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Explain how changing to a healthier diet can benefit Mr. Edwards
Current diet is SAD; Changing to a mediterranean diet/DASH will decrease inflammation, LDL, TD, BP, HR & overall risk for another cardiac episode
What are the steps in Motivational Interviewing
1. open ended questions for pt to consider how/why to change 2. Listen to understand pt experiences; capture account; use empathy 3. Inform w/ permission
Discuss the principle behind Motivational Interviewing
Guiding style of interview: It assumes the patients know whats best for them; helps them confront ambivalence to change; gets patient to say how/why to change
Justify the use of the SHARE technique with Mr. Edward's treatment plan
1st appt: statin myalgia pain; Mayo Clinic; new statin+CoQ10 2nd appt: discusses Mr. Edwards values not wanting medication; seek alternative treatments
Describe the SHARE technique
Seek pt participation Help pt explore/compare treatments Asses pts values/preferences Reach decision together Evaluate pts w/ follow up
Justify the use of Vitamin D in the treatment of ASCVD
Vitamin D deficiency is independently associated with myalgia, myositis, myopathy, myonecrosis; statins may affect vitamin D levels
Justify the use of CoQ10 in the treatment of ASCVD
endogenous CoQ10 plays a role in muscle cell energy production; statins decrease endogenous CoQ10
Discuss the FITT principle and how it could be used for Mr. Edwards
Frequency; Intensity; Timing; Type prescription for exercise routine that is patient specific
Discuss the benefits and risks of the Nutraceutical Supplement Green Tea Extract and Green Tea (EGCG) in treating/managing dyslipidemia?
Catechins may improve the lipid profile; reduction in total cholesterol; anti-inflammatory; stimulatory effects of caffeine
Discuss the benefits and risks of the Nutraceutical Supplement Omega-3s in treating/managing dyslipidemia?
decrease total mortality; decreased LDL circulation; antiinflammatory, antithrombotic, lower blood pressure (BP)-heart rate; prolonged high doses bad
Discuss the benefits and risks of the Nutraceutical Supplement Red Yeast Rice in treating/managing dyslipidemia?
statin like properties; decrease obesity related inflammation, insulin resistance, nonalcoholic fatty liver disease; must be highly purified/certified
Discuss the benefits and risks of the Nutraceutical Supplement Niacin (Vitamin B3) in treating/managing dyslipidemia?
reducing total cholesterol and LDL; increasing HDL; decrease coronary events and plaque; dosing should be titrated since it is lipid soluble; hyperglycemia/gout
What is the normal range for CK?
healthy adult, the serum CK level varies with a number of factors (gender, race and activity), but normal range is 22 to 198 U/L (units per liter)
Describe how creatine kinase relates to muscle breakdown
During muscle degeneration, muscle cells break open and go into bloodstream. Rise in CK in the blood indicates that muscle damage occurred or is occurring
What is Creatine Kinase?
CK is a type of protein, known as an enzyme
Discuss the sequela of ASCVD
Coronary Artery Disease (CAD) Cerebral vascular disease Peripheral Vascular disease
What are the cholesterol levels that are measured in a lipid panel?
HDL LDL Triglycerides Total Cholesterol
What are the benefits of Statins?
decrease cholesterol protect against heart attack and stroke generally safe, highly effective
Prevalence of ASCVD in the US
Leading cause of death in the US (1 out of 4) Affects races roughly equally Roughly 6% of the population has heart disease 220 billion dollar cost burden
Describe treatment and management of ASCVD
lifestyle changes Antiplatelet therapy if you have had a heart attack already beta-blocker medication statins
What are the benefits and potential problems with the UnDo IT program?
Benefits: great lifestyle choices Problems: cost, time consuming
What are the components of the UnDo IT?
Eat Better Move More Stress Less Love More
Explain the Mayo Clinic Statin Choice Decision Aid
Calculates your risk of having a heart attack in the next 10 years based on your risk factors Deciding whether or not to go on a statin, a primary prevention
Differentiate between primary, secondary and tertiary risk reduction?
Primary: prevent atherosclerosis Secondary: prevent damage from the atherosclerosis Tertiary: Prevent further damage after a cardiac event
What risk factors are associated with ASCVD that are not lifestyle activities and or diseases?
Age >45 men; Age> 50 women Family history
What diseases are associated risk factors of ASCVD?
Diabetes Hypertension Hyperlipidemia
What lifestyle activities are associate risk factors of ASCVD?
Smoking Decreased physical activity Standard American Diet
What changes and supplements can be taken to improve statin related myalgias (muscle pain)?
Supplements: Vitamin D, CoQ10 Change the Statin High potency statin at lower dose given less frequently
What are the adverse side effects of statins?
Main: Muscle Pain others: Headache, weakness, fatigue, dizziness; malaise; GI complaints; increased blood glucose
This rare but serious side effect of statins is diagnosed by measuring serum creatine kinase
Rhabdomyolysis
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