Drugs for Lipid Disorders Flashcards
1
Q
what are the three main types of lipids?
A
- triglycerides
- phospholipids
- steroids
2
Q
triglycerides
A
- account for 90% of total lipids in the body
- important source of energy
3
Q
phospholipids
A
- essential for the formation of plasma membranes
4
Q
steroids
A
- building block for bile acids, vitamin D, cortisol, estrogen and testosterone
- cholesterol
5
Q
what are the three lipoproteins?
A
- high density lipoprotein (HDL)
- low density lipoprotein (LDL)
- very low-density lipoprotein (VLDL)
6
Q
high-density lipoprotein
A
- transports cholesterol from tissues back to the liver
7
Q
low-density lipoprotein
A
- transports cholesterol from the liver to tissues
8
Q
very low-density lipoprotein
A
- primary carrier of triglycerides
9
Q
dyslipidemia
A
- increases risk for atherosclerosis and coronary artery disease
- occurs predominantly in men compared to non-menopausal women
- after menopause, risk becomes higher because the protective effects of estrogen are gone
- associated with generic alterations in fat metabolism and with excessive dietary intake of fats
- moderate alcohol consumption increases “ good: cholesterol (HDL) levels
10
Q
what are some non pharmacological management of lipid disorders?
A
- eliminate smoking
- moderate alcohol consumption
- maintain weight
- regular exercise and stress
- reduce dietary saturated fat, trans-fat, and cholesterol
- increase consumption of plant sterols/stanols and soluble fibre (nuts, olive oil, corn, rye, oats, rice, wheat)
11
Q
statins (HMG-CoA reductase inhibitors mechanism of action
A
- blocks cholesterol synthesis
- increase the number of LDL receptors in the liver and stimulates removal of LDL From the blood
- can be combined with other cholesterol lowering medications and antihypertensive medications
- contraindicated in women who are pregnant
12
Q
what are some adverse effects of statins?
A
- headache, GI upset, heartburn
13
Q
what are some drug-drug & drug-food interactions with statins?
A
- avoid alcohol and grapefruit juice
- risk of rhabdomyolysis increased with drugs that inhibit CYP 450 enzymes
- potentiate the effects of warfarin and increase estrogen levels in women using combination oral contraceptives
- proton pump inhibitors and H2RA antagonists increase bioavailability of some statin drugs
14
Q
selective cholesterol absorption inhibitors
A
- inhibits intestinal cholesterol absorption; blocks absorption up to 50%
- often co administered with statin therapy for clients that fail to reach their LDL targets with statin therapy alone
- combination tablets available
15
Q
what are some adverse effects/contraindications selective cholesterol absorption inhibitors?
A
- GI distress
- cannot be co-administered with bile acid resins; as they reduce efficacy of selective cholesterol absorption inhibitors
16
Q
bile acid resins
A
- bind to bile acids and increase the excretion of cholesterol
- reduction in cholesterol levels induces the formation of additional LDL receptors in the liver, increasing the rate at which LDL is removed from the blood
- about 20% drop in LDL cholesterol levels
17
Q
contraindications of bile acid resins
A
- interferes with absorption of other drugs; thiazide diuretics, warfarin, thyroid hormones, corticosteroids
- take other meds 1 hour before or 4 hours after
- may induce vitamin deficiency; vitamin A, D, E and vitamin K deficiency leads to increase bleeding
18
Q
PCSK9 inhibitors
A
- inhibits PCSK9 proteins that target the liver LDL receptors for degradation, more LDL receptors are on the liver and LDL gets brought into the liver
- lower LDL levels by 50-70%
- inject subcutaneously every 2 weeks, or once a month
19
Q
Niacin
A
- no longer recommended for the routine management of hypercholesterolemia
- may still have a role for those clients at a very high risk for cardiovascular events with contraindications for satins or bile-acid sequestrants
- toxicity profile for most patients