Hyperlipidemia Flashcards
rate limiting enzyme for intracellular cholesterol biosynthesis
HMG-CoA reductase
familial hypercholesterolemia
increased LDL
familial hypertriglyceridemia
increased TG
familial combined hyperlipidemia
increased LDL
increased TG
hypoalphalipoproteinemia
isolated HDL < 35
drugs that later lipid profiles
thiazide diuretics (increase TG)
BB (increase TG, decrease HDL)
OCP (increase cholesterol, increase TG)
optimal LDL C
<100
HDL-C
60 high
TC
<200 desirable
TG
<150 normal
Major CHD risk factors
LDL cigarette smoking HTN low HDL (high HDL negates a RF) Fhx premature CHD Age
always use antihyperlipidemic drugs in conjunction with
diet, exercise, weight reduction
inhibits mobilization of FFA’s from adipose tissue, results in decreased VLDL
niacin
best med choice to increase HDL. used in hyperlipoproteinemias, and as an adjunct to decrease TG
niacin
adverse effects: vasodilation, nausea, dyspepsia, activation of PUD, hyperuricemia, worsen glucose tolerance, hepatotoxicity (LFTs 3X normal!)
niacin
monitor glucose, uric acid, LFTs
niacin
contraindicated in DM, gout, peptic ulcer and LIVER DISEASE
niacin
drug interactions: hypotension with BP lowering drugs, DM meds- hyperglycemia, and increased risk or hepatotox with statins
niacin
inhibit lipolysis and increase lipoprotein lipase, decreasing serum VLDL and increasing HDL
fibrates
decrease TG, increase HDL, may increase LDL
fibrates
med of choice for lowering TG. also used for combined increased cholesterol and TG
fibrates
adverse effects include GI, myopathy, hepatotoxicity, neutropenia, gallstones, and pancreatitis
fibrates
this class inhibits enterohepatic recycling or bile acids and salts- causing the liver to convert stored cholesterol to bile acids
bile acid resins
reduces TC, LDL (dose dependent), increases HDL and TG
bile acid resins
adverse effects are mostly GI- constipation, bloating, gas, nausea. Avoid in pts with diverticulitis, swallowing difficulties, motility disorders
bile acid resins
ADRs with warfarin, thyroid, digoxin- separate ALL meds by at least 2 hours
bile acid resins
contraindicated in biliary obstruction, TG >500, or TG>200 (relative)
bile acid resins
competitively inhibit HMG-CoA reductase (necessary for cholesterol synthesis-results in an increase in hepatic LDL receptors)
statins
decreases LDL, decrease TG, increase HDL. Proven efficacy to reduce major coronary events and stroke, CV related and total mortality, and coronary procedures
statins
pleiotropic effects: CV (stabilize plaques, enhance NO production, decrease oxidative stress), renal (modulate inflammation), endocrine (improve insulin sensitivity), and skeletal (inhibit bone resorption)
statins
this class has few adverse effects. Most common are HA, myalgia, and dyspepsia. Hepatotoxicity and myopathy can occur
statins
reacts with CYP450 3A4 inhibitors- cyclosporine, grapefruit juice, macrolides, triazole antifungals, fluoroquinolones, SSRIs, diltiazem, verapamil, amiodarone, omperazole, protease inh
statins
statins not metabolized by 3A4
prava, fluva, rosuva
this statin increased warfarin effects
lovastatin
monitor AST/ALT, CK
statins
caution in liver and renal disease, contra in pregnancy
statins
combo niacin ER/ lovastatin- increases risk of myopathy. Monitor LFTs
advicor
inhibits absorption of cholesterol at the brush border of the SI, causing a decrease in delivery of cholesterol to the liver
ezetimbe
this drug may increase risk of AST/ALT elevation when used in combo with statins
ezetimbe
ADRs include GI, HA< arthralgia, sinusitis
ezetimbe
if LDL >205 above goal or patient is high/moderately high risk, what is our DOC
statins
if TG >500, use these drugs to reduce risk of pancreatitis
fibrate or niacin
