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IOS 9 Exam 4
Pharmacotherapy of Metabolic Syndrome
| Question | Answer |
|---|---|
| Cardiometabolic is | Cardiovascular and insulin resistance as well as obesity |
| AHA.NHLBI Metabolic Guidelines Primary Goal | Reduce risk of Atherosclerositic events and closely related goal is to decrease risk of developing DM-Lifestyle for all, treat accoring to HTN, Dyslipid, ASA risk |
| ADA prevention/delay of Type 2 | Weight loss, regular physical activity, D/C tobacco, work on HTN, dyslipidemia-Level A |
| ADA Prevention/delay Type 2 Drug therapy to treat Pre-DM | Not recommended- Level E |
| Metformin, Acarbose, Glitazones have been shown to delay onset of type 2 do we treat | No |
| AHA/NHLBI lifestyle modifications abdominal obesity goals | Reduce weight by 7-10% during first year of therapy, continue weight loss thereafter to extent possible with goal to ultimately achieve desirable weight (BMI <25Kg.m2), waist <40men, wom<35 |
| AHA/NHLBI lifestyle modifications physical activity is | Regular moderate activity (encourage aerobics) at least 30min of continous/intermittent (prefer 60) 5d/wk prefer daily-In CVD get physical activity Hx, exercise test |
| AHA/NHLBI lifestyle modifications Atherogenic diet | Goal is to reduce intake saturated <7% and trans fats,cholesterol <200. Total fat 25-35% total calories most unsaturated, and simple sugars should be reduced |
| Example of Atherogenic diet | Mediterranean diet: CHO50-60%, 15-20% protein, <30% fat, <10saturated (not goal), <300 cholesterol not at goal, but shown to reverse Met Syndrome when exercised 30 minutes QD |
| AHA/NHLBI Disease Control-Atherogenic dyslipidemia Primary Goal | LDL - ATP II goals |
| AHA/NHLBI Disease Control-Elevated BP | <140/90 or DM/CKD 130/80 reduce BP further to extent possible through lifestyle (BP>120/80=lifestyle changes)Thiazide first Line (worsen fasting glucose) |
| AHA/NHLBI Disease Control-Elevated Glucose | For impaired fasting glucose delay progression to Type 2=weight reduction, lifestyle therapy and increased physical activity, In type 2 pharmacotherapy of necessary to achieve Hb A1C <7% |
| AHA/NHLBI Disease Control- Prothrombotic state | Reduce thrombotic and fibrinolytic risk, High risk patients ASA therapy, moderately high risk-consider ASA |
| Dyslipidemia ATP Guidelines | High Risk CHD or equiv(>20Fram), Moder-High 2 risks(10-20% Fram), Moderate risk 2risk (<10%) Low Risk 0-1 risk |
| High risk LDL goal and Non-HDL goal | <100 or optinal <70 if mutant LDL or established AVD, Non-HDL <130 or <100 (unless greater than 500) |
| Moderately high LDL and Non-HDL goals | Either <130 or optional <100 if Cigarettes, HTN, low HDL, family Hx, age |
| Moderate risk LDL and Nono-Hdl Goal | <130 |
| HTN treat according to JNC 7 | ALLHAT showed not difference between Amlodipine, Lisinopril, Thiazide in DM or fasting glucose- choices may increase fasting glucose but not effect on CVD |
| Antithrombic therapy goals are | Decrease platelet function and minimize risk of thrombosis- ASA prefered of plavix for Framingham>10% So High risk, and moderately high risk patients (10-20%) (not FDA recommended in Primary prevention |
| Secondary prevention ASA therapy guideline | Use in all patients that do not have contraindications, it does reduce risks of MI or Stoke but not death risk |
| Antioxidants-Vitamins and folic acid | Do not reduce CV events |
| Potential new metabolic treatment | Rimonabant a Cannabinoid 1- receptor decrease weight, and wasit circumference, lowers TG and raised HDL, and promotes smoking cessation BUT NAUSEA AND DEPRESSION |
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liza001
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