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Hyperlipidemia template



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Definition of HyperlipidemiaAn elevation of blood lipids; cholesterol, cholesterol esters, phospholipids, and/or triglycerides
Risk Factors for HyperlipidemiaFamily Hx of CHD Physical inactivity Smoking Age: Men >45, Women >55 or premature menopause without estrogen replacement Obesity Diet high in saturated fat HDL <40 mg/dL Diabetes
Assessment Findings in HyperlipidemiaXanthomata Xanthelasma Corneal arcus prior to age 50 Bruits Angina Pectoris Myocardial infarction Stroke
Diagnostic Studies for HyperlipidemiaFasting lipid profile (9-12 hours fasting) Urinalysis (to detect nephrotic syndrome) TSH (to detect hypothyroidism which may cause hypercholesterolemia
Classification of LDL levels<100 Optimal 100-129 Near or above optimal 130-159 Borderline High 160-189 High >/= 190 Very High
Classification of Total Cholesterol levels< 200 Desirable 200-239 Borderline High >/= 240 High
Classification of HDL levels<40 Low >/=60 High (negative risk factor)
Lipid Screening RecommendationsEvery 5 years beginning at age 20 for those who smoke, have diabetes, or have a hx of heart disease Every 5 years starting at 35 for males and 45 for females
Nonpharmacologic Management of HyperlipidemiaTherapeutic lifestyle changes: Nutrition, Weight reduction, Increased physical activity Patient education regarding risk factors, lifestyle modifications, diet, exercise, etc
Pharmacological Management of HyperlipidemiaStatins Bile Acid Sequestrants Nicotinic Acid Fibric Acids Cholesterol Absorption Inhibitor
Statins in HyperlipidemiaInhibit HMG-CoA, the enzyme which is partly responsible for cholesterol synthesis Liver func test before starting, then at 6 and 12 wks, and after dose increase In conjuction with diet, exercise, & weight reduction in over weight pts
Bile Acid Sequestrants in HyperlipidemiaBind bile acids in the intestine which prevents their absorption. These insoluble bile acid complexes are excreted in feces Used to lower LDL in conjunc with diet May prevent absorption of fat soluble vitamins (A, D, E, & K) and many oral meds. Monitor for constipation and flatulence
Fibric Acids in HyperlipidemiaIncrease lipolysis and elimination of triglyceride rich particles from plasma, resulting in lower LDL. Gemfibrozil (a FA) given with statins can produce rhabdomyolysis and acute renal failure. Increase risk of gallstone formation Monitor liver func studies and glucose during therapy; both may be elevated
Niacin in HyperlipidemiaThought to decrease hepatic VLDL production; VLDL is converted to LDL Monitor liver function studies before starting treatment, at 6 & 12 wks, with each dose increase, and periodically Monitor for myalgias and rhabdomyolysis Causes flushing and hypotension
Cholesterol Absorption InhibitorInhibit absorption of cholesterol by the small intestine. Can be used alone or with a Statin GI complaints are most common Not necessary to monitor liver function unless concurrently with another med requiring LFT monitoring
Pregnancy/Lactation Considerations with HyperlipidemiaCholesterol levels are usually elevated during pregnancy Treatment is contraindicated
Considerations for Special Populations with HyperlipidemiaElderly: Benefits seen with total cholesterol and LDL reduction Statins typically well tolerated by elderly Diabetics: Aggressive management of hyperlipidemia needed
Follow up for HyperlipidemiaEvaluate lipid levels every 5 years starting at age 20 if normal values obtained



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