- oral anticoagulants - drugs metabolized by CYP3A4 enzyme

antilipemic drugs Flashcards by maya chan

what are the 2 forms of lipids in blood

triglycerides and cholesterol

How well did you know this?

Not at all

Perfectly

what are lipoproteins

combination of triglyceride or cholesterol with apolipoprotein

How well did you know this?

Not at all

Perfectly

VLDL are produced by

liver

How well did you know this?

Not at all

Perfectly

HDL are responsible for

recycling of good cholesterol

How well did you know this?

Not at all

Perfectly

risk of coronary heart disease is 3x greater with cholesterol levels of

5.2mmol/l

How well did you know this?

Not at all

Perfectly

dyslipidemia treatments

meds, nondrug means (exercise)

How well did you know this?

Not at all

Perfectly

what is the Framingham risk score

measures the ratio of HDL to LDL

How well did you know this?

Not at all

Perfectly

first-line therapy for hypercholesterolemia

statins (HMG- CoA)

How well did you know this?

Not at all

Perfectly

statins action

-reduces plasma concentrations of LDL by 30 -40%
- decrease in plasma triglycerides by 10-30%
- increase in HDL by 2-15%

How well did you know this?

Not at all

Perfectly

statin examples

atorvastatin (Lipitor) and rosuvastatin calcium (Crestor)

How well did you know this?

Not at all

Perfectly

statin MOA

-lowers blood cholesterol levels by decrease rate of production.
-less cholesterol produced= increase in number of LDL receptors to recycle LDL from circulation.

How well did you know this?

Not at all

Perfectly

statin adverse effects

mild Gi disturbances
rash
headache
myopathy- most common. muscle pain. can lead to rhabdomyolysis

How well did you know this?

Not at all

Perfectly

when do you not use statins

pts with elevated liver enzymes or liver disease

How well did you know this?

Not at all

Perfectly

rhabdomyolysis

breakdown of muscle protein and can result in myoglobinuria.
usually reversible early with discontinuation of statin.

How well did you know this?

Not at all

Perfectly

myoglobinuria

urinary elimination of the muscle protein myoglobin.
can lead to acute kidney injury or death.

How well did you know this?

Not at all

Perfectly

symptoms to report immediately when taking statins

muscle soreness or changes in urine color (tea colored)

How well did you know this?

Not at all

Perfectly

statin interactions

oral anticoagulants
drugs metabolized by CYP3A4 enzyme

How well did you know this?

Not at all

Perfectly

what are the drugs metabolized by CYP3A4

erythromycin, azole antifungals, quinidine sulphate, verapamil hcl, diltiazem hcl, HIV and hep C protease inhibitors, amiodarone hcl, cyclosporine, clarithromycin, amlodipine

How well did you know this?

Not at all

Perfectly

grapefruit juice and statins

can increase risk of myopathy

How well did you know this?

Not at all

Perfectly

atorvastatin calcium and rosuvastatin MOA

lowers LDL and triglyceride levels and raises good cholesterol and HDL
dosed once daily with evening meal

How well did you know this?

Not at all

Perfectly

bile acid sequestrant example

cholestyramine resin (Olestyr)

How well did you know this?

Not at all

Perfectly

bile acid sequestrant MOA

prevent bile acid reabsorption from small intestine

How well did you know this?

Not at all

Perfectly

what do bile acids do

absorption of cholesterol

How well did you know this?

Not at all

Perfectly

the more bile acids excreted…..

the more the liver converts cholesterol to bile acids, reducing cholesterol in the liver and circulation.

How well did you know this?

Not at all

Perfectly

bile acid sequestrates indications

-type 2 hyperlipoproteinemia - relief of pruritus associated with partial biliary obstruction - may be used along statins

bile acid sequestrants adverse effects

-constipation - heartburn, nausea, belching, bloating. take fibre and increase fluid to relieve symptoms.

overdose of bile acid can cause

bowel obstruction

when should drugs be taken with bile acid sequestrants

1 hr before or 4-6 hours after

high doses of bile acid sequestrant decreases the absorption of

fat soluble vitamins (A,E,D,K)

contraindications of cholestyramine resin

known hypersensitivity, phenylketonuria or complete biliary obstruction, pregnancy

cholestyramine resin can also treat

loose bowel movements

niacin is also known as

vitamin b3

lipid-lowering properties require much ____ doses when used as a vitamin

higher

niacin is given as an adjunct to

statins

niacin MOA

inhibits lipolysis in adipose tissue, decreases esterification of triglycerides in the liver and increases the activity of lipoprotein lipase.

resultant effect

decreased triglyceride level, decreased LDL and increase HDL

niacin also stimulates the fibrinolytic system to...

break down fibrin clots

niacin indications

- lowers triglycerides and LDLs -increases HDLs therapeutic effects after 1-4 days -max effects on 1-3 weeks

niacin contraindications

peptic ulcer idsease, hypertenstion, active hemorrhagic process, gout

niacin adverse effects

flushing, pruritus, GI distress

how to reduce flushing with niacin

take aspirin 30min prior to taking niacin

fibric acid derivatives MOA

-activate lipoprotein lipase which breaks down cholesterol -suppresses release of free fatty acid form adipose -inhibit the synthesis of triglycerides -increases cholesterol into bile.

how much does gemfibrozil increase HDL levels by

25%

fibric acid derivatives contraindications

drug allergy, severe liver or kidney disease, cirrhosis, gallbladder disease, pregnancy

fibric acid derivatives adverse effects

abdominal discomfort, diarrhea, nausea, blurred vision, headache, risk of gallstones, prolonged prothrombin time, increased enzyme levels.

gemfibrozil interactions

enhances action of oral anticoagulants (increased bleeding time with warfarin before clotting).

fibric acids are all given with a

statin

fibric acid derivatives and statins increase the risk of

myositis, myalgia and rhabdomyolysis

lab test results on gemfibrozil

-decreased hemoglobin, hematocrit and WBC count - increased aspartate, aminotransferase, activated clotting time, lactate dehydrogenase level and bilirubin level

example of cholesterol absorption inhibitor

ezetimibe (ezetrol)

ezetimbe MOA

-inhibits absorption of cholesterol and related sterols from the small intestine - results in lower LDL, apolipoprotein and triglycerides -increases HDL -can be used as monotherapy or combined with a statin

garlic is used as an

antispasmodic, antiseptic, antibacterial, antiviral, antihypertensive, anti platelet, lipid reducer

garlic adverse effects

dermatitis, vomiting, diarrhea, anorexia, flatulence, anti platelet activity

garlic interactions

warfarin, diazepam, protease inhibitors. can enahance bleeding with NSAIDS

flax uses

atherosclerosis, hypercholesterolemia, hypertriglyceridemia, GI distress, menopause symptoms, bladder inflammation

flax may cause

diarrhea, allergic reaction

flax interactions

antihyperglycemic drugs, anticoagulant drugs

omega 3 fatty acids are used to

reduce cholesterol

omega 3 fatty acids may cause

rash, belching, allergic reactions

omega 3 fatty acids interactions

anticoagulant drugs

omega 3 fatty acids are contraindicated in

pregnancy

contraindications of antilipemic drugs

biliary obstruction, liver dysfunction

patients on long-term therapy may need supplemental _____

fat soluble vitamins (A,D,E,K)

when should you take other medications with antilipemics

1 hr before or 4-6 hours after meals

to minimize effects of niacin

start on a low initial dose and increase gradually. take meds with meals

adverse effects to report while taking antilipemics

GI upset, constipation, abnormal bleeding, yellow skin