OVER 150; HDL <40M AND <50F; BP MORE THAN 130/85, AND FASTING GLUCOSE GREATER THAN 100
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TREATMENT OF METABOLIC SYNDROME
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TREAT OBESITY WITH INTENSIFYING WEIGHT MANAGEMENT AND INCREASING PHYSICAL ACTIVITY; THEN TREAT LIPID AND NON LIPID RISK FACTORS IF THEY PERSIST DESPITE LIFESTYLE THERAPIES (TREAT HTN, USE ASPIRIN IN CHD, TREAT ELEVATED TG OR LOW HDL
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NORMAL TG
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LESS THAN 150
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VERY HIGH TG
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OVER 500
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ONLY CATEGORY OF TG WE USE MEDS FOR
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VERY HIGH TG OVER 500
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WHAT IS CONSIDERED HIGH TG?
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200-499
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WHAT IS CONSIDERED BORDERLINE HIGH TG?
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150-199
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WHAT IS CONSIDERED HIGH TG?
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200-499
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AFTER LDL IS REACHED AND TG ARE STILL MORE THAN 200, WHAT SECONDARY GOAL DO WE WORK TOWARD?
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NON HDL CHOLESTEROL 30 MG HIGHER THAN LDL GOAL
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WHY DO WE NOT USE BILE SEQUESTRANT OR STATIN IN A PATIENT WITH TG OVER 500?
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CAUSES STATIN INDUCED PANCREATITIS AND WILL RAISE TG
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WHAT SPECIFIC GROUP OF PATIENTS TEND TO HAVE HIGH TG?
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DIABETICS
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DOC FOR TG OVER 500
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FIBRIC ACID WITH EXTRA LOW FAT DIET AND MODERATE EXERCISE
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IF LDL GOAL HAS BEEN REACHED AND TG IS STILL BETWEEN 200 AND 499, CONSIDER DOING WHAT TO REACH THE NON HDL GOAL?
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INTENSIFY THERAPY WITH LDL LOWERING DRUG OR ADD NICOTINIC ACID OR FIBRATE TO FURTHER LOWER NON HDL
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IF TG IS ABOVE 500 INITIALLY, WHAT IS THE INITIAL COURSE OF ACTION?
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START FIBRATE OR NICOTINIC ACID TO LOWER IT, THEN SHIFT FOCUS TO LOWERING THE LDL
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HOW DO WE TREAT LOW HDL?
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FIRST REACH LDL GOAL, THEN INTENSIFY WEIGHT CONTROL/EXERCISE; IF TG ARE ABOVE 200, ACHIEVE NON-HDL GOAL, AND IF THE TG ARE LESS THAN 200 IN CHD/EQUIVALENT, CONSIDER NICOTINIC ACID RO FIBRATE
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2 MOST EFFECTIVE WAYS TO RAISE HDL
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EXERCISE AND STOP SMOKING
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IF A PERSON HAS 2+ RISK FACTORS AND A 20% OR LESS RISK, WHEN DO WE INITIATE TLC?
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AT 130 OR MORE
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IF A PERSON HAS A 2+ RISK AND 10 YR RISK OF LESS THAN 20%, WHEN DO WE INITIATE DRUG THERAPY?
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IF THE TEN YEAR RISK IS 10-20%, INITIATE AT 130; IF IT IS LESS THAN 10%, INITIATE AT 160
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WHEN THERE ARE 0 TO 1 RISK FACTORS, WHAT IS THE LDL GOAL?
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LESS THAN 160
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WHEN THERE ARE 0/1 RISK FACTORS, WHEN DO YOU INITIATE TLC?
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AT GREATER THAN 160
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WHEN THERE ARE 0/1 RISK FACTORS, WHEN DO YOU INITIATE MEDICATION?
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GREATER THAN 190
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WHAT IS THE DRIG OPTIONAL RANGE WHEN A PATIENT HAS 0/1 RISK FACTORS?
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160-189
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2 ADDITIONAL GUIDELINES FOR IMPLEMENTING OPTIONAL DRUG THERAPIES
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CRP INCREASE (1.5-10) MILD OR MODERATE; METABOLIC SYNDROME
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WHAT ARE TLC FEATURES IMPLEMENTED WHEN A PATIENT'S LDL IS ABOVE GOAL?
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TLC DIET, WEIGHT MANAGEMENT, AND INCREASED PHYSICAL ACTIVITY
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WHAT IS THE TLC DIET?
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SATURATED FAT LESS THAN 7% OF CALORIES; CHOLESTEROL LESS THAN 200 MG PER DAY; CONSIDER INCREASED FIBER AND PLANT STEROLS TO ENHANCE LDL LOWERING
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