Chapter 50: Lipid Lowering Drugs Flashcards
What are the therapeutic lifestyle changes a patient can make to improve his lipid profile? Change in particular increases HDL?
Diet, exercise, weight control, and smoking cessation. Exercise particularly running and swimming can raise HDL.
Can a patient stop exercising and watching his diet when he starts a statin therapy?
No, he should continue with the exercise/diet regimen as the combination of drugs and TLC have a maximum effect. Exercise increases HDL, Statins LOWER LDL.
What are the HMG-CoA reductase inhibitors? What are some examples? What is the mechanism of action for these drugs? What are the serious adverse effects of these drugs? What are some adverse drug interactions? What lab tests would we run to look for these rare serious effects?
These are the STATIN drugs. They work by a complex process that involes increasing the number of LDL receptors on hepatocytes. Production with hepatocytes make more HMG-CoA reductase. Cholesterol is returned to pretreatment levels. More LDL receptors are synthesized which enables hepatocytes to remove LDL from blood.
Adverse reactions: Hepatotoxicity, myopathy, rhabdomyolysis, new onset diabetes, and cataracts.
Interactions: Comb statins with other lipid lowering drugs raises risk for SERIOUS adverse effects: liver and kidney toxicity, and rhabdomyolysis. Statins comb. with CYP34 drugs: raise STATIN levels (lovastatin, and simvastatin) significantly. Other drugs that may raise statin levels: macrolide antibiotics, azole antifungals, HIV protease inhibitors, Amiodarone, and cyclosporine.
Baseline liver function tests and creatine kinase are necessary. Thyroid baseline testing may also be necessary if muscle pain develops. ***Pts who have renal disease must exercise GREAT caution using statin drugs.
Which type of cholesterol do statin drugs lower
LDL and triglycerides
Asian patients should not take what statins?
Rosuvastatin, as this drug produces DOUBLE blood levels of the drug.
When will the effects of the statins first be seen?
Effects of statins will be seen within 2 weeks. Maximal effects within 4-6 weeks
When in the day should statins be taken?
Statins should be taken in the evening as cholesterol synthesis increases during the night.
What is nicotinic acid? What effect does it have on the lipid profile? What are its adverse effects? How can aspirin diminish one of these effects?
Nicotinic acid: Niacin. It reduces LDL, triglyceride levels, and increases HDL.
Adverse effects: skin flushing, itching, GI effects, hepatotoxicity, hyperglycemia, gouty arthritis, and raise blood levels of uric acid.
**Aspirin can be given prior to this medication to prevent itching and flushing.
What is gemfibrizol? What is this used to treat? What are the adverse effects? Does it have any adverse interactions with other lipid lowering drugs?
Drug that is useful for treating high levels of plasma triglycerides (VLDLs).
Adverse effects: rashes, GI disturbances, gallstones, myopathy, liver injury.
Drug interaction: **Gemfibrozil displaces Warfarin from plasma albumin, which increases anticoag. effects.
**also increases risk of statin induced myopathy when used with another statin.
What is colesevelam? How does it affect LDL, blood glucose? Adverse effects?
Bile acid sequestrant that lowers LDL and is used in conjunction with statin therapy. Colesevelam is used to control hyperglycemia in pts with type II DM.
Adverse reaction: constipation, bloating, indigestion, and nausea. Other DM drugs should be taken 1 hr before colesevelam. or four hours after.
Patients who take colesevelam should be cautioned about which side effect when they first start to take this drug?
Hypoglycemia.
