Term
Who should/those with which conditions be screened for dyslipidemia?
What can result from severe hypertriglyceridemia? |
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Definition
Who should be screened for dyslipidemia?
Men > 40, Women > 50, diabetics, HTN, smokers, obese, FH or CAD, inflammatory diseases such as SLE, RE, psoriasis, CKD, HIV infection treated with HAART, those with clinical manifestations of hyperlipidemias (xanthomes, xanthalesmas), ED
Severe hypertriglyceridemia --> pancreatitis |
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Term
Conditions that can cause secondary hyperlipidemia:
Medications that can cause secondary hyperlipidemia: |
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Definition
Conditions that can cause secondary hyperlipidemia:
Alcohol excess, CKD, Diabetes, Obesity, Hypothyroidism, Nephrotic syndrome, Obstructive liver disease, Pregnancy
Medications that can cause secondary hyperlipidemia:
Beta Blockers without intrinsic sympathomimetic activity or alpha blocking activity, corticosteroids, HAART, HRT, oral contraceptives, thiazide diuretics |
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Term
| What assessment tool should be used to assess 10 year risk of a cardiovascular event, and therefore whether or not dyslipidemia therapy should begin. |
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Definition
| Framingham Risk Score (FRS) |
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Term
Initiating treatment for LDL vary based on FRS.
When should LDL treatment begin for low risk FRS (10 year risk <10%):
medium risk FRS (10 year risk 10-19%):
high risk FRS (10 year risk >20%): |
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Definition
Initiating treatment for LDL vary based on FRS.
When should LDL treatment begin for low risk FRS (10 year risk <10%):
>5mmol/L
medium risk FRS (10 year risk 10-19%):
LDL>3.5mmol/L
high risk FRS (10 year risk >20%):
ALL patients. |
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Term
What are the targets for the following:
TC/HDL ratio:
Non-HDL-C:
Trigs: |
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Definition
What are the targets for the following:
TC/HDL ratio:<4
Non-HDL-C: < 3.5mmol/L
Trigs: <1.7mmol/L |
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Term
| What qualifies as Metabolic Syndrome? |
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Definition
Metabolic syndrome:
Central obesity, and two of the following:
Trig: >1.7mmol/L
HDL-C: < 1.0mmol/L (men)
HDL-C: < 1.3mmol/L (women)
BP > 135>80 mm Hg
Fasting glucose 5.7 - 7.0 mmol/L |
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Term
Lipid lowering agents.
Arrange the following drugs in terms of greatest LDL reduction, HDL improvement, and TG reduction:
Resins, Statins, Niacin, Fibrates, Ezetimibe |
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Definition
LDL lowering:
Statins >Resins & Niacin & Ezetimibe> Fibrates (may do nothing or slight decrease)
HDL improvement:
Niacin & Fibrates > Resins & Statins > Ezetimibe
TG lowering:
Niacin & Fibrates> statins & Ezetimibe > RESINS* may increase TG |
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Term
Resins -
What are the drugs ?
Effect on LDL, HDL, and TG?
Are they considered safe ?
Can they be used in children or breastfeeding women ? |
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Definition
Resins -
What are the drugs - Colestipol, cholestyramine
Effect on LDL, HDL, and TG?
LDL - moderately lowers
HDL - slightly elevates
TG - slightly INCREASES*** not good.
Are they considered safe ? Yes, constipation and bloating can cause noncompliance
Can they be used in children or breastfeeding women ? yes |
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Term
Statins
Effect on LDL, HDL, and TG?
Which statins have the greatest TG lowering effect ?
Precautions/monitoring parameters?
Can they be used in children? |
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Definition
Statins
Effect on LDL, HDL, and TG?
LDL - EXCELLENT. Best.
HDL - moderately increase
TG - slight decrease/maybe nothing
Rosuvastatin & Atorvastatin have the greatest TG lowering effect.
Watch for hepatotoxicity and myopathy.
Can be used in children >10 years old with familial hypercholesterolemia |
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Term
Niacin
Effect on LDL, HDL, and TG?
What can it be combined with, and why?
Safety concerns/Side effects. Use in those who are glucose intolerant ?
With what other dyslipidemic agent should caution be taken, and why ? |
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Definition
Niacin
Effect on LDL, HDL, and TG?
LDL - moderate decrease
HDL - Exellent increase
TG - Excellent decrease
Causes flushing, pruritis and dry skin, GI disturbances, increases blood sugar. Hepatotoxicity. LESS SE's with XR formulation, but more hepatotoxicity.
*Antihyperglycemics can be adjusted when beginning niacin therapy in anticipation of elevated blood glucose.
