Term
| Drugs that cause hyperlipidemia |
|
Definition
anabolic steroids
corticosteroids
protease inhibitors
atypical antipsychotics
thiazide diuretics
tacrolimus
cyclosporine
isotrention
beta blockers
mirtazapine |
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Term
| Lipid Panel Recommendations |
|
Definition
all adults >20yo
every 5 years
fasting state-12 hours
HDL and total cholesterol only reliable in non fasting state
food/etoh/hyperglyc increase TG |
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|
Term
|
Definition
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Term
|
Definition
<100 or
<70 for at high risk patients |
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|
Term
|
Definition
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Term
| isolated hypercholesterolemia |
|
Definition
increased LDL
associated with premature Coronary artery disease (CHD)
high total cholesterol |
|
|
Term
| isolated hypertriglyceridemia |
|
Definition
high chylomicrons
or
high VLDL
or
both
elevated TG |
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Term
|
Definition
high VLDL and LDL
or
high IDL (+VLDL)
associated with premature CHD |
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|
Term
Risk of CHD, risk equivalent or 10-yr risk >20%
lipid goal and when to initiate drug therapy
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|
Definition
<100 or <70
drug therapy: >100 |
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Term
| 2+ risk factors with a risk 10-20% LDL goal and when to initiate drug therapy |
|
Definition
goal <130 or <100
drug therapy: >130 |
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Term
| 2+ risk factors and risk <10% LDL goal and when to initiate drug therapy |
|
Definition
goal LDL <130
drug therapy: >160 |
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|
Term
| 0-1 risk factor LDL goal and when to initiate drug therpy |
|
Definition
LDL goal <160
drug therapy: >190 |
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Term
| Coronary Heart Disease risk |
|
Definition
history of MI
elective PCI or CABG
chronic angina
(we know these patients have plaque) |
|
|
Term
|
Definition
Peripheral Artery disease (PAD)
Carotid Artery disease
Abdominal Aortic aneurysm (AAA)
Diabetes Mellitus
high risk ppl with multiple risk factors (framingham >20%) |
|
|
Term
|
Definition
M >/=45yo
F>/=55yo
family hx: premature sudden death or MI in first degree relative(M<55, F<65)
current smoker
HTN >/= 140/90 or on htn med
HDL<40mg/dl |
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Term
|
Definition
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Term
|
Definition
=LDL + VLDL= TC-HDL
represents all atherogenic lipoproteins
VLDL~TG/5
can calculate non-HDL in non-fasting state
GOAL non-HDL=LDL + 30 |
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Term
| Target HDL and lower CHD risk? |
|
Definition
| AIM-High trial: raising HDL with niacin in patients with LDL 40-80 and established CHD did not reduce CV events over 32 months |
|
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Term
|
Definition
high LDL
high TG
low HDL
(weight reduction, fibrates, niacin) |
|
|
Term
| statins (HMG-CoA reductase inhibitors) |
|
Definition
most potent agents for reducing LDL
"pleoptropic events"
-plauqe stabilization
-reduce inflammation and oxidative stress
-restore/improve endothelial function
-inhibit platelet aggregation |
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|
Term
|
Definition
n/v dyspepsia diarrhea constipation
fatigue
transaminitis (increase AST/ALT)
increased risk with dose/potency of drug
not correlated with hepatotoxicity
myopathy(lowest=fluvastatin-highest=simvastatin 80 mg)
if CK >10 x ULN stop until myopathy resolves, rechallenge with lower dose, different statin or longer dosing interval
consider coenzyem Q10 |
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Term
|
Definition
baseline--6-12wks--q 6-12 months
LFTs
CK, s/sx of myopathy
lipid panel |
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|
Term
|
Definition
once daily
most short t1/2 best at night
except atorvastatin and rosuvastatin
cost: 4$ for pravastatin and lovastatin |
|
|
Term
|
Definition
| most potent for raising HDL |
|
|
Term
| Crystalline IR (OTC or Niacor) |
|
Definition
250mg once daily to start
increase q 4-7 days to 2g/day div BID/TID
after 2 months can increase q2-4 weeks to max 6g/day div TID |
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Term
|
Definition
500mg QHS to start
increase by 500mg q 4 weeks to max 2g QHS |
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Term
| Niacin Contraindications and Precautions |
|
Definition
CI: active liver disease, active peptic ulcer, arterial bleeding
CAUTION: gout, etohism,preg C, avoid nursing |
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|
Term
|
Definition
flushing/warm, pruritis, rash, acanthosis nigricans
N/V/D/anorexia
mild hyperglycemia, insulin resistance
increased uric acid
transaminitis
decreased PLT
increased PT
mild decrease in phosphorus |
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Term
|
Definition
minimize flushing by: take IR with meals, ER @bedtime or snack
avoid alcohol, spicy foods, hot beverages or baths around dose
ASA 325mg or low dose NSAID 30-60 mins prior to dose
educate patient symptoms will improve
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