HYPERLIPIDEMIA

RISK FACTORS

Arterioschlerosis: hardening of the vessels

MEDICATION THERAPY (When diet changes are not enough after 6 months)

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LABS

ASSESSMENTS: Checking for differences. EQUALITY IS IMPORTANT

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PULSES make sure equal in strength; check all sites

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BLOOD PRESSURE

Bruits-turbulent, swooshing sound- auscultating pulses common in carotids, abdominal aortas

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Strong are easily palpated, weak are hard to palpate, absent are critical. Don't document absent if you cant feel it, doppler the pulse first[ X mark indicates where it can be found];

DONT CHECK CAROTID PULSES AT THE SAME TIME ;

Problems with perfusion

Intermittent claudication: pain in calf that worsens from standing/walking throughout the day. It improves with rest and in the morning.

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CAPILLARY REFILL

Less than 3 seconds as soon as you let go; check under below finger nail for those with painted nails

SKIN COLOR & TEMP

Normal for ethnicity

look for differences in MAPS (mean arterial pressures) to see if one side is getting more pressure

document site because pressures are different

check in both extremities

Bounding pulse are visibly seen

TOTAL LIPID PANAL: 12 hour fasting

HDL-C: genetic; "Good" cholesterol; women > 45; men >55

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LDL-C: genetic; "Bad" cholesterol want to be below 130; high risk is >190;

Triglycerides: related to diet; want it to be less than 150

Total cholesterol normal under 200 mg/dL for patients in general

VDL-C: values not needed

Greater than 240 high risk for adverse cardiovascular events (heart attack, stroke)

201-239 borderline risk for adverse cardiovascular events

Hypertension

Smoking (reduces HDL-C levels)

Males over 45; Females over 55

Genetics (HDL & LDL)

Diet (effects triglycerides)

Diabetes

INFLAMMATORY MARKERS-nonspecific to hyperlipidemia- will show up with infection, trauma, surgery etc; can be decreased in STATIN patients and create a false normal; women and African Americans will have a higher normal naturally

C Reactive Protein (CRP); 0-10; 0-1.0 the higher the number the more inflammation there is

Erythrocyte sedimentation rate (ESR): how long it takes from erythrocytes to settle

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Artherioschlerosis: fat build up in the vessels

LIFESTYLE CHANGES

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Weight reduction: increases HDL's & decreases LDL's

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Exercise: 30 minutes a day X 5 times a week

Increases HDL levels

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SMOKING CESSATION

If they cant quit encourage to reduce. (patches, lozenges, Albutrin, gum)

Diet changes: low fat, low cholesterol

Step 1: 30% of total calories per day should come from fats; less than 10% should come from saturated fats; increase fiber

Step 2: 30% of total calories per day should come from fats; less than 7% should come from saturated fats; increase fiber

Mediterranean Diet: {Red meats- Monthly; } {fish/eggs/poultry}weekly || {cheeses/yogurt} weekly; {Olive oil}daily ||{Fruits}{Veggies}{nuts, legumes, beans}-daily||{ Whole grains, breads, pastas daily}|| {Daily activity on the bottom} 6 8oz glasses of water a day; wine 1-2 glasses for men and 1 glass for women daily

still need to include lifestyle changes

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STATINS [HMG COA reductase inhibitors]

FIBRATES

side effects: GI symptoms-nausea, vomiting, constipation, diarrhea, abdominal pain

appear to increase risk of diabetes

reduce LDL, & Triglycerides; have no impact on HDL

most not approved with children

works on specific enzyme in the liver so less cholesterol is made

not safe during pregnancy

cant have with grapefruit or grapefruit juice

serious side effects-TOXIC TO LIVER (hepatotoxicity): Look for JAUNDICE (eyes, skin) Labs: look at ALT, AST & bilirubin

serious side effects: MYOPATHY-muscle pain; {do full musculoskeletal assessment} Stop the med; see if the pain improves

Lipitor, Lescol, Mevacor, Zocar

BILE ACID SEQUESTRANTS

decrease production of cholesterol

increase HDL, decrease VDL, most effective in lowering triglycerides

gemfibrozil(Lopid), fenofibrate(Tricor) chlofibrate (Atromid-S)

check AST, ALT, bilirubin levels

safe for pregnancy

side effects: GI symptoms-nausea, vomiting, constipation, diarrhea, abdominal pain

Gallbladder disease should not use these

attach to cholesterol in the intestine so they cant be absorbed & excreted in the feces

lower LDL, raise HDL

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all in powder form and need to mixed with 6 oz of liquid (water or juice)

effect other meds; should not be taken within 2 hours of other meds

can be used in pregnancy

side effects: GI symptoms-nausea, vomiting, constipation, diarrhea, abdominal pain

changes characteristics of stool-more fat in feces will make it float

Used with STATINS

cholestyramine (Questran) colestipol (Colestid) colesevelam (Welchol)

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NIACIN (Vitamin B3)

increased uric acid in blood (causes Gout)

increased blood sugars

can cause hepatotoxicity

if they have itchy skin use antihistamine (diphenhydramine)

recommend to take with meals or 325 mg of aspirin if safe

side effects are dose dependent-the higher the dose the greater the side effect: Flushed skin

water soluble; excreted out of the urine if there is too much (urine will be BRIGHT YELLOW)

lowers LDL & triglycerides

helpful for collateral circulation