Full Clinical Guidelines - Community First Health Plans.

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10.4 Drugs Affecting Lipoprotein Metabolism • Consider drug simultaneously with TLC for CHD and CHD equivalents • Consider adding drug to TLC after 3 months for other risk categories Drug Class HMG CoA reductase inhibitors (statins) Bile acid sequestrants Nicotinic acid Fibric acids Agents and Daily Doses Lovastatin (20-80 mg) Pravastatin (20-40 mg) Simvastatin (20-80 mg) Fluvstatin (20-80 mg) Atorvastatin (10-80 mg) Cerivastatin (0.4-0.8 mg) Cholestyramine (4-16 gm) Colestipol (5-20 gm) Colessevelam (2.6-3.8 gm) Immediate release (crystalline) nicotinic acid (1.5-3 gm), extended release nicotinic acid (Niaspan®)(1-2 gm), sustained release nicotinic acid (1-2 gm) Gemfibrozil (600 mg BID) Fenofibrate (200 mg) Clofibrate (1000 mg BID) Lipid/Lipoprotein Effects LDL ↓18-55% HDL ↑ 5-15% TG ↓ 7-30% LDL ↓15-30% HDL ↑ 3-5% TG No change or increase LDL ↓5-25% HDL ↑ 15-35% TG ↓20-50% LDL ↓5-20% (may be increased in patients with high TG) HDL ↑ 10-20% TG ↓20-50% Side Effects Myopathy Increased liver enzymes Gastrointestinal distress Constipation Decreased absorption of other drugs Flushing Hyperglycemia Hyperglycemia (or gout) Upper GI distress Hepatotoxicity Dyspepsia Gallstones Myopathy Contraindications Absolute: • Active or chronic liver disease Relative: • Concomitant use of certain drugs* Absolute: • dysbetalipoproteinemia • TG > 400 mg/dL Relative: • TG > 200 mg/dL Absolute: • Chronic liver disease • Severe gout Relative: • Diabetes • Hyperuricemia • Peptic ulcer disease Absolute: • Severe renal disease • Severe hepatic disease Cyclosporine, macrolide antibiotics, various anti-fungal agents, and cytochrome P-450 inhibitors (fibrates and niacin should be used with appropriate caution). Taken from NCEP Expert Panel. Executive Summary of the Third Report of the National Cholesterol Education Program(NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III ). Bethesda, Md: National Heart, Lung, and Blood Institute, National Institutes of <strong>Health</strong>; 2001. NIH publication 01-3670. 88 H EALTH PLANS www.cfhp.com
NATIONAL CHOLESTEROL EDUCATION PROGRAM (NCEP) GUIDELINES FOR LDL-C 1 ATP III CLASSIFICATION OF LDL, TOTAL, AND HDL CHOLESTEROL (mg/dL) LDL Cholesterol – Primary Target of Therapy < 100 Optimal 100 – 129 Near optimal / above optimal 130 – 159 Borderline high 160 – 189 High ≥ 190 Very high Total Cholesterol < 200 Desirable 200 – 239 Borderline high ≥ 240 High HDL Cholesterol < 40 Low ≥ 60 High Therapeutic Lifestyle Changes (TLC) if LDL is Above Goal • TLC Diet: • Saturated fat < 7% of calories, cholesterol < 200 mg/day • Consider increased viscous (soluble) fiber (10 – 25 g/day) and plant stanols / sterols • (2 g/day) as therapeutic options to enhance LDL lowering • Weight management • Increased physical activity 1. Taken from NCEP Expert Panel. Executive Summary of the Third Report of the National Cholesterol Education Program(NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III ). Bethesda, Md: National Heart, Lung, and Blood Institute, National Institutes of <strong>Health</strong>; 2001. Final Report 2004 Update 10.5 ATP III Classification of Cholesterol H EALTH PLANS www.cfhp.com 89
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Community First Health Plans Qualit
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10.5 ATP III Classification of Chol
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Such information is released only t
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Non Voting • Martin Jimenez, Dire
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The purpose of these guidelines is
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Table 1. Adult Preventive Services
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Recommended Adult Immunization Sche
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Footnotes — Recommended Adult Imm
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CFHP has adopted the National Asthm
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Patient Name ______________________
