Hyperlipidemia Flashcards
Total number of cholesterol in blood
240mg/dl
Total number of TAG in blood
150mg/dl
Types of HL
1- primary ( familial): genetically determined
2- secondary
Types of primary and describe them
Type1= +chylomicron ( familial hyperchylomicronemia)
Type2a =+ldl (familial hypercholestrolemia)
Type2b =+ldl & vldl ( familial compined hyperlipidimia)
Type4 =+vldl ( familial hyper triglyceridimia)
Type5 =+ vldl & chylomicron ( familial mixed hyperlipidimia )
Secondary HL
Hyper cholesterolimia : hypothyrodism, nephrotic syndrome and drugs
Hyper triglyceridimia : alcohol 🍺, dm , gout and chronic renal failure
Ldl pathway
1- utilized by the tissues well
2- return again to liver ( ldl receptor )
3- deposited subintimal causing atherosclerosis
Hdl function
Collect unestrified cholesterol and estrificated and then return it to liver eg ldl
حدوتة ال metabolism
حدوتة مصرية
Lines of lipid lowering drugs
1- intestinal cholesterol absorption inhibitors
Bile acid seqestrant ( binding resin) : cholestyramine and colestipol
2- HMG CoA reductase inhibitors
Statins
3- activator of lipoprotein lipase
fibracic acid derivatives ( fibrates)
4- lipolysis inhibitors
Niasin ( vitamin b3)
Mechanism of cholestyramine
Forming complex with bile acids => - enterohepatic absorbtion of it
- cholesterol
Therapeutic uses of cholestyramine
1- hyper cholesterolimia ( type 2a)
Very effective as it reduces (10% -20%) of cholestrol in blood
2- diarrhea due to bile acid malabsorptions
3- pruritis of obstructive jaundice
Adverse effects of cholestyramine
1- GIT upset ( most common) : vomitting and nausea and steatorrhea
2 reduce fat soluble vitamins
3- reduces absorption of anion drugs like digitalis and warfarin
Mechanism of ezetimibe
Selective inhibitor of intestinal cholesterol and even if there is no dietary cholesterol it inhibits the reabsorbtion of cholesterol in bile excretion
Therapeutic uses of ezetimibe
Hyper cholesterolimia : very effective as it reduces (25%) of cholesterol blood
Advers effect of ezetimibe
Reversible hepatic dysfunction: tests must be done regularly
Mechanism of statins
HMG CoA reductase enzyme competitive inhibitor => - cholesterol &+ ldl return to liver
Therapeutic uses of statins
Hyper cholesterolimia
Adverse effects of statins
H: hepatic dysfunction: it should be stoped if liver enzymes are >3 folds the upper normal
M: myopathy, myositis, rhabdomyolysis in skeletal and cardiac muscle leading to cpk increase
G: Git upset ( most common) vomiting and nausea
CoA : cataract especially in middle aged persons
Reductase : renal dysfunction ( especially with lovastatin
Best time taking statins
In night as cholesterol biosynthesis occurs at night , especially with semvastatin which has shorter half life
Contraindications with statins
Pregnancy as it’s teratogenic
Mechanism of fibrates
Activate (PPAR -a) gene leading to +++ lipoprotein lipase enzyme => — TAGs
Therapeutic uses of fibrates
Hyper triglyceridimia
Fenofibrate has antidieurtic action in people with diabetes insipdus
Adverse effects of fibrates
Git upset ( most common)
Myopathy so its contraindicated with statins
Hepatic dysfunction
Skin rash and dermatologic reactions
Mechanism of niasin ( vitamin b3)
Inhibit lipolysis of adipose tissue
Inhibit fatty acid synthesis by liver => – TAGs
Therapeutic uses of niasin
Must be combined with other drugs to make effective effect treating hyperlipidima
Adverse effects of niasin
Skin flushing and burning sensation due to ++ histamine and PGs release but it can be treated by asprin 30 minutes before
Git irritation ( histamine ++ hcl)
Hyperurcimia
Hyperglycemia
Contraindications of niasin
Peptic ulcer
How is type 1 (hyperchylomicronimia ) treated
It’s treated mainly by diet control
