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32 Cards in this Set
- Front
- Back
- 3rd side (hint)
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What non-drug factors can cause hypercholesterolemia? (elevated LDL levels)
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*Nephrotic syndrome
*hypothyroidism *obstructive liver disease *Anorexia |
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What drugs can cause hypercholesterolemia?
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*beta-blockers, cyclosporine
*glucocorticoids, isotretinoin *mirtazapine, progestins, protease inhibitors *sirolimus, thiazide diuretics |
BIG C MPP STD
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Formula for calculating LDL
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LDL=TC-HDL-(TG/5)
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Under what circumstance can you not use the LDL equation?
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TG>400mg/dl
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Total cholesterol
-desirable -high |
desirable <200mg/dl
high >240mg/dl |
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LDL cholestrol
-optimal -very high |
optimal <100mg/dl
very high >190mg/dl |
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HDL cholesterol
-low -high |
low <40mg/dl
high >60mg/dl |
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TG
-normal -very high |
normal <150mg/dl
very high >500mg/dl |
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The primary target of therapy is reducing LDL levels. Under what circumstance is this not the case?
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TG>500mg/dl
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CHD and CHD risk equivalents
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CHD-h/o MI, angina, certain procedures (CABG, angioplasty)
CHD risk equivalents-peripheral artery disease, abdominal aortic aneurysm, carotid artery disease, diabetes mellitus OR multiple risk factors and a 10yr risk of >20% based on framingham |
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Major risk factors
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*smoking
*HTN (>140/90) or taking BP meds *Low HDL (<40mg/dl) *family hx of premature CHD *age (men>45) (women>55) |
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What is considered a negative risk factor?
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HDL>60mg/dl
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What constitutes a postive family history of premature CHD?
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*1st degree relative
*actual CHD even had to happen before the age of: -55 in males -65 in females |
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When must the framingham score be determined?
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If pt has greater than or equal to 2 risk factors
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CHD or CHD risk equivalent (10-yr risk >20%)
-LDL gaol -when to start TLC -when to start drugs |
*LDL goal=<100mg/dl
*Start TLC= >100 *Start drugs= >130 |
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Greater than or equal to 2 risk factors (10 year risk less than or equal to 20%)
-LDL goal -When to start TLC -When to start drugs |
*LDL goal= <130
*Start TLC= >130 *start drugs = -10yr risk 10-20%= LDL>130 -10yr risk <10%= LDL >160 |
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0-1 risk factor
-LDL goal -when to start TLC -when to start drugs |
LDL goal=<160
Start TLC= >160 Start drugs= >190 |
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What is considered TLC with regards to diet?
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*reduce saturated fat intake <7% of total calories/day
*cholesterol <200mg/day *increase soluble fiber intake (10-25g/day) *increase plant stanols/sterols (2g/day) |
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What is the timeline for TLC?
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After 6-12 weeks, reassess lipid panel-if still above goal, initiate drug therapy
3 visits |
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Non-drug causes of Hypertriglyceridemia
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*diabetes type II
*Obesity *physical inactivity *Pregnancy *Acute hepatitis *Lupus *nephrotic syndrome *genetic disorders |
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Drug causes of hypertriglyceridemia
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*alcohol consumption
*bile acid sequestrants *estrogens *isotretinoin *Beta-blockers *thiazide diuretics *glucocorticoids *interferons |
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When should drug treatment for hypertriglyceridemia be initiated?
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greater than or equal to 500mg/dl
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What are patients with >500mg/dl triglyceride level at a high risk of?
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Pancreatitis
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What classes of drugs should be considered for hypertriglyceridemia?
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Fibrate, Nicotinic acid, or omega-3
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What non-pharmacological treatments should be recommended for hypertriglyceridemia?
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Very low-fat diet (<15% of calories from fat)
Intensify weight reduction and exercise Educate on alcohol avoidance |
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If triglycerides are greater than or equal to 200 after LDL goal is reached, what is the next step?
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set a secondary goal of non-HDL cholesterol and target therapy to reach that goal
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What is the formula for Non-HDL cholesterol?
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VLDL + LDL or Total cholesterol - HDL
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How do you determine the Non-HDL goal?
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LDL goal + 30mg/dl
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What are therapy options to reach non-HDL goals?
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Nicotinic Acid or fibrates to lower VLDL
Intensify TLC and LDL lowering therapies |
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What factors lead to low HDL?
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*cigarette smoking
*lack of physical exercise *malnutrition *obesity *hypertriglyceridemia *type 2 diabetes *very high carbohydrate diet |
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What drugs lead to low HDL?
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*anabolic steroids
*isotretinoin *progestins *beta-blockers |
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What is the treatment strategies for low-HDL?
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If LDL goal is reached and TG is <200mg/dl, may CONSIDER adding drugs that would increase HDL (niacin or fibrates) in patients that have CHD or CHD equivalents (high risk)
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