Dyslipidemia

Question 1

Composition

Answer 1

HDL = Good

Cholesterol and Triglycerides = Bad

Question 2

Atherosclerosis

Answer 2

Inflammation in arterial wall

Question 3

LABS

Answer 3

Know ideals, not risks.
Total cholesteral < 100
HDL >60
Trigliceriedes <150
Serum Cholesterol <200

Question 4

Managing Dyslipidemia

Answer 4

1. Lifestyle
2. HMG-CoA reductase inhibitor is a STATIN (lower LDL by 20-40% and measure at 4 weeks)
3. Bile-acid sequestrants (often combined with statins)…inc. excretion of LDL (cholesterol) in stool
4. Nicotinic Acid (often used with Bile-Acid Sequestrants)…dec.VLDL and dec. LDL levels, inc. vasodilation of capillaries.
5. Fibrates (second line therapy)…dec. triglyceride levels and inc. HDL (DO NOT lower LDLs)
6. Ezitimibe (cholesterol absorption inhibitor)…stops absorption of cholesterol in food & MUST be taken with statin.

Question 5

Why are statins great?

Answer 5

trifecta: lower LDL by 25-60%, raise HDL by 6-12%, lower TG by 14-29%.

Question 6

HMG CoA Reductase Inhibitor

Answer 6

Statin
Prototype: atorvastatin (Lipitor)
Check cholesterol after 4 weeks
-Freq. monitoring of LFTs, AST, ALT
-Baseline Liver Function test

Question 7

Atorvastatin

Answer 7

Routes: PO
Onset: 2-4 weeks
Duration of Action: Half life 14 hrs/30 hr active metabolites
Indications: Hypercholesterolemia and CV event prevention.
Mechanisms of Action:
Adverse effects: GI, diarrhea/constipation, rhabdomyolysis (breakdown of muscle fibers), liver failure (S/sx of muscle cramps/weakness/pain/myopathy/myalgia)
Contraindications: prego, lactation, liver impairment

Question 8

Bile Acid Sequestrants

Answer 8

Questran

Question 9

Questran

Answer 9

Route: PO
Onset: 1-2 days, 30 days for max effect.
Duration: 2-4 weeks
Indications: Hypercholesterolemia, pruritis assoc. with biliary obstruction. (don’t need to know)
Mechanisms: Binds to bile acids, lowers LDL
Adverse Effects: GI, constipation, bloating, belching, nausea, GI tract obstruction, hyperchloremic acidosis, *malabsorption syndrome.
ContraIndications: Complete biliary obstruction, caution in GI disorders
Prego: Category B, possible interference with vitamin absorption.

S/Sx light and urine dark, pain and vomiting.

Question 10

Niacin (Niaspan)

Answer 10

Route: PO
Onset: 30-60min.
Duration of action: 5 hr
Indications: dyslipidemia
Mechanisms: Dec. production of VLDL, incl. HDL, B-complex vitamin.
Adverse effects: facial flushing/hot flashes, GI/nausea/excess gas/diarrhea/hepatotoxicity/gout.
Contraindications: none. **Caution in diabetes and hx of liver disease. dec. insulin.
Prego: Category C

Question 11

Gemfibrozil (Lopid)

Answer 11

Route: PO
Onset: 1-2 hrs
Duration: Half life 1.5 hrs.
Indications: Hypertriglyceridemia, 2nd line therapy after statins
Mechanisms: Thought to inhibit lipolysis in adipose tissue, inc. excretion of TG in feces.
Adverse Effects: GI abdominal cramping, diarrhea, nausea, dyspepsia (indigestion), diminished libido, cholelithiasis (gall stones), anemia, rhabdomyolysis with statins.
Contraindications: CAUTION in gallbladder, liver, and kidney disease.
Prego Category C

Question 12

Cholesterol Absorption Inhibitor

Answer 12

Prototype = ezetimibe
-Blocks absorption of cholesterol in the small intestine and MUST be administered with statin b/c body responds by making more cholesterol.
-Now a 2nd or 3rd line agent.
-Adverse effect: Nasopharyngitis, myalgia, arthralgias, URI, diarrhea, **GI/Muscle
Category C.

Question 13

Combination Drugs

Answer 13

Niacin/Lovastatin
Simvastatin/Niacin
Simvastatin/Ezetimibe
Pravastatin/Aspirin
Atorvastatin/Amlodipine