Dyslipidemia Flashcards
Hyperlipemia
Excess tag
Hyperlipidemia
Hyperlipoproteinemia
Cholesterol
Hydrophilic
Cholesteryl ester
Hydrophilic
Chylomicrons carrying dietary TAGs to the liver
Can’t be decreased or increased with any intervention
Hyper TAG
DM
Myxedema
Alcohol
Estrogen
Uremia
Corticos
GSD
Hypopituutarism and acromegaly
Hyperchol.
Hypothyroidism
Early nephrosis
Resolving lipemia
Anorexia nervosa
Cholestasis
Hypopituitarism
Corticos
Hypolipidemic drugs
Statins
Niacin
Fabric Acid Derivatives (Fibrates)
Bike acid - binding resins
Inhibitors of Intestinal Sterol Absorption
Statins - HMG-CoA reductase inhibitors
(3 - hydroxy, 3-methyl glutaryl CoA recuctase)
Lovostatin
Simvastatin
Pravastatin
Atrovastatin
Fluvaastatin
Ruaovastatin
Pitavastatin
Statins
Decreases chol.
And LDL receptors
Decreasing LDL in plasma
Increasing HDL
Decreases TAG
Pleutropic effect of statins
Improved endothelial function
Reduced inflammation reduced platelet aggregation
Neivascularisation jnductuon in ischaemic tissues
Antithrombotic
Enhanced fibrinolysis and immune suppression
Statins taken orally excreted jn bile, urine and feces
Taken at bed time because long half life (1-3hrs except:
Atrova (14hrs), rosuva (12hrs) and pitava statin (19hrs)
Statins used in
All types of hyperlipidemia
-alone or with others like resins, niacin or ezetimibe
Use immediately after ACE
Adverse effects
High ALT and AST (×3)
Myopathy and rhabdomolysis
Break down of muscles
In blood stream
Pain
Dark cola red
Potentiate oral anticoagulants and antidiabetic ad they displace them from plasma proteins
Statins
Not used in pregnancy and lactation
No chol. for hormones and milk
Niacin - nicotinic acid
Decreases bothe VLDL and LDL and increases HDL so they can be combined with statins for synergism
Mechanism of Niacin (absorbed orally)
Adipose tissue
Liver
Plasma
In adipose
Niacin binds to it’s receptors decreasing mobilisation of FA so no TAG and no VLDL
In the liver (no synthesis and esteeification of fat)
Inhibits DAG acetyl transferase so no TAG synthesis and no VLDL
In plasma
Increases LipoProtein Lipase activity that clears VLDL and chylomicron
Niacin used for
Mixed hyperlipidemia
Taken with oher drugs
Niacin causes puritis and flushing
Because Prostaglandin that can be treated with aspirin
Nausea, pain and gastric distress
Because niacin induces histamine release
Nicotinic acid also dependent on OASS
So causes hyperurecemia
Also elevates Hepatic enzymes (×2) without liver toxicity as well
Niacin
Take Niacin and potentiate
Anti hypertensive (this can be accompanied by atherosclerosis so it treats that)
Fibric acid (fibrates) - Decrease VLDL and some LDL
Gemfibrozil and fenofibrate
Fibrates, agonist of peroxisome proliferator activated receptor alpha
Decreases TAG
Increases LPL which hydrolyzes TAG and Decreases VLDL
Directly increases lipolysis decreasing TAG and VLDL
Fibrates (also increases HDL by inhibiting it’s catabolism
Take fibrates with
Food
Also used in mixed hyperlipidemia
Fibrates
Most common adverse dibrates effecf
GIT upset
Arrhythmias in
Fibrates
You have gall stones in excess chol. with fjbrates
As doesn’t get directed towards TAG synthesis
Also causes myopathies and myositis
When fibrates taken with statins
Potentiate oral anticoagulants and antidiabetics
Firates
Firates can cause
Hepatotoxicity
No fibrates in
Pregnancy and lactation
Gall bladder release
Hepatic and renal dysfunction
Bike acid binding resins
Colestipol
Cholestyramine
Colesevelam
Resins used in
Isolated increase in LDL
No absorption of resins orally
So goes to be excreted and affects natural enetrogepatic circulation of bile
Uregulates LDLreceptoprs and scavangas
Resins
Resins for
Treattment of peeps with hyperchol.
Adverse resins
Constipation
Decreases absorption fat soluble vitamins
Interactions with resins
Digoxin
Thiazide
Wayfaring
Aspirin
Phenylbutazone
Pamrava and flucastatin
Tetracycline
Thyroxine
Iron salts
Folic acid
Ascorbic acid
Take drugs 1 - 2 hrs before
Resin (unless niacin)
Coleselvam
No digoxin
Wayfaring
Reductase inhibitors
Ezetimibe
Inhibitors of intestinal steroid absorption
Inhibits chol. Absorption, both dietary adln
Ezetimibe
Less than 10yrs no statins
Unless Pravastatin
No lipophilic statin with CYP inhibitors
Increases myopathy and rhabdomyolysis
