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32 Cards in this Set

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What non-drug factors can cause hypercholesterolemia? (elevated LDL levels)
*Nephrotic syndrome
*hypothyroidism
*obstructive liver disease
*Anorexia
What drugs can cause hypercholesterolemia?
*beta-blockers, cyclosporine
*glucocorticoids, isotretinoin
*mirtazapine, progestins, protease inhibitors
*sirolimus, thiazide diuretics
BIG C MPP STD
Formula for calculating LDL
LDL=TC-HDL-(TG/5)
Under what circumstance can you not use the LDL equation?
TG>400mg/dl
Total cholesterol
-desirable
-high
desirable <200mg/dl

high >240mg/dl
LDL cholestrol
-optimal
-very high
optimal <100mg/dl

very high >190mg/dl
HDL cholesterol
-low
-high
low <40mg/dl

high >60mg/dl
TG
-normal
-very high
normal <150mg/dl

very high >500mg/dl
The primary target of therapy is reducing LDL levels. Under what circumstance is this not the case?
TG>500mg/dl
CHD and CHD risk equivalents
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
Major risk factors
*smoking
*HTN (>140/90) or taking BP meds
*Low HDL (<40mg/dl)
*family hx of premature CHD
*age (men>45) (women>55)
What is considered a negative risk factor?
HDL>60mg/dl
What constitutes a postive family history of premature CHD?
*1st degree relative
*actual CHD even had to happen before the age of:
-55 in males
-65 in females
When must the framingham score be determined?
If pt has greater than or equal to 2 risk factors
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
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
0-1 risk factor
-LDL goal
-when to start TLC
-when to start drugs
LDL goal=<160

Start TLC= >160

Start drugs= >190
What is considered TLC with regards to diet?
*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)
What is the timeline for TLC?
After 6-12 weeks, reassess lipid panel-if still above goal, initiate drug therapy

3 visits
Non-drug causes of Hypertriglyceridemia
*diabetes type II
*Obesity
*physical inactivity
*Pregnancy
*Acute hepatitis
*Lupus
*nephrotic syndrome
*genetic disorders
Drug causes of hypertriglyceridemia
*alcohol consumption
*bile acid sequestrants
*estrogens
*isotretinoin
*Beta-blockers
*thiazide diuretics
*glucocorticoids
*interferons
When should drug treatment for hypertriglyceridemia be initiated?
greater than or equal to 500mg/dl
What are patients with >500mg/dl triglyceride level at a high risk of?
Pancreatitis
What classes of drugs should be considered for hypertriglyceridemia?
Fibrate, Nicotinic acid, or omega-3
What non-pharmacological treatments should be recommended for hypertriglyceridemia?
Very low-fat diet (<15% of calories from fat)

Intensify weight reduction and exercise

Educate on alcohol avoidance
If triglycerides are greater than or equal to 200 after LDL goal is reached, what is the next step?
set a secondary goal of non-HDL cholesterol and target therapy to reach that goal
What is the formula for Non-HDL cholesterol?
VLDL + LDL or Total cholesterol - HDL
How do you determine the Non-HDL goal?
LDL goal + 30mg/dl
What are therapy options to reach non-HDL goals?
Nicotinic Acid or fibrates to lower VLDL

Intensify TLC and LDL lowering therapies
What factors lead to low HDL?
*cigarette smoking
*lack of physical exercise
*malnutrition
*obesity
*hypertriglyceridemia
*type 2 diabetes
*very high carbohydrate diet
What drugs lead to low HDL?
*anabolic steroids
*isotretinoin
*progestins
*beta-blockers
What is the treatment strategies for low-HDL?
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)