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Managing Asthma Long Term 41 FIGURE
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FIGURE 14. CLASSIFYING ASTHMA SEVER
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FIGURE 16. STEPWISE APPROACH FOR MA
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FIGURE 20. CLASSIFYING SEVERITY OF
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II. Some hyperactive-impulsive or i
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COMMUNITY FIRST HEALTH PLANS BEHAVI
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Criteria Requirements 33. Release o
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The evaluation of breast disease is
Page 37 and 38: Prevent Child Texas, a non-profit o
Page 39 and 40: AMERICAN ACADEMY OF PEDIATRICS: Fai
Page 41 and 42: possible), a careful, complete, and
Page 43 and 44: Examination/Test Oral / Dental Insp
Page 45 and 46: GLYCEMIC CONTROL BIBLIOGRAPHY • R
Page 47 and 48: Publication # 45-11647 Targets* A1
Page 49 and 50: WORKSHEET Revised 10-20-05 Advancin
Page 51 and 52: D. Optimizing analog insulin use Re
Page 53 and 54: Publication # 45-11266 Age 126 mg/d
Page 55 and 56: Hypertension Algorithm for Diabetes
Page 57 and 58: Lipid Algorithm For Type 1 and Type
Page 59 and 60: References: Revised 1-24-08 • Col
Page 61 and 62: WEIGHT LOSS ALGORITHM FOR OVERWEIGH
Page 63 and 64: Publication #45-11825 Screening 1 :
Page 65 and 66: Publication #45-12000 DIABETIC FOOT
Page 67 and 68: DIABETIC FOOT CARE/REFERRAL ALGORIT
Page 69 and 70: Publication # 45-12083 WEIGHT MANAG
Page 71 and 72: 9 H EALTH PLANS www.cfhp.com 71
Page 73 and 74: Revised 10-25-07 IV INSULIN INFUSIO
Page 75 and 76: Revised 10-25-07 Publication #: 45-
Page 77 and 78: Revised 2-21-08 Publication #: E45-
Page 79 and 80: Abbreviations AGI Alpha-Glucosidase
Page 81 and 82: Orders for Adults with DKA and Hype
Page 83 and 84: D i a b e t e s t r e a t m e n t a
Page 85 and 86: CFHP has adopted the National Insti
Page 87: No CHD; 0 to 1, or 2+ Risk Factors
Page 91 and 92: NATIONAL CHOLESTEROL EDUCATION PROG
Page 93 and 94: Identification, Evaluation, and Tre
Page 95 and 96: 11.3 Treatment of Hypertension H EA
Page 97 and 98: ALGORITHM FOR TREATMENT OF MAJOR DE
Page 99 and 100: CFHP has established guidelines for
Page 101 and 102: A. Documentation ______ B. Continui
Page 103 and 104: CFHP PCP MEDICAL RECORD REVIEW TOOL
Page 105 and 106: 13.3 Specialist Medical Record Docu
Page 107 and 108: 13.4 Specialist Medical Record Revi
Page 109 and 110: Risk Factors for Osteoporosis Fract
Page 111 and 112: It is well documented that obesity
Page 113 and 114: CLASSIFICATION OF OVERWEIGHT AND OB
Page 115 and 116: 16.1.1 Preventive Pediatric Health
Page 117 and 118: H EALTH PLANS www.cfhp.com 117
Page 119 and 120: TEXAS MEDICAID PROVIDER PROCEDURES
Page 125 and 126: CHILDREN’S SERVICES HANDBOOK P h
Page 127 and 128: CHILDREN’S SERVICES HANDBOOK P R
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H EALTH PLANS www.cfhp.com 139
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FIGURE 2: Recommended immunization
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Comprehensive antepartum care is vi
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The following variables should be e
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CRITERIA 19. Unresolved Problems Fr
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CFHP OB/GYN SPECIALTY MEDICAL RECOR
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CFHP OB/GYN SPECIALTY MEDICAL RECOR
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According to the National Institute
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. aminotransferase (AST) and alanin
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PREVENTION RECOMMENDATIONS 1. The E
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2 to 20 years: Boys Body mass index
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AsthmaMatters is an initiative deve
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According to the Centers for Diseas
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