Dyslipidemia Flashcards
What are adverse effects of “statins”
headache dyspepsia myositis elevation of hepatic transaminase levels non serious and reversible cognitive side effects increases in blood glucose
What are monitoring parameters for “statins”
Baseline ALT»_space;> ALT as clinically indicated
Creatine kinase test as needed for myositis
What are adverse effects of Fibric Acids
Nausea Diarrhea Vomiting Dyspepsia Flatulence Abdominal distress Fatigue Headache Rash
What are monitoring parameters for Fibric Acids
- Baseline ALT
- alk phos. ALT
- alk phos 6-12 wks x 2, q12mo therafter
- fasting lipid profile 6-12 wks after dose change, q12mo thereafter
- creatine kinase test as needed for myositis
What are adverse effects of Bile Acid Resins
Indigestion bloating nausea constipation abdominal pain flatulence
What are monitoring parameters for Bile Acid Resins
Fasting lipid profile 6-12 wks after stable dose then q12mo thereafter
What are adverse effects of Nicotinic Acid (Niacin)
flushing itching tingling headache naseau gas heartburn fatigue rash elevation serum glucose and uric acid
What are monitoring parameters for Nicotinic Acid
- Baseline ALT
- alk phos. ALT
- alk phos 6-12 wks x 2, q12mo therafter
- after stable dose acheived X2 month fasting lipid profile, uric acid and glucose, fasting lipid profile q12mo thereafter
- creatine kinase test as needed for myositis
How do statins effect lipid levels?
They lower LDL synthesis and increase LDL breakdown by:
Inhibiting HMG CoA reductase, an enzyme that is important in the conversion of HMG CoA to Mevalonate, a vital step in cholesterol synthesis within the liver.
Therefore, statins help REDUCE the amount of endogenous cholesterol produced.
They also stimulate hepatic LDL receptors to enhance LDL clearance from plasma.
How do Bile Acid Resins effect lipid levels?
Increase in LDL breakdown, and a decrease in cholesterol absorption by:
Binding to bile acids within the GI tract and prevent their reabsorption, excreting the bile acids in the feces. A drop in bile acids signals the liver to generate bile acids from existing cholesterol.
How do Fibrates effect lipid levels?
Increases VLDL clearance and decreases LDL absorption by:
Activating nuclear receptors that are involved in cellular function, ultimately causing a decrease in the production of TG-rich lipoproteins VLDL and IDL and an increase in HDL.
How does Nicotinic Acid (Niacin) work on lipid levels?
Lowers VLDL and LDL synthesis and TG levels by:
Inhibits FA release from adipose tissue and inhibits FA and TG production in the liver.
How does Ezetimibe effect lipid levels?
Inhibits cholesterol absorption by:
Interacting with a transporter located in the brush boarder membrane of the enterocytes. This limits the cholesterol content within chylomicrons and thus reduces liver cholesterol stores, upregulates LDL receptors and lowers serum cholesterol levels.
If a patient is considered high risk by NCEP guidelines what is their LDL goal and when do you consider meds for them?
LDL goal = /= to 100,
if their LDL is < 100 but they have other CV risk factors (like high TG or low HDL), you can consider combining a fibrate or nicotinic acid with an LDL-lowering drug
What is the LDL goal of a patient with moderately high risk (greater than 2 and 10 year risk of 10-20%), and when do you consider drug therapy
LDL goal= 130
100-129= at baseline or with TLC, LDL lowering drug is get LDL <100 is an option
