Hyperlipidemia Flashcards
When might you use Gemfibrozil?
- When other drugs haven’t worked.
- For patients who have low HDL levels and high triglycerides
What can you combine statins with?
Ezetimibe
Niacin
Bile-binding resins (Gemfibrozil)
statins MOA
HMG-CoA reductase inhibitors
What does niacin and fibrates both have in common?
both equally good at reducing triglycerides.
MOA for fibrates
regulates gene transcription.
Lowers triglycerides by affecting (reducing activity of) an enzyme that removes triglycerides from VLDL
What are statins really good at?
<<<< LDLs (20-50%)
whats the good thing about ezetimibe?
can be combined with statins to << LDLs without needing a large dose of statin.
(synergistic)
Niacin causes flushing. What other symptoms?
pruritus
hyperglycaemia (but only if diabetes is controlled)
Why do you need to be careful combined NSAIDs with fluvastatin?
use same CYP2C9 pathway
Drug interactions are important with cholestyramine & colestripol, why?
need 2 hour gap between taking medications because they bind to digoxin, thyroxin, warfarin.
what did the 4000 px statins study show?
Reduced death, MI, stroke with statins.
two representative drugs of bile acid-binding resins
- Cholestyramine
- Colestripol
3.
What is strongly associated with atheromas?
Raised serum cholesterol is a risk factor for atherosclerosis, especially when associated with a low value of HDL
Common adverise effects of Gemfibrozil?
- myalgia
- GI disturbances
(best not to combine with statins)
Why would you use cholestyramine & colestripol?
good for hypercholesterolemia and for patients who don’t tolerate other drugs.
MOA Ezetimibe?
inhibits absorption of both biliary and dietary cholesterol.
What’s the function of VLDL?
major carrier of plasma triglyerides
and the precursor to LDL.
Prophylasis solution to flushing from niacin?
aspirin
Fibrate representative drug
Gemfibrozil
Commone adverse effects of statins?
myalgia
GI problems
myositis
hepatotoxicty
rhabdomyolysis (monitor liver enzyme if >> muscle pains)
other names for niacin?
B3, nicotinic acid
MOA of niacin?
Reduces the supply of free fatty acids that the liver uses to incorporate into VLDL.
- does this by inhibiting lipolysis in adipose tissue
adverse effects of ezetimibe?
well tolerated.
maybe diarrhoea
occassionally headaches
statins and warfarin? what’s the score?
statins slightly inhibit warfarin metabolism
What is Niacin good for?
BIGGEST effect on increasing HDLs!!
Adverse effects of cholestyramine & colestripol?
GI disturbances, occasionally perianal pruritis and skin rash
What is the target value of serum cholesterol?
< 5.0 mmol/l
What is the risk of CAD directly related to?
serum cholesterol levels
What are the main effects of Gemfibrozil?
- Lowers triglycerides
increases HDL
When would you use Niacin?
to increase HDL levels
to reduce risk of pancreatitis (like fibrates, niacin reduces triglyercide levels)
ONLY drug that can reduce lipoprotein (a)!!!
What’s the MOA of cholestyramine & colestripol?
prevents uptake of bile in the GI tract.
- therefore liver has to use more cholesterol to synthesis new bile.
ALSO - Up regulates Liver LDL receptors and more cholesterol is delivered to the liver.
Which drugs inhibit CYP3A4 pathway?
erthromycin
itraconazole
ritonavir
statins have important drug interactions, which pathway does atorvastin, lovastain and simvastin use?
CYP3A4
