Cardiology #4 (Hyperlipidemia) Flashcards
What is the difference between hypertriglyceridemia and hypercholesterolemia?
Hypertriglyceridemia: elevated triglycerides or VLDL, or both
Hypercholesterolemia: elevated LDL
What are the three MC etiologies of hypercholesterolemia?
- Pregnancy
- Hypothyroidism
- Kidney failure
What are common etiologies of hypertriglyceridemia?
- DM
- ETOH
- obesity
- steroids
- estrogen
What are some clinical manifestations of hyperlipidemia?
- Most patients are asymptomatic; however, hypertriglyceridemia may cause pancreatitis
- May develop Xanthomas - fat buildup under the skin (Achilles tendon) or Xanthelasma (lipid plaques on eyelids)
Explain what the American College of Cardiology/American Heart Association recommends for screening for hyperlipidemia
Higher risk = > 1 risk factor (smoking, hypertension, family history) or 1 severe risk factor. Initiate screening at age 20-25 for males; 30-35 for females.
Lower risk: initiate screening at 35 for males, 45 for females.
What are the 5 Lipid Guidelines for initiating a statin therapy?
1) Type 1 or Type 2 DM between ages of 40-75
2) Without cardiovascular risk ages 40-75 and > 7.5% risk for having a heart attack or stroke within 10 years
3) People > 21 with LDL levels > 190 mg/dL
4) Any form of clinical atherosclerotic cardiovascular disease
5) < 19 years old with familial hypercholesterolemia
What is the best medication type to lower elevated LDL levels?
Statin
Bile Acid Sequestrants
What is the best medication type to lower elevated triglycerides?
Fibrates
Niacin
What is the best medication type to increase HDL?
Niacin, Fibrates
If the patient has Type II Diabetes, what medication should be given for cholesterol?
Statins, Fibrates
What is the mechanism of action of statins?
Inhibits the rate-limiting step in hepatic cholesterol synthesis via inhibition of the enzyme HMG-CoA reductase.
What are some adverse effects of statins?
- Muscle damage (myositis, myalgias, rhabdomyolysis)
- Increased LFT, hepatitis (MC)
- GI symptoms
- Diabetes Mellitus
What are some contraindications of statins?
- Pregnancy
- Persistently elevated LFTs
- Breastfeeding
Nicotinic acid (Niacin) has an MOA of
Increases HDL (delays HDL clearance). Decreases hepatic production of LDL and VLDL. Decreases triglycerides
True or False: Niacin is the best drug to increase HDL levels?
True
Adverse effects of Niacin
- Increased prostaglandins (flushing, warm sensation, pruritus, headache)
- Dry skin, hyperglycemia, GI symptoms (reduced if taken with meals)
What can be given prophylactically to reduce the flushing of Niacin?
NSAIDs or Aspirin
What are two fibrates?
- Fenofibrate
- Gemfibrozil
What is the MOA of fibrates?
-Inhibit triglyceride synthesis, increase the activity of lipoprotein lipase
Best drug to decrease triglycerides?
Fibrates
Adverse effects of fibrates
- Increased gallstones
- GI symptoms
- Headache
- Dizziness
- Myalgias, myositis
What is the ONLY fibrate FDA approved to be used in combination with a statin?
Fenofibric acid
Name three bile acid sequestrants
Cholestyramine
Colestipol
Colesevelam
MOA of bile acid sequestrants
- Binds bile acid in the intestine, blocking reabsorption of bile acids
- Liver has to make new bile acids, so this reduces LDL receptors
- Decreases LDL levels
Name some facts about bile acid sequestrants
- Used in combination with statins to reduce LDL levels
- Safe in pregnancy
- Cholestyramine is used to treat pruritus associated with biliary obstruction
Adverse effects of bile acid sequestrants
- GI side effects
- Increased triglyceride levels
- Osteoporosis with long-term use
Bile acid sequestrants may impair absorption of what other medications?
- Antibiotics
- Digoxin
- Warfarin
- Fat-soluble vitamins
Therefore, take these medications 1 hour before or 4 hours after bile acid sequestrants
Ezetimibe inhibits intestinal cholesterol absorption. It is often used with a statin to reduce LDL levels. What are some adverse effects?
- Headache
- Diarrhea
- Increased LFTs (especially with statin use)