Can be combined with a selective prostaglandin D2 antagonist as it increases tolerability.
Take caution when using with statins because both cause hepatotoxicity and myotoxic effects. |
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Term
Fibrates - name them
Effect on LDL, HDL, and TG?
Which fibrate should not be combined with a statin? is combining the other 2 safe?
What type of patients are fibrates particularly useful at improving lipid profile ? |
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Definition
Fibrates - Gemfibrozil, fenofibrate, bezafibrate
Effect on LDL, HDL, and TG?
LDL - variable- bezafibrate & fenofinrate > gemfibrozil
HDL - Good HDL improving agents
TG - Good TG reducing agents
Gemfibrozil should NOT be combined with statins.
Particularly useful in patients with type 2 diabetes. |
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Term
Ezetimibe
Effect on LDL, HDL, and TG?
Compliance vs resins ? |
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Definition
Ezetimibe
Effect on LDL, HDL, and TG?
LDL - moderately lowers
HDL - slightly improves HDL
TG - slightly lowers TG
More compliance than with resins because of a better side effect profile. |
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Term
Dyslipidemia and pregnancy
Lipid profile trend in pregnancy ?
How do you manage dyslipidemia in pregnancy women? What is the exception ?
Due to this exception, what supplementation is recommended ?
Dyslipidemic agents in breastfeeding women? |
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Definition
Dyslipidemia and pregnancy
Everything increases, including HDL.
Possible teratogenic effects, discontinue ALL dyslipidemic agents, with the EXCEPTION of RESINS.
Because resins also block the absorption of lipid soluble vitamins, supplementation of lipid soluble vitamins is recommended.
Not recommeded take dyslipidemic agents while breastfeeding. |
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Term
Resins - Name them:
Adverse effects:
Drug interactions:
Comments:
Contraindications: |
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Definition
Resins - Name them: cholestyramine & colestipol
Adverse effects: Constipation & bloating (most frequent), blocks absorption of fat soluble vitamins, increases trasaminase, INCREASES TRIGS.
Drug interactions: take 1 hours before or 4-6 hours after medications, warfarin, Statins (can use with st.
Comments: High fibre and water intake recommended to reduce constipation
Contraindications: TG over 4.6mmol/L due to TG increasing effects. |
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Term
Statins -
Adverse effects:
Drug interactions:
Comments:
Contraindications: |
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Definition
Statins -
Adverse effects:
common: GI, HA, muscle pain, increases LFT (dose dependent), increases CK,
Rare: rhabdomyolysis, SLE,
Drug interactions: 3A4
Comments:
Atorvastatin & are better for Triglycerides.
Pravastatin & Rosuvastatin have fewer drug interactions
Contraindications: Pregnancy, increased alcohol intake, gemfibrozil (can use the other 2 fibrates with them) |
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Term
Ezetimibe -
Adverse effects:
Drug interactions:
Comments:
Contraindications: |
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Definition
Ezetimibe - Ezetrol
Adverse effects: Generally well tolerated, not as bad as others in terms of hepatotoxicity.
Drug interactions: Fibrates increases ezetimibe, p450 substrate.
Comments: Can be used in combinations
Contraindications: Liver disease. |
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Term
Fibrates -
Adverse effects:
Drug interactions:
Comments:
Contraindications: |
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Definition
Fibrates -
Adverse effects: GI upset, rash, abdominal pain, myalgia
Drug interactions: sulfonurea (increase effect of sulfonurea) & other diabetic agents
Comments: Particularly useful in type 2 diabetic patients.
Cannot combine gemfibrozil with statins
Contraindications: hepatic/renal dysfunction, smoking or statins(with gemfibrozil) |
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Term
Niacin
Adverse effects:
Drug interactions:
Comments:
Contraindications: |
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Definition
Niacin
Adverse effects: flushing, pruritus, dry skin, HA, GI upset. INCREASES GLUCOSE, increaes LFT,hepatotoxic, torsades de pointes, ulcers
Drug interactions: statins
Comments: XR immediate side effects not as bad, but worse hepatotoxicity
Contraindications: uncontrolled diabetes, peptic ulcer disease |
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Term
Side effects in dyslipidemic agents
Statins -
Niacin -
Fibrates -
Resins -
Ezetimibe - |
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Definition
Side effects in dyslipidemic agents
Statins - increase LFTs, myalgias
Niacin - flushing, dry skin, pruritis, GI disturbances, increases blood sugar
Fibrates - Rash, GI disturbances
Resins - Bloating, constipation
Ezetimibe - Well tolerated, back pain, arthralgias, |
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