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40 Cards in this Set

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what is the number one side effect of niacin?
flushing
what drug is contraindicated for p with high TRG, but is recommended if they have normal TRG's?
Fibric ACIDS. lowers LDL with normal TRG's
mixtures of fatty cholesterol and proteins in the blood that transport cholesterol, trg's and other lipids to various tissues.
lipoproteins
what is the optimal level for LDL cholesterol?
<100
what is the optimal level for HDL?
low <40
high >60
what is the desirable level for total cholesterol?
<200
what are some major positive risk factors that put patients at risk for hyperlipidemia
smoking
HTN/ and/or BB
low HDL
family H/O
men >45
women>55
what is the one negative risk factor that works in favor of your patients health
HIGH HDL
what are the two main types in making the dx of hyperlipidemia?
Primary: no s/s of CHD
SECONDARY: s/s of chd w/event
if a patient has no H/O CHD and less than 2 chd risk factors, what should their LDL goal be ?
< 160
29 y/o female has an LDL of 210 and otherwise normal chol panel + non-contributory PMH. what is your plan/treatment?
start meds for elevated LDL. low end statin: lipitor 10mg QD. + educate about diet
59 y/o female presents with an LDL 171, HDL 31 and is taking "some medication" for her high blood pressure. what is your plan/treatment?
start meds due to 2 or more risk factors and LDL >160. crestor 10mg QD. plus possible combo of niacin extended release 1 gm QD to raise HDL
40 y/o diabetic male presents with LDL 149, HDL 29 and TRG 160. what med is contraindicated ?
fibric acid due to elevated TRG's.
inhibits enzyme that is responsible for converting HMG-COA to mevalonate which is the rate limiting step in the production of cholesterol?
STATINS (HMG CoA reductase inhibitors)
what is the efficacy of the STATIN class?
reduce LDL 18-55%
reduce TRG 7-30%
reduce major coronary events
what is the strongest statin?
crestor 5-40 mg QD.
what is the weakest statin?
lipitor 10-80mg QD
what labs do we need to monitor in a patient who is on a statin?
CPK
LFT's
lipid levels
what does CPK measure?
creatinine protein kinase: muscle breakdown
what are some side effects of the statins?
myalgias
arthralgias
increased LFT's
before starting a patient on a statin what lab do you need?
LFT for a baseline
what is an absolute contraindication for statins?
liver disease
which med works by binding to bile acids to disrupt enterohepatic recirculation of bile acids?
bile acid sequestrants
what is the efficacy of bile acid sequestrants?
reduce LDL 15-30%
increase HDL 3-5%
may increase TRG's
reduce CHD mortality
what is the major side effect for the bile acid sequestrants?
constipation. it'a a binding bulk-forming agent.
what is a CI of using a bile acid sequestrant?
elevated TG >400
what is the representitive example of a bile acid sequestrant?
welchol 2.6- 3.8 gm QD
what are known drug interactions for welchol?
warfarin
BB
Thiazides
what drug is available OTC that reduces LDL by 25% and trg by almost 50%?
niacin
this drug inhibits mobilization of free fatty acids from peripheral adipose tissue. VLDL synthesis reduced.
Nicotinic acid=niacin
what is the efficacy of niacin?
lowers LDL 5-25%
lowers TRG 20-50%
raises HDL 15-35%
reduces coronary events and reduces total mortality
when is niacin contraindicated?
in patients with:
liver disease
gout
PUD
which drug reduces the rate of fat production in the liver?
FIBRIC acids
which drug causes gall stones?
fibric acid
what drug should not be used for a patient with elevated trg?
tricor (fibric acid) it increases the LDL
this drug inhibits cholesterol absorbtion from the GI tract?
zetia
what is the efficacy of zetia?
lowers LDL 15-20%
increases HDL by 3%
what is the number one side effect of zetia?
rash then HA
in management of high TRG's what is the goal of therapy?
to prevent pancreatitis
what drugs are used to treat high TRG's?
fibrates or nicotinic acids