Anti Lipid drugs

Question 1

how is LDL calculated

Answer 1

LDL = TC-HDL-TG/5 ( if TG are >400 this doesnt work)

Question 2

high risk and very high risk ( factors and LDL and non-HDL-c ( VLDL + LDL)

Answer 2

CHD or CHD risk equivalent LDL < 130

very high CHD+ multiple risk factors LDL < 100

Question 3

Drugs used for hypercholesterolemia

Answer 3

HMG-CoA reductase inhibitors 
bile acid sequestrants 
nicotinic acid 
fibrates 
ezetimibe 
omega-3 fatty acids

Question 4

HMG-CoA reductase inhibitors

Answer 4

simvastatin and other statins inhibit cholesterol synthesis;
increase LDL receptor and decrease plasma LDL
-myalgia, myopathy, hepatotoxicity, cytochrom p450 interactions, rhabdomyolysis
- combine with niacin with high cholesterol and TG

Question 5

bile acid sequestrants

Answer 5

cholestyramine complexes cholesterol and bile salts in GI track, increase LDL receptor, decrease plasma LDL, bloating, prevents absorption of lipid soluble vitamins and drugs

Question 6

nicotinic acid

Answer 6

niacin decreases secretion of VLDL, decrease LDL and may increase HDL; also good for decreasing TG, flushing can occur and some hepatotoxicity

Question 7

fibrates

Answer 7

gemfibrozil activates peroxisome proliferators activated receptor -alpha (PPAR-alpha) which increases synthesis of lipoprotein lipase: decreases TG and some decrease in LDL

causes: nausea , rashes, muscle pain, potentiates the effect of statins

used for high TG

Question 8

ezetimibe

Answer 8

prevents absorption of cholesterol and decreases LDL

causes: GI discomfort

used to lower cholesterol

Question 9

omega-3 fatty acids

Answer 9

decreases TG with an increase in LDL

Question 10

Steps to achieve optimal lipid level

Answer 10

1. access cardiac heart disease risk and LDL cholesterol goals, statins are usually the first line of therapy
2. add ezetimibe or a bile acid sequestrant if the LDL goal is not achieved or the patient is not tolerant of statin
3. consider adding niacin, omega-3 fatty acid, or a fibrate for low HDL or elevated triglyceride in higher risk patients