Screening (Cholesterol, HTN, Diabetes & Osteoporosis)

How often should lipid testing be performed in adults over 20 years old?

Once every 5 years (fasting, not accounting for chylomicrons).

How often should lipid levels be checked in hyperlipidemia patients?

Every 6-12 weeks until LDL goal, then annually.

What are the Total Cholesterol (TC) classifications?

Desirable: <200 mg/dL; Borderline High: 200-239 mg/dL; High: ≥240 mg/dL.

What are the LDL-C classifications for ASCVD patients?

Desirable: <70 mg/dL.

What are the LDL-C classifications for the general population?

Desirable: <100 mg/dL; Above desirable: 100-129 mg/dL; Borderline High: 130-159 mg/dL; High: 160-189 mg/dL; Very High: ≥190 mg/dL.

What are the Non-HDL-C classifications for ASCVD patients?

Desirable: <100 mg/dL.

What are the Non-HDL-C classifications for the general population?

Desirable: <130 mg/dL; Above desirable: 130-159 mg/dL; Borderline High: 160-189 mg/dL; High: 190-219 mg/dL; Very High: ≥220 mg/dL.

What are HDL-C values considered low?

Men: <40 mg/dL; Women: <50 mg/dL.

What are the triglyceride (TG) classifications?

Normal: <150 mg/dL; Borderline High: 150-199 mg/dL; High: 200-499 mg/dL; Very High: ≥500 mg/dL.

What is the Friedewald equation?

LDL = TC - (HDL + TG/5).

How is Non-HDL cholesterol calculated?

Non-HDL = Total Cholesterol - HDL.

What are the 4 statin benefit groups?

1. Clinical ASCVD (MI, stroke, angina, revascularization, PAD).

2. 2. LDL-C ≥190 mg/dL.

3. 3. Age 40-75 with diabetes and LDL 70-189 mg/dL.

4. 4. Age 40-75 without ASCVD or diabetes with LDL 70-189 mg/dL and 10-year ASCVD risk ≥7.5%.

What is the Cholestech LDX Analyzer used for?

Measures lipid profile, glucose, TC + HDL, liver enzymes; requires CLIA Waiver (CMS-116).

What are the steps to collect a blood sample for cholesterol testing?

Wear gloves, swab finger with alcohol, lance finger at 90°, wipe first drop, collect 35 microliters of blood, apply bandaid.

What patient history questions should you ask before cholesterol testing?

History of ASCVD (MI, angina, stent, bypass, stroke, TIA), diabetes, kidney disease, family history of high cholesterol, diet, exercise, medications, side effects.

What are the goal values for cholesterol and glucose?

TC: <200 mg/dL;

TG: <150 mg/dL;

HDL: >40 men, >50 women;

LDL: <100 mg/dL (general), <70 mg/dL (ASCVD);

TC/HDL ratio: <4.5; Non-HDL: <130 mg/dL (general), <100 mg/dL (ASCVD);

Glucose: 70-100 mg/dL.

What is blood pressure?

Force exerted by circulating blood on vessel walls, expressed as systolic/diastolic mmHg.

What is systolic blood pressure?

Top number, peak pressure during cardiac contraction, Phase 1 Korotkoff sounds.

What is diastolic blood pressure?

Bottom number, lowest pressure during cardiac relaxation, Phase 5 Korotkoff sounds.

What are the BP classifications?

Normal: <120/<80; Elevated: 120-129/<80; Stage 1 HTN: 130-139/80-89; Stage 2 HTN: ≥140/≥90; Hypertensive crisis: >180/>120.

What are the BP goals for patients?

General: <130/80 mmHg; HTN + Diabetes/CKD: <130/80 mmHg; HTN + CKD + Proteinuria: <125/75 mmHg.

What are causes of primary vs secondary hypertension?

Primary: 90% of cases, multifactorial, unknown cause. Secondary: <10%, due to CKD, renovascular disease, endocrine disorders, drugs.

What diseases can cause secondary hypertension?

CKD, renovascular disease, Cushing’s, hyperaldosteronism, thyroid disorders, pheochromocytoma, sleep apnea.

What drugs can cause hypertension?

Caffeine, corticosteroids, estrogens, NSAIDs, pseudoephedrine, phenylephrine, cyclosporine, tacrolimus, erythropoietin, antidepressants, street drugs.

What are the major risk factors for hypertension?

Tobacco, obesity, inactivity, stress, age (men >55, women >65), diet (high sodium/low potassium), family history, alcohol, CKD/DM/hyperlipidemia, African American ethnicity.

What are the consequences of uncontrolled hypertension?

Brain: stroke/TIA. Eyes: hemorrhage, edema, vision loss. Heart: HF, angina, MI, LV hypertrophy. Kidneys: microalbuminuria, renal failure. Peripheral vessels: PAD.

What patient prep is required for accurate BP measurement?

No caffeine, smoking, adrenergic drugs 30 min prior; empty bladder/bowel; quiet room; no tight clothing; patient relaxed and silent.

What posture is required for BP measurement?

Seated 5 min, back supported, arm at heart level, feet flat, legs uncrossed, no talking.

What cuff size and placement should be used for BP measurement?

Cuff encircles arm fully, positioned at heart level, locate brachial artery.

How do you estimate systolic BP before auscultation?

Palpate radial pulse, inflate cuff until pulse disappears, note that pressure.

What Korotkoff sounds correspond to systolic and diastolic BP?

Phase I = systolic (appearance of sound), Phase V = diastolic (disappearance of sound).

