Chapter 44: Lipid Lowering Medications Flashcards
Cholesterol
Critical to normal cell function of every cell in the body -Need for cell membrane synthesis, bile synthesis, hormone development
Contributes to the development of atherosclerosis (cholesterol containing plaque form with in the arteries and block them. Results in angina, MI, Stroke,)
Increased dietary saturated fats leads to high cholesterol
LDL add to atherosclerosis. HDLs protect from atherosclerosis
Estrogen allows for more HDL for women
Serum lipid profile
(fasting preferred)
Cholesterol- <200 mg/dL
Triglycerides <150 mg/dL
Lipoproteins
LDL < 130 mg/dL
When a person gets older with comorbidities, want LDL to be <100 mg/Dl
HDL >55 for women; > 45 for men
2 sources of cholesterol
Diet and liver
Non-pharmacologic methods for cholesterol reduction
Eat heart healthy foods
-Choose healthier fats
-Eliminate trans fats
-Eat foods rich in Omega 3 fatty acids
-Increases soluble fiber
-Add Whey protein
-Exercise as possible -increases HDL.
-Stop smoking.
Types of Lipid Lowe agents
HMG-CoA Reductase Inhibitors
Statins***
Most common
Bile-acid Sequestrants
Folic acid derivatives (Fibrates)
Niacin
Cholesterol Absorption Inhibitor
Ex of stains
Fluvastatin (Lescol)
Lovastatin (Mevacor)
Pravastatin (Pravachol)
Simvastatin (Zocor)
Rosuvastatin (Crestor)*
Atorvastatin (Lipitor)*
Most effective drugs for lowering LDLs and total cholesterol
May increase HDL and lower trig
Most widely prescribed drug
Statin MOA
Inhibits HMG-CoA reductase in liver -> inhibit cholesterol synthesis
Statin use
Primarily to lower LDLs and total Cholesterol, prevention of CV events, Post MI therapy, DM
Post MI -on statin for rest of life
DM –on statins bc CV disease is primary cause of death in DM pt
Inhibits cholesterol synthesis
Statin SE
Myopathy’s and rhabdomyolysis (can damage muscles), Hepatotoxicity, New onset DM,
Manifests in muscle pain. Dx –daw blood and see CPK levels (too much muscle breakdown dt muscle injury). Another problem is muscle resale myoglobin which travels around in blood and lodge in kidney and cause renal impairment. D/c medications
Statins safety and monitoring
Obtain lipid panel. Obtain baseline LFTs and CK level. Monitor lipid panel monthly early in treatment. Need LFT before starting to ensure their liver can handle it. If they have increased LFT do not start them on this medication. If they have normal LFT to start, then goes up with tx –d/c. *concern with alcoholic pt on statin. Ask to avoid alc.
Higher risk of toxicity with poly-pharmacy.
Contraindicated in pregnancy and liver illnesses .
Avoid grapefruit juice.
R/o new onset DM (1 in 500 pt). Likely pt was pre DM before starting statin.
Category X for preg
Often have pt take stain at night bc liver makes cholesterol at night
CPK, total CK
Enzyme found in the heart, brain, skeletal muscle and other tissues
Increased amounts are released into the blood with muscle damage
Measures the amount of CK in blood
Normally a small amount in blood primarily from skeletal muscles
Any condition causing muscle damage can cause an increase
Strenuous exercise
Rhabdomyolysis (muscle destruction)
Stroke
MI
Trauma
Statins
decreases LDL by 25% with lower doses and 55% with higher doses.
increases HDL’s, decreases triglycerides by 20-50%.
Highly protein bound so usually ordered for once daily.
Positive effect seen in approx 2 weeks and up to 4 weeks for therapeutic results. Start dosage low then increase.
Contraindicated in liver disorder. Pregnancy category X.
Statins differ in different ways
Ability to reduce cholesterol
Ability to interact with other drugs
Frequency with which they cause rhabdomyolysis
Bile acid sequestrants ex
cholestyramine (Questran) -Newest, most tolerated
colestipol (Colestid)
colesevelam (WelChol)
BAS MOA
Binds intestinal bile acids preventing them to be absorbed in the small intestine. Do not get absorbed, get excreted faster.
BAS use
To reduce LDLS. Used in conjunction with statins
