Antihyperlipidemics Flashcards
how long does it take antihyperlipidemics to work
several weeks!
high cholesterol risk factors: age
male >= 45
female >= 65
high cholesterol risk factors
age family history current cigarette smoking htn low HDL DM premature menopause without estrogen therapy
good lipoprotein
HDL!
bad lipoprotein (x3)
VERY LDL
Intermediate DL
LDL
hyperlipidemia presentation
atheroma (plaque in blood vessels)
tendonous xanthoma (tendon bumpies)
xanthoma (eye bumpies)
corneal arcus (white ring of fatty deposits around cornea)
non-fasting lipid panel checks…
HDL, total cholesterol
fasting lipid panel checks…
HDL, total cholesterol
triglycerides, LDL
hyperlipidemia treatment
lifestyle modifications first! (diet, exercise, smoking)
Questran (cholestyramine)
bile-acid sequestrant
- reduces LDL
- binds with bile salts in intestines
- bound bile acids and cholesterol are eliminated in feces
Questran (cholestyramine): adverse effects
GI DISTRESS:
constipation, bloating, belching, nausea, esophageal obstruction, esophageal irritation (safety!!!!)
Lopid (gemfibrozil)
fibric acid derivative
- reduces VLDL, triglycerides
LITTLE EFFECT ON LDL
- inhibits:
- breakdown of stored fats
- uptake of free fatty acids
- hepatic production of triglycerides
Lopid (gemfibrozil): adverse effects
- GI related symptoms
- cholelithiasis (gall stones)
- increases coumadin effects
Niacin (Vitamin B3)
Nicotinic Acid
- reduces VLDL and LDL, triglycerides
Niacin (Vitamin B3): adverse effects
LOOKS LIKE ALLERGIES BUT ISN’T
- skin flushing, itching (stimulation of prostaglandins)
- GI intolerance
- myalgias
LIMITS USE: premed with aspirin or other prostaglandin inhibitor
Zetia (ezetimibe)
Cholesterol absorption inhibitor
- decrease cholesterol absorption
- not intended for monotherapy
Zetia (ezetimibe) adverse effects
GI distress
- statins
MOST EFFECTIVE FOR ANTIHYPERLIPIDEMIA
HMG-CoA Reductase Inhibitors
- inhibits 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase
- reduces cholesterol synthesis and LDL
- nocturnal dosing preferred (not eating at night, liver starts producing cholesterol and breakdown of fats)
Lipitor (atorvastatin)
HMG-CoA Reductase Inhibitor
Lipitor (atorvastatin): adverse effects
- GI distress
** Rhabdomyolysis ** (total body massive muscle irritation/breakdown)
monitor CK (huge levels!)
DON’T EAT GRAPEFRUIT AND POMEGRANATE
Lipitor (atorvastatin): discontinue with
- unexpected muscle pain
- weakness/fatigue
- fever
significance: grapefruit and pomegranates
inhibits Cytochrome P450 which leads to…
- increase in serum drug level therefore increasing risk of rhabdomyolysis
