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1. Check
1. LDL, HDL, Cholesterol, TG
2. check every 5 years
3. check 6-8 weeks after treating the pt
2. Primary prevention
1. If LDL>190
1. ASCVD>10% ⇒ moderate dose Statin
2. ASCVD 5-10% ⇒ discuss starting drugs
3. ASCVD<5% ⇒ only F/U
4. Repeat checkups after 6-8 weeks of treatment
5. Goal: decrease 50% in LDL level
3. Statins:
1. Tab Atorvastatin (10, 20, 40mg) start with 10-40 mg , max 80 mg/day
2. tab Lovastatin 20 mg, start with 20-40 mg max 80 mg/day
3. tab Rosuvastatin (5, 10, 20 mg) start with 10-20 mg max 40 mg/day
4. Fibrates
1. Tab Gemfibrozil (450, 600 mg) bid
2. tab Gemfibrozil 300 mg bid max 1200 mg /day
3. cap fenofibrate (100, 200 mg ) qd, start with 50-100 mg/day max 200 mg qd
5. Bile chelators:
1. Powder cholestyramine 4gr bid before meal
2. tab nicotinic acid 100 mg tds or qid
3. tab ezetimibe 10 mg qd (block bile absorption)
4. tab fish oil bid
6. Approach:
1. First line drugs
1. Statins: tab atorvastatin 40 mg po qd #30
1. Statins are more effective on LDL
2. may cause myositis ⇒ check CPK, ALT, AST, ALP
3. may cause rise LFT
4. check LFT, TSH, FBS, CK, lipid profile before starting drugs
2. Fibrates: Cap gemfibrozil 300 mg bid #90
1. do not prescribe with statins
2. more effective on TG
3. start with one of them
2. 2nd line drugs: if first line was not effective, add these drugs
1. tab nicotinic acid 100 mg tds #130
1. first week 1 pill
2. 2nd week 2 pills
3. 3rd week 3 pills
2. Tab Niacin 50mg qd up to 2gr/day
3. tab fish oil bid effective on TG
4. Powder cholestyramine 4gr bid with food
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