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24 Cards in this Set
- Front
- Back
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85. CHD or CHD risk equivalents:
a. LDL goal: b. Initiate Lifestyle Changes at what level: c. Consider drug therapy at what level: |
1. LDL goal: <100
2. Initiate Lifestyle Changes at what level: 100 (all pts regardless of LDL) 3. Consider drug therapy at what level: 130 |
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86. No CHD but >2 risk factors
a. LDL goal: b. Initiate Lifestyle Changes at what level: c. Consider drug therapy at what level: |
1. LDL goal:130
2. Initiate Lifestyle Changes at what level:130 (all pts regardless of LDL) 3. Consider drug therapy at what level:130 |
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87. No CHD but 2 risk factors
a. LDL goal: b. Initiate Lifestyle Changes at what level: c. Consider drug therapy at what level: |
1. LDL goal:< 130
2. Initiate Lifestyle Changes at what level: 130 3. Consider drug therapy at what level: 160 |
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88. No CHD but 0-1 risk factors
a. LDL goal: b. Initiate Lifestyle Changes at what level: c. Consider drug therapy at what level: |
1. LDL goal: <160
2. Initiate Lifestyle Changes at what level: 160 3. Consider drug therapy at what level: 190 |
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89. In diagnosing hyperlipidemia, what 4 other lab tests should be checked to exclude secondary causes of hyperlipidemia?
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1. TSH (hypothyroidism)
2. LFTs (chronic liver disease) 3. BUN and Cr, urinary proteins (nephritic syndrome) 4. Glucose levels (diabetes) |
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90. General tx guidelines for hyperlipidemia?
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a. Long-term goal is to reduce CHD risk.
b. Short-term goal is to reduce LDL the (apo-b) levels. |
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91. Therapy for high LDL cholesterol?
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a. Dietary therapy is the initial measure.
b. Lowering fat intake (esp. sat fats) reduces serum cholesterol more than lowering cholesterol intake. c. Foods rich in w3 are particularly beneficial. d. With an intensive diet, LDL can be reduced by an average of 10%, as follows: i. <30% of total calories from fat; w/fewer than 10% from saturated fat. ii. <300 mg/day of cholesterol. |
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92. How does exercise and wt. loss reduce risk of CAD?
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a. Exercise increases HDL and reduces other CAD risk factors by lowering BP and enhancing the efficiency of peripheral oxygen extraction.
b. Wt. loss reduces myocardial work as well as the risk of diabetes. |
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93. Therapy for high TG levels?
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a. >500 should be treated w/medication.
b. Niacin is the first-line drug for hypertriglyceridemia c. Gemfibrozil also lowers TGs effectively. |
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94. Tx of TG levels < 500?
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a. Can be managed w/wt. loss, diet, and exercise.
b. Wt. loss should be the primary goal. c. Initiate drug therapy if wt. reduction is insufficient or not feasible. |
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95. Effects of HMG CoA reductase inhibitors (statins)?
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a. Lower LDL levels (most potent for lowering LDL)
b. Minimal effect on HDL and TG levels. |
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96. How do HMG CoA reductase inhibitors (statins) effect mortality?
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a. Have been shown to reduce mortality form CV events and significantly reduce total mortality.
b. Drugs of choice for lowering LDL. |
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97. How should SE be monitored for HMG CoA reductase inhibitors (statins)?
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a. Monitor LFTs (monthly for first 3 months), then every 3-6 months.
b. Harmless elevation in muscle enzymes (CPK) may occur. |
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98. 3 effects of Niacin?
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1. Lowers TG levels
2. Lowers LDL levels 3. Increased HDL. |
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99. Contraindication to Niacin use?!?
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a. Do not use in DM pt (may worsen glycemic control).
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100. What is the most potent drug for increasing HDL and decreasing TG levels?
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a. Niacin.
b. It is a second-line agent for lowering LDL. |
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101. SE of Niacin?
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a. Flushing effect (cutaneous flushing of face/arms)
b. Pruritus may be present. c. Check LFTs and CPK levels as w/statin drugs. |
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102. Effects of Bile-acid binding resins (Cholestyramine, Cholestipol)?
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1. Lowers LDL
2. INCREASES TG levels! b. Effective when used in combination w/statins or niacin to tx severe disease in high-risk pts. c. 3rd-line agents for lowering LDL. |
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103. AE of Bile-acid binding resins (Cholestyramine, Cholestipol)?
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1. GI side effects
2. Poorly tolerated. |
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104. Effects of Fibrates (gemfibrozil)?
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1. Lowers VLDL
2. Lowers TG 3. Increases HDL. b. Can be used if above drugs fail |
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104. Effects of Fibrates (gemfibrozil)?
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1. Lowers VLDL
2. Lowers TG 3. Increases HDL. b. Can be used if above drugs fail. |
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105. SE of Fibrates (Gemfibrozil)?
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a. GI (mild)
b. Mild abnormalities in LFTs c. Gynecomastia d. Gallstones e. Wt. gain f. Myopathies |
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106. How is CV risk effected by oestrogen replacement therapy in postmenopausal women?
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a. Recent HERs trial showed no benefit of hormone replacement therapy on cardiovascular outcomes in women w/established CHD.
b. However, the study did not address the issue in women w/o CHD. c. The results are somewhat controversial. |
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107. What 2 classes of drugs can induce transient elevations in LFTs and therefore LFTs must be monitored?
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a. Statins and Fibrates.
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