Exam 6 - Drugs for Hyperlipidemia Flashcards
LDL and non-HDL goal for a person of lower risk: 0-1 risk factors
LDL goal: <160
non-HDL goal: 190
What is the only way to raise your HDL?
exercise; has no effect on LDL but increases HDL by 4-22%
Statins: MOA
HMG-CoA Reductase inhibitors
Do not use 80 mg dose
Simvastatin
As a group, what are statins the drug of choice for?
LDL reduction
Metabolized by 3A4
Atorvastatin
Lovastatin
Simvastatin
Metabolized by 2C9
Rosuvastatin
Statin adverse effects
- Elevation in liver enzymes
- Myopathy (myalgia, myositis, rhabdomyolysis)
- cognitive dysfunction (age>50)
- elevated blood glucose/diabetes
Complaints of muscle pain or weakness w/o elevation in creatine kinase (CK), marker for muscle damage
Myalgia
Complaints of muscle aches/pains w/ mildly elevated CK levels (<10 times the ULN)
Myositis
Complaints of muscle pain w/ presence of dark urine and a CK level > 10 times the ULN
Rhabdomyolysis
Drug interactions of Statins: potentiate the risk of myopathy/rhabdomyolysis
- Amidarone
- Azole antifungal agents
- Macrolide antibiotics
- Verapamil
Cholestyramine
Bile acid sequestrant
Colesevelam (Welchol)
Bile acid sequestrant
Cholestyramine and Colesevalam/Wilchol are both indicated for
Hypercholesteremia
Indicated for diarrhea and pruritis associated w/ partial biliary obstruction.
Cholestyramine
Indicated to improve glycemic control in adults w/ Type II diabetes mellitus
Colesevelam (Welchol)
interrupts the enterohepatic circulation of bile acids which depletes cholesterol content of hepatic cells
Bile acid sequestrants MOA
Bile acid sequestrant: adverse effects
- constipation
- abdominal pain
- bloating
- dyspepsia (indigestion)
- flatulence
- INCREASES TG (TG>400 mg/dL contraindicated)
Bile acid sequestrant: drug ineractions
What do these drugs decrease the absorption of?
- warfarin
- levothyroxine
- digoxin
- thiazide diuretics
When should other medications be taken when taken bile acid sequestrants?
other medications should be taken at least 1 hour before or 4 hours after the bile sequestrant
Inhibits intestinal absorption of dietary and biliary cholesterol at the brush border of the small intestine
Ezetimibe
Ezetemibe: adverse effects
- GI: diarrhea, abdominal pain
- increase in ATL
Gemfibrozil
Fibrate
Fenofibrate
Fibrate
Fibrates: adverse effects
- abdominal pain, INCREASE IN GALLSTONES
- MYALGIA, MYOPATHY
- increase in serum creatinine
Activates peroxisome proliferator activator - alpha (PRAR-alpha) which enhances catabolism (by LIPOPROTEIN LIPASE) of triglycerides and decrease hepatic synthesis of VLDL particles and increases HDL levels
Fibrates MOA
Fibrates contraindications
- severe hepatic disease
- SEVERE RENAL DISEASE (DO NOT USE FENOFIBRATE)
- PREEXSITING GALLBLADDER DISEASE
Gemfibrozil drug interaction
- CONTRAINDICATED: INCREASES REPAGLINIDE LEVELS (HYPERGLYCEMIA)
- increases statin levels (muscle toxicity)
Fenofibrate drug interaction
has minimal impact on statin levels
Enhance lipoprotein lipase
Niacin MOA
Niacin adverse effects
- GI (nausea, exacerbation of peptic ulcers)
- flushing, pruritus
- liver dysfunction (liver enzyme abnormalities)
- glucose intolerance (hyperglycemia)
- hyperuricemia/gout
- peptic ulcer disease
Niacin contradindications
- significant hepatic dysfunction
- active peptic ulcer disease
- gout
Indicated to treat hypertriglyceridemia > 500 mg/dL
Omega-3-acid ethyl esters
Indicated for high TG (> or equal to 500 mg/dL)
Icosapent ethyl
Icosapent ethyl
may prolong bleeding time
What should you monitor when giving Icosapent ethyl?
LFT (patients w/ hepatic impairment), lipids
Moderate risk: 2+ riskfactors
10-year risk < 10%
LDL goal: < 130
non-HDL goal: <160
High risk: CHD or CHDrisk equivalents
10-year risk >20
LDL goal: <160
Moderate high risk: 2+ risk equivalents
10-year risk 10%-20%
LDL goal: <160
Use caution in patients w/ known hypersensitivity to fish and/or shellfish
Icosapent ethyl
What do omega-3 ethyl esters contain that icosapent ethyl doesn’t? And what does it cause?
- contains DHA
- causes an increase in LDL
