18 - Drugs used in dyslipidemia Flashcards
Chylomicrons or LDL
Premature atherosclerosis: increased ___________
Acute pancreatitis: increased ___________
LDL
Chylomicrons
Primary dietary factors that contribute to elevated plasma lipoproteins
Cholesterol and Saturated fats
Alcohol raises _______ and ________ levels and should be avoided in pxs with high __________
TG and VLDL
TG
Drugs most effective at lowering LDL
Statins
Resins
Ezetimbe
Niacin
Drugs most effective at lowering TG and VLDL and raising HDL
Niacin
Fibrates
Increases number of high affinity LDL receptors which clear LDL and VLDL remnants from the blood
Inhibits hepatic cholesterol synthesis
What is the Drug, Class
Simvastatin, HMG-CoA Reductase Inhibitor (Atorvastatin, Rosuvastatin, Fluvastatin, Pravastatin, Lovastatin, Pitavastatin)
Reversible competitive inhibitor of HMG-Coa reductase
Increased hepatic cholesterol uptake
Increased HDL, Decreased LDL
Drugs for High LDL
SE: Hepatotoxicity, myopathy, risk for rhabdomyolysis when used with fibrates
Drug, Class?
Simvastatin, HMG-CoA Reductase Inhibitor (Atorvastatin, Rosuvastatin, Fluvastatin, Pravastatin, Lovastatin, Pitavastatin)
Why are statins given at night?
Cholesterol synthesis predominantly occurs at night
Binds bile acids and prevent their intestinal absorption, diverting hepatic cholesterol to bile acid synthesis
Increase in HDL, decreases LDL (modest)
Class?
Bile Acid Binding Resins
Binds bile acids, increasing cholesterol use for their replacement
Modest lowering of LDL
Drug for hypercholesterolemia (high LDL), pruritus in cholestasis
SE: constipation, bloating, steatorrhea
Increases TGs and VLDL in patients with high TGs
Avoid in pxs with diverticulitis
Side effect of constipation can be treated with fiber supplements/psyllium
What is the Drug, Class
Cholestyramine, Bile Acid Binding Resins (Colesevelam, Colestipol)
Inhibits NPC1L1 transporter (in the jejunal enterocyte) that mediates gastrointestinal uptake of cholesterol and phytosterols
Drug for high LDL
SE: hepatotoxicity (increases with statin use)
Synergistic LDL lowering effect with statins
Drug, Class
Ezetimibe, Cholesterol absorption blocker
Cholesterol analog
Takes the place of dietary and biliary cholesterol
Drug for high LDL
SE: GI upset, bloating
Drug, Class
Sitosterol, Sterol absorption blocker
Most effective agent for increasing HDL levels
Reduces LDL cholesterol, triglycerides and VLDL
SE: flushing, hyperuricemia, impaired glucose tolerance, arrhythmia
Avoid in pxs with PUD
Potentiates effects of anti-hypertensives
Niacin, antihyperlipidemic drug
Pre-treatment with _________ causes reduction of flushing as a side effect of Niacin
Aspirin
Drugs that cause flushing
VANC
Vancomycin
Adenosine
Niacin
CCB
Increases synthesis of lipoprotein lipase, enhancing clearance of triglycerides
Stimulates fatty acid oxidation, limiting supply of TG and decreases VLDL synthesis
Increases HDL levels
Little or no effect on LDL
Class?
Fibrates
Activate PPAR-alpha
DOC for hypertriglyceridemia (low HDL, high LDL)
SE: increased risk for Cholesterol gallstones
Increased risk of myopathy and rhabdomyolysis when used with statins
Avoid in pxs with hepatic and renal dysfunction
Gemfibrozil, Fibrates (Fenofibrate, Bezafibrate)
All patients with hyperlipidemia are treated first with _______________
Dietary modification
Synergistic drug combinations for Familial Hypercholesterolemia
Niacin + Statin
Statin + Ezetimibe
Synergistic drug combinations for Familial Combined Hypercholesterolemia
Niacin + Resin
Statin + Fibrate
Antihyperlipidemic combination at increased risk of cholelithiasis
Fibrate + Resin
Antihyperlipidemic combination causing impaired statin absorption
Statin + Resin
Antihyperlipidemic combination at increased risk of myopathy and rhabdomyolysis
Statin + Fibrate
DOC for high LDL or VLDL, or both
Statins
DOC for high TG
Fibrates
DOC for low LDL
Niacin
Primary hyperchylomicronemia
Primary Tx?
Secondary Tx?
Low-fat diet
Niacin + Fibrate
Familial Hypercholesterolemia
Primary Tx?
Secondary Tx?
Statin
Niacin + Ezetimibe
Familial dysbetalipoproteinemia
Primary Tx?
Secondary Tx?
Fibrate + Niacin
Statin
Familial hypertriglyceridemia
Primary Tx?
Fibrates + Niacin
