Drugs For Hyperlipidemia Flashcards
Primary dietary factors that contribute to elevated plasma lipoproteins
Cholesterol Saturated fats
Alcohol raises _______ and ________ levels and should be avoided in pxs with high __________
TG and VLDL TG
Drugs most effective at lowering LDL
Statins Resins Ezetimbe Niacin
Drugs most effective at lowering TG and VLDL and raising HDL
Niacin Fibrates
Increases number of high affinity LDL receptors which clear LDL and VLDL temnants from the blood Inhibits hepatic cholesterol synthesis Drug, Class
Simvastatin, HMG-CoA Reductase Inhibitor (Atorvastatin, Rosuvastatin, Fluvastatin, Pravastatin, Lovastatin, Pitavastatin)
Reversible competitive inhibitor of HMG-Coa reductase Increased hepatic cholesterol uptake Increased HDL, Decreased LDL Drugs for High LDL SE: Hepatotoxicity, myopathy, risk for rhabdomyolysis when used with fibrates Drug, Class?
Simvastatin, HMG-CoA Reductase Inhibitor (Atorvastatin, Rosuvastatin, Fluvastatin, Pravastatin, Lovastatin, Pitavastatin)
Why are statins given at night?
Cholesterol synthesis predominantly occurs at night
Binds bile acids and prevent their intestinal absorption, diverting hepatic cholesterol to bile acid synthesis Increase in HDL, decreases LDL (modest) Class?
Bile Acid Binding Resins
Binds bile acids, increasing cholesterol use for their replacement Modest lowering of LDL Drug for hypercholesterolemia (high LDL) pruritus in cholestasis SE: constipation, bloating, steatorrhea Increases TGs and VLDL in patients with high TGs Avoid in pxs with diverticulitis Side effect of constipation can be treated with fiber supplements/psyllium Drug, Class
Cholestyramine, Bile Acid Binding Resins (Colesevelam, Colestipol)
Inhibits NPC1L1 transporter (in the jejunal enterocyte) that mediates gastrointestinal uptake of cholesterol and phytosterols Drug for high LDL SE: hepatotoxicity (increases with statin use) Synergistic LDL lowering effect with statins Drug, Class
Ezetimibe, Cholesterol absorption blocker
Cholesterol analog Takes the place of dietary and biliary cholesterol Drug for high LDL SE: GI upset, bloating Drug, Class
Sitosterol, Sterol absorption blocker
Most effective agent for increasing HDL levels Reduces LDL cholesterol, triglycerides and VLDL SE: flushing, hyperuricemia, impaired glucose tolerance, arrhythmia Avoid in pxs with PUD Potentiates effects of anti-hypertensives
Niacin, antihyperlipidemic drug
Pre-treatment with _________ causes reduction of flushing as a side effect of Niacin
Aspirin
Drugs that cause flushing
VANC Vancomycin Adenosine Niacin CCB
Increases synthesis of lipoprotein lipase, enhancing clearance of triglycerides Stimulates fatty acid oxidation, limiting supply of TG and decreases VLDL synthesis Increases HDL levels Little or no effect on LDL Class?
Fibrates
Activate PPAR-alpha DOC for hypertriglyceridemia (low HDL, high LDL) SE: increased risk for Cholesterol gallstones Increased risk of myopathy and rhabdomyolysis when used with statins Avoid in pxs with hepatic and renal dysfunction
Gemfibrozil, Fibrates (Fenofibrate, Bezafibrate)
All patients with hyperlipidemia are treated first with _______________
Dietary modification
Synergistic drug combinations for Familial Hypercholesterolemia
Niacin + Statin Statin + Ezetimibe
Synergistic drug combinations for Familial Combined Hypercholesterolemia
Niacin + Resin Statin + Fibrate
Antihyperlipidemic combination at increased risk of cholelithiasis
Fibrate + Resin
Antihyperlipidemic combination causing impaired statin absorption
Statin + Resin
Antihyperlipidemic combination at increased risk of myopathy and rhabdomyolysis
Statin + Fibrate
DOC for high LDL or VLDL, or both
Statins
DOC for high TG
Fibrates
DOC for low LDL
Niacin
Primary hyperchylomicronemia Primary Tx? Secondary Tx?
Low-fat diet Niacin + Fibrate
Familial Hypercholesterolemia Primary Tx? Secondary Tx?
Statin Niacin Ezetimibe
Familial dysbetalipoproteinemia Primary Tx? Secondary Tx?
Fibrate + Niacin Statin
Familial hypertriglyceridemia Primary Tx?
Fibrates + Niacin
Chylomicrons or LDL Premature atherosclerosis: increased ___________ Acute pancreatitis: increased ___________
LDL Chylomicrons
