Hyperlipidemia Flashcards
what are the 3 major classes of lipoproteins?
LDLs
HDLs
very low density lipoproteins (VLDLs)
where is synthesis of lipids greatest?
liver
what does the intestinal mucosa secretes?
VLDL (TG-rich)
what do triglycerides break down into?
FFA + phospholipids (transferred to HDL)
what enzyme breaks down cholesterol?
HMG-CoA reductase (rate limiting step)
what type lipidemia is from a single inherited gene defect or caused by combo of genetic and environmental factors
primary hyperlipidemia
what type lipidemia is result of generalized metabolic disorders ie., DM, excessive ETOH, hypothyroidism, primary biliary cirrhosis
Secondary hyperlipidemia
what is due to dysfunctional or absent LDL receptors and leads to increased LDL (250-450)
Familial hypercholesterolemia (FH)
What id due to a decreased LPL activity leading to decreased TG removal. manifests as TG of 200-500
Familial hypertriglyceridemia (FHTG)
Defect with increased HDL catabolism. Will have isolated HDL <35.
Hypoalphalipoproteinemia
what are 3 drugs that may alter lipid profiles
Thiazide diuretics (increase TGs) Beta blockers (Increase TGs, decrease HDL) OCPs (increase cholesterol and TGs)
what do macrophages due to LDL
Oxidize LDL and then take up the LDL creating foam cells which makes the cell surface more adhesive
What does HDL promote?
Reverse cholesterol transport
what is Preventing the development of atherosclerosis and cardiovascular disease
primary prevention
Prevent the progression of cardiovascular disease and recurrence of cardiovascular events
secondary prevention
what is the optimal LDL level?
<100
what is the desirable total cholesterol level?
<200
what should HDL be between?
40-60
what should triglycerides be less than?
<150
what should antihyperlipidemic drugs be combined with?
diet
exercise
weight reduction
after antihyperlipidemia drugs are started when should you get labs?
4-8 weeks after starting therapy
What is the MOA of Niacin?
Inhibits mobilization of FFA’s from adipose tissue => results in decreased VLDL synthesis by the liver
therapeutic uses for niacin?
mixed hyperlipoporteinemias
increase HDL (most effective)
decrease TG
ADRs with niacin
Vasodilation –> Flushing, itching, HA
GI- activation of PUD
hepatotoxicity (LFTs 3X ULN) (get LFTs q 6-8 weeks)
contraindications w/ niacin
DM (worse glucose tolerance), gout, peptic ulcer
liver dz
what is an anithyperlipidemic drug that is a fibrate?
Gemfibrozil (main one)
fenofibrate
MOA of gemfibrozil
inhibits lipolysis and increases liporprotein lipase. Decrease serum VLDL and increase HDL
what is gemifibrozil approved for?
Lowering TG in patients with hypertriglyceridemia
used for combined increased cholesterol and TG (in combo)
ADRs with gemfibrozil
GI (most common, decrease with time) myopathy hepatotoxicity neutropenia gallstones and pancreatitis (avoid in high risk patients)
What are 2 bile acid binding resins?
Cholestyramine
Colestipol
MOA of bile acid binding resins
inhibit enterohepatic recycling of bile acids and salts
liver stimulated to convert stores cholesterol to bile acids
What do bile acid binding resins lower?
Total cholesterol
LDL in dose dependent area
(may increase TGs)
ADRs of bile acid binding resins
primarily GI
can increase triglycerides
what three drugs should you not give w/i 2 hours of bile acid binding resins?
warfarin, thyroid, digoxin
Contraindications with bile acid binding resins
Biliary obstruction, fasting TG >500
relative is fasting TG >200
MOA of HMG-COA reductase inhibitors
Competitively inhibit the rate-limiting enzyme (HMG-CoA Reductase) necessary for cholesterol synthesis results in an increase in hepatic LDL receptors
effects of HMG-CoA reductase inhibitors
Decrease LDL, TG, increases HDL
Other CV benefits with statins
Stabilize atherosclerotic plaques
enhance vascular nitric oxide production
attenuate inflammation due to vascular injury
decrease oxidative stress
What drug class also inhibit bone resorption, modulate inflammatory precess in glomerular mesangial.
statins
when do statins have their greatest efficacy?
dinner or at bedtime to coincide with peak cholesterol biosynthesis
Most common ADRs with statins
HA, myalgias, dyspepsia
Hepatotoxicity (LFTs)
myopathy and CPk >10 x normal
Biggest contraindications with statins
grapefruit juice macrolides triazole antifungals fluoroquinolones diltiazem verapamil amoidarone omperzole protease inhibitors
What does lovastatin due to warfarin?
increases warfarin effects
what is a drug that combines Niacin ER and lovastatin?
advicor
ADRs with advicor
increased risk of myopathy
monitor LFTs
drug that inhibits absorption of choelsterol at the brush border of the small intestine and there is decreased delivery of cholesterol to the liver.
Ezetimbe (cholesterol absorption inhibitor)
ADRs with ezetimbe
HA
GI
arthralgia
sinusitis
what is simvastatin + ezetimbe
Vytorin
when should vytorin be used?
only is other drugs aren’t working well enough
is there any CV benefit for replacing estrogen for women going into menopause?
No, not recommended to use estrogen to prevent CAD
what is fish oil effective at lowering
Triglycerides
side effects of lovaza (Rx fish oil drug)
can effect bleeding time (more thinning of blood)
may impair insulin secretion
GI
What does metamucil help lower
LDL
What are OTC things that help with hyperlipidemia
Garlic
olestra
red yeast rice
what can moderate alcohol consumption help with
Increase HDL
decreased LDL oxidation
decreased platelet aggregation
