chapter 10- dyslipidemia Flashcards
what is dyslipidemia
high cholesterol
what component are triglycerides
a sugar
what is within a lipid-protein
cholesterol, phospholipid, triglyceride
what synthesizes lipids
the liver and intestine
what do lipids control
energy sources
what are the three most common diagnoses in the US
HTN, diabetes, high cholesterol
what is metabolic syndrome
Conditions that occur together that increase the risk of heart disease
-doubles it!
what are the conditions of metabolic syndrome
-Central or abdominal obesity
-increased triglycerides
-high LDL –lousy lipid
-low HDL – good lipid
-increased BP
-Increased glucose
what is dyslipidemia/hyperlipidemia a risk factor for
- CAD
-atherosclerosis
-pathophysiologic effects
-MI and ischemia
-CVA
-PAD
what is primary hyperlipidemia
genetic, mutation of the LDL receptor. 1/500 people have this.
what is secondary hyperlipidemia
caused by dietary habits and/or other diseases
symptoms of high cholesterol
-loose stool
-depression
-stomach distention
- poor appetite
-weight gain
-heart pain
-fatigue
-cholesterol pockets — normally seen by eyes
-aching pain in joints
what should total cholesterol be?
borderline?
high?
-less than 200 mg
-200 to 239 mg
-more than 240 mg
what should LDL cholesterol be?
Alright?
borderline?
high?
very high?
-less than 100 mg
-100-129 mg
-120-159
-160-189
-190 or above
what should HDL cholesterol be?
alright?
low?
-60 mg or higher
- 40-59 mg
- less than 40 mg
when should cholesterol panels be drawn
in the morning, after a fast
what is the Mediterranean diet
-olive oil
-legumes
-fruit and veggies
-fish
-dairy
medications that affect cholesterol
-atenolol
-amiodarone
-prednisone
-diuretics
what can be a solution for post-menopausal women
hormone replacement
what food category can you increase in your diet
fiber
how do HMG-CoA reductase inhibitors work
“statins”
decrease cholesterol production, decrease total cholesterol and LDL, VLDL, without affecting HDL– may actually increase
common statins
ATORVASTATIN
-pravastatin
-lorostatin
-rosuvastatin
-simvastatin
side effects of statins
MYALGIA –muscle dysfunction, pain, weakness, in the legs, will keep on med unless it can not be tolerated.
-nausea
-constipation/diarrhea
what meds do statins interact with
mg+ antacids. “azole” antifungals, some antibiotics, cholestyramine
when to give and what to avoid with statins
give in the evening that’s when synthesized
-no grapefruit or pomegranate
-red rice yeast
-vitamin B3
PREGNANCY — normally not given if possible
rhabdomyolysis or changes to liver enzymes!
how do bile acid sequestrants work
what is the main one?
binds to bile acid in the intestine causing excretion, can not be recirculated in the liver, and makes the acid from cholesterol, lowering LDL.
cholestyramine
pharmacokinetics of cholestyramine
not absorbed orally, unchanged in stool. will take effect within a week and reach peak within a month
Side effects of cholestyramine
GI fullness, flatulence (gas), constipation/diarrhea
what to know about the administration of cholestyramine
decreases absorption of other drugs: glipizide (DM), folic acid, propranolol, thiazide diuretics, thyroid hormone, warfarin
decreases: A, D, E, K
Fiber will increase the effect
GIVE 1 hour before or 4-6 HOURS AFTER other beds
ideally early morning or late night
how do fibrates work?
common fibrates?
increase oxidation of fatty acids in the liver and muscle, decrease production of triglycerides, VLDL and increase HDL
fenofibrate and gemfibrozil
common side effects and who cannot have them?
Gi discomfort, diarrhea, GALLSTONES
NOT FOR PEOPLE WITH GALLBLADDER ISSUES
medication interactions with fenofibrate and gemfibrozil and when to take them
can enhance warfarin, increase kidney side effects with statins, decrease the effect of bile acid meds
Gemfibrozil should be taken on an empty stomach, 30 minutes before eating
how do cholesterol absorption inhibitors meds work?
most common med?
inhibit the absorption of cholesterol in the intestine, leading to decreased levels in the liver, increasing clearance from the blood
EZETUNIBE
side effects of ezetimibe
HA, diarrhea, nausea
what is it normally taken with, and when should it not be taken
can be taken by itself or with a statin
should not be taken during pregnancy
how do PCSK9 inhibitors work, and when are they used
inactivates the protein in the liver that regulates the lifespan of cholesterol. can cause a 60-70% decrease in LDL.
used on people with genetic hypercholesterol on max statin dose
example of PCSK9 med, how it is administered, and side effects
alirocumab
sub Q every 2-4 weeks, doses vary
itching, nasopharyngitis and muscle pain
how does niacin B3 work, side effects, and when can it not be used
boosts levels of HDL and lower triglycerides and LDL
S: facial flushing, stomach upset, diarrhea, RAISED BLOOD SUGAR
cant be used with liver issues, stomach ulcers, changes to glucose, muscle damage, low BP, heart rhythm changes
main complaint of using Omega 3 fatty acids and what types are there
fishy aftertaste
-acid ethyl esters and carboxylic acids
examples of combination therapy
Advicor: extended release of niacin and lovastatin
Simcor: simvastatin and niacin
Niacin dose can change within both
