Antihyperlipidemics

Question 1

how long does it take antihyperlipidemics to work

Answer 1

several weeks!

Question 2

high cholesterol risk factors: age

Answer 2

male >= 45

female >= 65

Question 3

high cholesterol risk factors

Answer 3

age
family history
current cigarette smoking
htn
low HDL
DM
premature menopause without estrogen therapy

Question 4

good lipoprotein

Answer 4

HDL!

Question 5

bad lipoprotein (x3)

Answer 5

VERY LDL
Intermediate DL
LDL

Question 6

hyperlipidemia presentation

Answer 6

atheroma (plaque in blood vessels)
tendonous xanthoma (tendon bumpies)
xanthoma (eye bumpies)
corneal arcus (white ring of fatty deposits around cornea)

Question 7

non-fasting lipid panel checks…

Answer 7

HDL, total cholesterol

Question 8

fasting lipid panel checks…

Answer 8

HDL, total cholesterol

triglycerides, LDL

Question 9

hyperlipidemia treatment

Answer 9

lifestyle modifications first! (diet, exercise, smoking)

Question 10

Questran (cholestyramine)

Answer 10

bile-acid sequestrant

• reduces LDL
• binds with bile salts in intestines
• bound bile acids and cholesterol are eliminated in feces

Question 11

Questran (cholestyramine): adverse effects

Answer 11

GI DISTRESS:

constipation, bloating, belching, nausea, esophageal obstruction, esophageal irritation (safety!!!!)

Question 12

Lopid (gemfibrozil)

Answer 12

fibric acid derivative
- reduces VLDL, triglycerides

LITTLE EFFECT ON LDL

• inhibits:
• • breakdown of stored fats
• • uptake of free fatty acids
• • hepatic production of triglycerides

Question 13

Lopid (gemfibrozil): adverse effects

Answer 13

• GI related symptoms
• cholelithiasis (gall stones)
• increases coumadin effects

Question 14

Niacin (Vitamin B3)

Answer 14

Nicotinic Acid

- reduces VLDL and LDL, triglycerides

Question 15

Niacin (Vitamin B3): adverse effects

Answer 15

LOOKS LIKE ALLERGIES BUT ISN’T

• skin flushing, itching (stimulation of prostaglandins)
• GI intolerance
• myalgias

LIMITS USE: premed with aspirin or other prostaglandin inhibitor

Question 16

Zetia (ezetimibe)

Answer 16

Cholesterol absorption inhibitor

• decrease cholesterol absorption
• not intended for monotherapy

Question 17

Zetia (ezetimibe) adverse effects

Answer 17

GI distress

Question 18

• statins

Answer 18

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)

Question 19

Lipitor (atorvastatin)

Answer 19

HMG-CoA Reductase Inhibitor

Question 20

Lipitor (atorvastatin): adverse effects

Answer 20

• GI distress

** Rhabdomyolysis ** (total body massive muscle irritation/breakdown)

monitor CK (huge levels!)

DON’T EAT GRAPEFRUIT AND POMEGRANATE

Question 21

Lipitor (atorvastatin): discontinue with

Answer 21

• unexpected muscle pain
• weakness/fatigue
• fever

Question 22

significance: grapefruit and pomegranates

Answer 22

inhibits Cytochrome P450 which leads to…

- increase in serum drug level therefore increasing risk of rhabdomyolysis