Hyperlipidemia Flashcards
Definition and Etiologies of Hyperlipidemia
Defined as serum cholesterol >200 mg/dL Hyperlipidemia caused by: Lifestyle choices Poor diet choices Lack of exercise Secondary causes Medications—antipsychotics (risperdone), prednisone, beta blockers (mildly), diuretics Hypothyroidism Genetics—familial hypercholesterolemia
**Emphasis: Untreated hyperlipids lead to….
Untreated hyperlipidemia causes atherosclerosis
Increases risk of:
MI
CVA
Hyperlipid Labs:
Testing includes:
Fasting total cholesterol, LDL, HDL, and triglycerides
Total cholesterol alone fine for screening, but does not give complete picutre
What is the focus of the new guidelines?
New guidelines available from American Heart Association/American College of Cardiology
Still somewhat controversial, do not focus on target LDL, rather looking at overall risk
More evidenced based than ATP III
Hyperlipid TX begins with…
Starts with lifestyle changes Dietary modifcations Exercise program Modifying alcohol intake Evidence shows most patients still need a medication, even with adequate lifestyle changes
What is the goal for TX of hyperlipid?
Goal is to reduce relative risk of cardiac disease 20-30% regardless of their baseline LDL
Few studies show benefit of medications in those with a very low LDL (
Risk factors considering when treating hyperlipid:
Goal is to reduce relative risk of cardiac disease 20-30% regardless of their baseline LDL
Few studies show benefit of medications in those with a very low LDL (
What to use to assess risk:
Use the Framingham Scale to assess risk
Only good for patients 20 and older
Look at 10 year risk, not lifetime risk
Why? Few studies done on long term statin use. We know they have benefits very shortly after starting
Treat when risk of having a heart attack in the next 10 years is >20%
**Emphasis: At what % risk do you begin TX?
Treat when risk of having a heart attack in the next 10 years is >20%
If triglycerides are >500…
…treat triglycerides 1st
Determine goal of TX first-
Primary v. secondary
Primary: prevent a heart attack or stroke from happening in the first place
Secondary: prevent another heart attack or stroke
Specifics of Primary and Secondary TX goals:
Primary: prevent a heart attack or stroke from happening in the first place Typically a low to moderate dose statin Pravastatin 20-40 mg Atorvastatin 10 mg Rosuvastatin 5-10 mg Secondary: prevent another heart attack or stroke High dose statin Pravastatin 40-80 mg Atorvastatin 20-40 mg Rosuvastatin 20-40 mg
**Emphasis: Post-MI pts ALWAYS need…
A HIGH DOSE STATIN ON TOP OF LIFESTYLE CHANGES!
List the 5 types of hyperlipidemia meds-
- HMG-CoA reductase inhibitors
- Ezetimibe (Zetia)
- Bile acid resins (Cholestyramine, Welchol)
- Niacin (nicotinic acid)
- Fibric acid derivatives (gemfibrozil, fenofibrate)
List the 5 types of hyperlipidemia meds-
- HMG-CoA reductase inhibitors (Statins)
- Ezetimibe (Zetia)
- Bile acid resins (Cholestyramine, Welchol)
- Niacin (nicotinic acid)
- Fibric acid derivatives (gemfibrozil, fenofibrate)
HMG-CoA reductase inhibitors- names, MOA, PK
Simvastatin (Zocor), atorvastatin (Lipitor), pravastatin (Pravachol)
GOLD STANDARD of high cholesterol treatment!
Mechanism of Action: competitive inhibitor of HMG-CoA, which produces cholesterol. By inhibiting this enzyme LDL production is decreased and more LDL is catabolized, decreasing LDL levels
ie, SOLELY TARGETS LDL
Pharmacokinetics:
Not well absorbed (14% bioavailability)
Metabolized in liver via CYP3A4 (except pravastatin)
Excreted in stool
Certain genotypes increase risk of toxicity, increased bioavailibility- ie, ASIANS/ELDERLY
GOLD STANDARD of high cholesterol treatment is:
STATINS!
Simvastatin (Zocor), atorvastatin (Lipitor), pravastatin (Pravachol): SE’s and C/I
Side effects: myopathy, arthralgias, diarrhea, increased LFTs
Monitoring parameters: LFTs, lipids, CPK
Contraindications: active liver disease, increased LFTs
Simvastatin (Zocor), atorvastatin (Lipitor), pravastatin (Pravachol): Monitoring parameters:
LFTs, lipids, CPK
**Emphasis: Certain pts are at greater risk for toxicity from statins, who are they?
Certain genotypes increase risk of toxicity, increased bioavailibility- ie, ASIANS/ELDERLY
Simvastatin (Zocor), atorvastatin (Lipitor), pravastatin (Pravachol): are the side effects related to dose?
the myopathies and arthralgias can be dose-dependent
**Emphasis: what parameter are you especially wanting to follow, at initiation of RX and about 1 month?
LFT’s
Simvastatin (Zocor), atorvastatin (Lipitor), pravastatin (Pravachol): Pregnancy, BFEED, PEDS
Not safe in pregnancy, breastfeeding, safe in pediatrics >10 years old (heterozygous familial hypercholesterolemia only)
Simvastatin (Zocor), atorvastatin (Lipitor), pravastatin (Pravachol): best taken WHEN?
STATINS are best taken either with evening meal or at bedtime
