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47 Cards in this Set
- Front
- Back
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What is the first thing you start with when screening hyperlipidemia?
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Start with fasting lipids
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Apart from starting to screen with fasting lipids, what do you do if TG are over 400.
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You order a direct LDL
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If there are multiple risk factors, such as CHD or CHD equivalents, how often do you screen your patient?
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Yearly or more frequently
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If hyperlipidemia is discovered, then first rule out the secondary causes of dyslipidemia. What are the 6 secondary causes?
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1. DM
2. Hypothyroidism 3. Nephrotic Syndrome 4. Chronic Renal Failure 5. Obstructive Liver Disease 6. Drugs |
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What drugs can be secondary causes of dyslipidemia? (7)
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1. Progestins
2. Anabolic steroids 3. Corticosteroids 4. Protease inhibitors 5. Thiazides 6. Isotretinoin 7. Beta-blockers |
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How do you screen for metabolic syndrome?
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Any 3 of the following = Metabolic Syndrome
1. Elevated TG (150+) 2. Low HDL (<40 in males, <50 in females) 3. Hypertension 4. Fasting glucose 110+ 5. Abdominal obesity (waist circumference > 40 inches in males or >35 inches in females) |
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With hyperlipidemia you should ask about other independent risk factors (other than high LDL)? 5 of them
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1. Age and gender (males 45+, females 55+)
2. Hypertension (Treated or not) 3. Cigarette smoking 4. HDL < 40 (but HDL > 60 is a negative risk factor) 5. Family history (1st degree male < 55, female < 65) |
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What are the bile acid resins? 3
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Cholestyramine
Colestipol Colesevelam |
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These drugs trap bile in the intestine for excretion, leading to increase conversion of liver cholesterol into bile and up regulation of LDL receptors.
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Bile Acid Resins
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What is the primary role for bile acid resins?
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Usually 2nd line to lower LDL, but drug of choice in pregnancy in children.
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What are the effects of bile acid resins on other lipids?
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Increase HDL
Increase Triglycerides |
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What are some side effects with bile acid resins?
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GI, may raise triglycerides, may interfere with drug absorption
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What are contraindications for bile acid resins?
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GI motility disorder
TG > 300 |
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What are some interactions that can occur with bile acid resins?
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Warfarin, digoxin, and synthroid
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What is a special instruction for synthroid if you are giving it with a bile acid resin?
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Give synthroid 1 hour before or 4 hours after bile acid resin.
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What are the six types of statins?
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Atorvastatin, Simvastatin, Fluvastatin, Lovastatin, Pravastatin, Rosuvastatin
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What is the MOA of statins?
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Inhibitors of HMG CoA Reductase - most active @ 2am, so most statins should be given in evening or at bedtime (except lipitor and crestor)
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These are the drugs of choice for lowering LDL and may be used in children.
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Statins
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What is the statin that is safe for children?
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Pravastatin
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What effects do statins have on other lipids?
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They lower triglycerides and increase HDL
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What are two other benefits associated with statins?
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Cardioprotective
Beneficial for gallstones |
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What are some side effects associated with statins?
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Elevated LFTs - Must monitor LFTs
Myopathy (dose related) and increased risk if combined with a CYP-3A4 inhibitor - give Statin at no more than 25% max dose. Check CK only if there are signs of myopathy |
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Which statin does not act as a CYP-3A4 inhibitor?
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Pravastatin
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What are the contraindications for statins?
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Liver disease
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What are the interactions associated with statins?
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Other drugs that are metabolized by CYP-3A4
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What are the Ezetimibe drugs? 2 of them
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Zetia
Vytorin (Zetia and Zocor) |
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What is the MOA of Ezetimibe drugs?
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They are cholesterol absorption inhibitors
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What is the primary role of Ezetimibe?
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Synergizes with statins to lower LDL
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What are the effects Ezetimibe has on other lipids?
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Decreases triglycerides and Increases HDL
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What are the contraindications of Ezetimibe?
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Liver Disease
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What are the drug interactions that can occur when taking Ezetimibe?
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Resins, Fibrates, and cyclosporine
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What 2 drugs make up the fibrates?
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Gemfibrozil
Fenofibrate |
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What is the MOA of the fibrates?
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Increase TG clearance and decrease TH synthesis by the liver
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What is the primary role of fibrates?
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Drug of choice for lowering TG
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What are the effects on other lipids caused by fibrates?
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Increase HDL and decrease LDL
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What are the side effects of fibrates?
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Myopathy - especially in combination with statins
Gallstones GI discomfort, nausea, elevated LFTs, rash |
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What are the contraindications for Fibrates?
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Children
Pregnant or lactating Gallstones Hepatic dysfunction (relative) Renal failure (relative) |
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What are the drug interactions with fibrates?
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Statins
Oral anticoagulants Avandia, Rapaglinide - Diabetes meds |
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What are the types of niacin?
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Immediate release
Long acting Extended release - Niaspan |
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What is the drug of choice for lowering triglycerides?
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Fibrates
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What is the mechanism for niacin?
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Decreases hepatic TG synthesis enhances activity of lipoprotein Lipase, enhances clearance of Apo-A-I, increasing HDL
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What is niacin's affect on other lipids?
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Decrease TG and Decrease LDL
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What are the side affects associated with Niacin?
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Flushing (immediate release)
GI upset Peptic Ulcer Disease Liver Toxicity (monitor LFTs - especially with long acting) Insulin resistance (monitor glucose) Hyperuricemia (monitor uric acid) Birth defects Eye toxicity |
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What are the contraindications to using niacin?
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PUD
Liver disease Pregnancy Gout (relative) DM (relative) |
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What are the drug interactions with niacin?
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Statins (give statin at only 25% of max dose)
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At what number of risk factors do you have to calculate a Framingham score?
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2
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Why is a high-sensitivity C-Reactive protein an emerging risk factor for CAD?
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Because atherosclerosis is an inflammatory process
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