What actions should be taken for normal BP (<120/80)?

Encourage healthy lifestyle, congratulate patient.

What actions should be taken for elevated BP (120-129/<80)?

No drugs, recommend lifestyle modifications, recheck in 1 year.

What actions should be taken for Stage 1 or 2 hypertension?

Inform patient they may have hypertension, recommend physician visit within 1-2 months, possible medications.

What actions should be taken for hypertensive crisis (>180/120)?

Inform patient of emergency risk, refer immediately to ER.

What lifestyle modifications can reduce BP and by how much?

Weight loss (1 mmHg/kg), DASH diet (11 mmHg), sodium reduction (5-6 mmHg), physical activity (4-8 mmHg), moderate alcohol (4 mmHg).

What is diabetes?

Chronic hyperglycemia due to defects in insulin secretion, action, or both.

What is hypoglycemia?

Low blood sugar (<70 mg/dL), often due to insulin or medications.

What is hyperglycemia?

High blood sugar, leads to long-term organ damage (eyes, kidneys, nerves, heart, brain, vessels).

What is Type 1 diabetes?

Autoimmune destruction of beta cells, no insulin production, usually diagnosed <24 years, treated with insulin.

What is Type 2 diabetes?

Insulin resistance, obesity-related (80%), family history common, often treated with oral meds first.

What is gestational diabetes?

Glucose intolerance during pregnancy due to insulin resistance from hormones, affects ~4% of pregnancies.

What are risk factors for diabetes?

Aging, obesity, sedentary lifestyle, family history, ethnicity (African American, Native American, Pacific Islander, Hispanic, Asian).

What are the diagnostic cutoffs for fasting plasma glucose (FPG)?

Normal: <100 mg/dL; Pre-diabetes: 100-125 mg/dL; Diabetes: ≥126 mg/dL.

What are the diagnostic cutoffs for oral glucose tolerance test (OGTT)?

Normal: <140 mg/dL; Pre-diabetes: 140-199 mg/dL; Diabetes: ≥200 mg/dL.

What are the diagnostic cutoffs for A1C?

Normal: <5.7%; Increased risk: 5.7-6.4%; Diabetes: ≥6.5%.

What are the glycemic goals for patients with diabetes?

FPG: 80-130 mg/dL; PPG: <180 mg/dL; A1C: <7%.

What are 3 classic symptoms of hyperglycemia?

Polyuria (excess urination), polydipsia (excess thirst), polyphagia (excess hunger).

What are complications of long-term uncontrolled diabetes?

Retinopathy, nephropathy, neuropathy, cardiovascular disease, peripheral vascular disease.

What are the steps for fingerstick blood glucose testing?

Wash hands, insert strip in meter, swab site, lance side of finger, collect sample, apply to strip, wait for result.

What are examples of diabetes products used for management?

Glucometers, lancets, A1C kits, glucose tablets/gels, nutrition bars, ketone strips, insulin, BD autoshield, sugar-free cough products.

What is osteoporosis?

Low bone mass, bone tissue deterioration, fragility, increased fracture risk.

What types of bone are affected by osteoporosis?

Cortical bone (80%, protective, long bones); Trabecular bone (spongy, vertebrae, end of long bones, fracture-prone).

What are the stages of bone remodeling?

Resorption (osteoclasts break bone), Formation (osteoblasts rebuild), Mineralization (minerals added).

When does bone mass peak?

Between 25-35 years old.

What are the two stages of bone loss?

Stage 1 (men & women >35, 0.5-1% per year); Stage 2 (women after menopause, 3-5% per year for 5-10 years).

What are modifiable risk factors for osteoporosis?

Low calcium, low weight, inactivity, smoking, alcohol, glucocorticoids, fall risk environment.

What are nonmodifiable risk factors for osteoporosis?

Caucasian/Asian, female, postmenopausal, age >65, family history, small body frame.

What screening tests are used for osteoporosis?

DEXA scan (BMD), vertebral imaging, fracture history, lab tests (Vitamin D, bone markers).

What are the T-score classifications?

Normal: >-1.0; Osteopenia: -1.0 to -2.5; Osteoporosis: <-2.5.

What OTC treatments are used for osteoporosis prevention?

Calcium (carbonate with food, citrate without food), Vitamin D (D2 & D3, <2000 IU/day), exercise, alcohol & caffeine limits.

What are pharmacologic options for osteoporosis treatment?

Bisphosphonates, calcitonin, hormone replacement therapy, raloxifene, teriparatide, denosumab.

What is the pharmacist’s role in osteoporosis management?

Evaluate risk, recommend treatment, counsel on calcium/vitamin D/exercise, support adherence.

What is the purpose of the Pharmacists’ Patient Care Process (PPCP)?

Provides a consistent, patient-centered, collaborative framework for pharmacist care across settings.

What are the 5 steps of the PPCP?

Collect, Assess, Plan, Implement, Follow-up (Monitor & Evaluate).

What is the goal of the Collect step in PPCP?

Gather subjective and objective patient information to understand history and status.

What is the goal of the Assess step in PPCP?

Analyze collected information to identify problems and optimize care.

What is the goal of the Plan step in PPCP?

Develop individualized, evidence-based, cost-effective care plan with team collaboration.

What is the goal of the Implement step in PPCP?

Carry out the care plan with patient and healthcare team involvement.

What is the goal of the Follow-up step in PPCP?

Monitor and evaluate effectiveness, modify plan if needed.

What are the core actions of PPCP?

Collaborating, communicating, documenting.