Chapter 53: Cholesterol and Triglyceride Levels Flashcards
cholesterol is manufactured by cells primarily in the
liver
cholesterol comes from
dietary sources
cholesterol is required for
synthesis of certain hormones and bile salts
e.g. estrogen, progesterone, testosterone
lipoproteins function
transports lipids in the blood
Very-low-density lipoproteins (VLDLs)
- trglycerides
Low-density lipoproteins (LDLs)
- cholesterol is the primary core lipid
- greatest contributor to coronary artery disease
High density lipoproteins (HDLs)
- cholesterol primary core lipid
- carry cholesterol from peripheral tissues back to the liver thereby promoting cholesterol removal
what intitiates the development of atherosclerosis
LDL
Framingham Risk score
- risk level
- treatment recommendation
- therapeutic target
who is most susceptible to coronary artery disease
- older adults
- women
- diabetes
- unhealthy eating problems
- people exposed to air polution
- physically inactive
- stress
Lifestyle interventions
- smoking cessation
- mediterranean diet
- weight loss, diabetes treatment
- stress, alcohol
- exercise
drug classes
- HMG-CoA reductase inhibitors (statins)
- Bile acid sequestrants (resins)
- nicotinic acid [niacin]
- fibrates
- ezetimibe [Ezetrol]
- Monoclonal antibody inhibitors (evolocumab and alirocumab)
- Icosapent ethyl (Vascepa)
Metabolic abnormalities include
- high blood glucose
- high triglycerides
- waist circumference (large)
- hypertension
- prothrombotic state
- proinflammatory state
metabolic syndrome treatment goals
- reduce risk for atherosclerotic disease
- reduce risk for type 2 diabetes
- increase physical activity
HMG-CoA Reductase Inhibitors (Statins) is
most effective drug for lowering LDL
HMG-CoA Reductase Inhibitors (Statins) is used to
- reduce LDL cholesterol
- elevate HDL cholesterol
- reduce triglyceride levels
- promote plaque stability
- reduce risk for cardiovascular events
- increased bone formation (reduced osteoporosis, fractures)
HMG-CoA Reductase Inhibitors therapeutic uses
- hypercholesterolemia
- primarily and secondary prevention of cardivascular events
- Post MI therapy
- cardiovascular risk reduction in diabetes
does HMG-CoA Reductase Inhibitors have first pass effect
yes
which ethnicity is reccomonded lower doeses of HMG-Co-A reductase inhibitors
east asians
HMG-CoA Reductase Inhibitors adverse effects
- headache, rash, Gi disturbance, dyspepsia, constipation, abdominal pain
- myopathy/rhabdomyolysis, hepatotxicity, new onset diabetes
HMG- CoA Reducatase Inhibitors drug and food interactions
- drugs that inhibit CYP3A4
- grapefruit juice
HMG-CoA Reducatase Inhibitors dosing
once daily in the evenings
Examples of HMG-CoA Reductase Inhibitors (Statins)
Atorvastatin [Lipitor]
- Fluvastatin [Lescor]
- Pravastatin [Mevacor]
- rosuvastatin [Crestor]
- Simvastatin [Zocor]
Nicotinic Acid [Niacin] efffects on lipids
- reduces LDL and TG levels
- raises HDL levels better than other drugs
Nicotinic Acid [Niacin] adverse effects
- flushing and itching skin
- gastrointestinal upset
- hepatotxicity
- hyperglycemia
- gouty arthritis
Nicotinic Acid [Niacin} contradicitions
severe peptic ulcer disease, chronic liver disease
Bile acid Sequestrants are used
as adjuncts to statims to reduce LDL; can minimally increase HDL
Bile Acid Sequestrants examples
Cholestyramine [Questran]
- colestipol [colestid]
Bile Acid Sequestrants adverse effects
- consipation
- bloating
- indigestion
- decreased absorption of fat soluable vitamins
Bile Acid Sequestrants drug interaction
- Warfarin (antibiotics, Diuretics)
** space 2 hours apart from other meds
Ezetimibe [Ezetrol] therapeutic use
- reduces total cholesterol, LDL cholesterol, and apolipoprotein B
- approved for monotherapy and combined use with stains
Ezetimibe [Ezetrol] should be used cautiously in
liver dysfunction
Ezetimibe [ezetrol] adverse effects
- myopathy
- rhabdomyolysis
- hepatitis
- thrombocytopenia
- pancreatitis
what is the most effective available for lowering TG levels
Fibric Acid Derivative [Fibrates]
Fibric Acid Derivative [Fibrates] effect on HDL
can raise cholesterol
Fibric Acid Derivative [Fibrates] available drugs
Gemfibrozil [lopid]
- fenofibrate
- bezafibrate
Fibric Acid Derivative [Fibrates] can increase risk for bleeding in patients taking
warfarin
Fibric Acid Derivative [Fibrates] can increase the risk for rhabdomyolysis is patient taking
statins
Gemfibrozil effects on plasma lipoproteins
- decreases plasma TG content
- lowers VLDL levels
- can raise HDL cholesterol
Gemfibrozil drug interactions
- displaces warfarin from plasma albumin
Gemfibrozil adverse effects
rashes, gastrointestinal disturbances (abdominal pain, GI upset), gallstones, myopathy, liver injury (hepatotoxic)
Gemfibrozil contradictions
Hepatic or renal disease
Monoclonal Antibodies examples
Alirocumab [Praluent], Evolocumab [Repatha], Inclisiran [Leqvio]
monoclonal Antibodies are used for
patients with high LDL
Icosapent Ethyl [Vascepa] indication
decreasing risk of ASCVD events in clients with:
- diabetes and additional risk factors
- known CVD on a stain with high TG’s
Icosapent Ethyl [Vascepa] adverse effects
prolonged bleeding time
Icosapent Ethyl [Vascepa] dose
2g BID
