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leading cause of death in people over 65
atherosclerosis
atherosclerosis risk factor ages
male >= 45 female >=55
obesityt defined
BMI >= 30 kg over m squared
BMI formula
wt kg over square of ht in meters
what proportion of CHD RR with every 30 mg per dL increase in LDL
30%
Frederick-Levy Classification system
system used to classify hyperlipidemic patients in terms of plasma lipoprotein levels
Most common Ferderick-Levy Catagories
Type II a II b or IV
two main causes of secondary hypolipoproteinemia
HYPOthyroidism and DM
Thiazide effects on lipids
may increase total LDL
beta blocker effects on lipids
increase TG and decrease HDL
progestins effects in lipids
increase chylomicrons VLDL
glucocorticoids effect on lipids
increase total VLDL and LDL
anabolic steroids effects on lipids
increase TC and decrease HDL
cyclosporine effects on lipids
increaser TC and LDL
isotretinoin effects on lipids
increase TC and decrease HDL
risk factor BP for CHD
>= 140 over 90 or on HBP med
When to initiate lipid Rx tx in high risk CHD
LDL >= 100
other tests for high risk CHD lipid testing
highly sensitive CRP and Homocysteine
total fat intake for atherosclerosis dietart management
25 to 35% total calories
total saturated fatty acids intake for atherosclerosis dietart management
<7% total calories
total monounsaturated fatty acids intake for atherosclerosis dietart management
up to 20% of total calories
total polyunsaturated fatty acids intake for atherosclerosis dietart management
up to 10% of total calories
total protein intake for atherosclerosis dietart management
15% of total calories
total cholesterol intake for atherosclerosis dietart management
< 200 mg per day
LDL calculation for pts with TG below 400
HDL minus VLDL from TC
LDL monitoring timeframe if drug therapy initiated
LDL measured at baseline then at 4-6 weeks
Urine change if rhabdomyolysis present
dark red
starting dose lipitor
10 mg
starting dose fluvastatin
40-80 mg
starting dose lovastatin
40 mg
starting dose pravachol
5-10 mg
starting dose simvastatin
20-40
MOA of bile acid sequestrants
bind bile acid
drug of choice for type Iia hyperlipidemia
bile acid sequestrants
CI for bile acid sequestrants
really any GI complications or complaintys
Names of Bile Acid Sequestrants
cholestyramine
max dose cholestyramine
24 grams RESIN per day
max dose colestipol
30 grams per day
max dose colesevelam (welchol)
7 tablets per day
advantage to Welchol
better GI tolerance
MOA of nicotinic acid
reduces LDL and VLDL synthesis
nicotinic acid generalized drug interaction
decrease effects on hypoglycemic drugs
max dose IR niacin
ususally around 6 grams per day
max dose ER niacin
2 grams per day
Problems with nicotinic acid
may increase uric acid levels and worsen glycemic control
MOA fibric acid derivatives
increased lipoprotein lipase activity
how can a BB with no selectivity be overcom
use higher doses
which BB should be avoided in ischemia
agents with intrinsic sympathomimeet activity ACEbutolol
target HR for ischemic pts treated with BB
50-60 or lowest tolerated rate
Non-Dihydropyridine CCBs
verapamil and diltiazem
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