Hyperlipidemia Flashcards
What is the initial therapy for treatment of hyperlipidemia?
Lifestyle modifications
What is the first line drug therapy for hyperlipidemia?
HMG-CoA reductase inhibitors
What is the other name for the HMG-CoA reductase inhibitors?
Statins
What is the mechanism of action of statins?
They inhibit HMG-CoA reductase that is an enzyme that helps produce liver synthesis of cholesterol. By inhibiting the enzyme, the liver decreases synthesis cholesterol and increases cholesterol receptors and uptake of LDL-C. Statins can also help promote the decrease in atherosclerotic plaques through LDL-C reuptake
What are the common side effects of statins?
headache, rash, GI disturbances
What are adverse effects of statins?
Myopathy and rhabdo, hepatotoxicity, new-onset diabetes, reversible memory loss
What is a common education piece for patients on statins
Teaching about the S&S of myopathy
What is a lab value other than lipid panel you should monitor in patients on a statin?
LFTs d/t the ADR of hepatotoxicity
What is the category risk in pregnancy for statins?
Category X
What is the effect on LDL-C from statins?
% reduction is based on statin intensity
What food should patients on statins avoid?
Grapefruit d/t the CYP3A4 inhibition thus raising statin levels
When should follow up lipid panels be drawn?
6-8 weeks after initiation of therapy for adjustment
How often should we follow up with patients on statins?
6-8 weeks until at goal, then 8-12 weeks for the first year
What is the mechanism of action of the bile-acid sequestrants?
Prevent reabsorption of the bile acids by binding to the bile acids when excreted into the GI tract thus increasing the need for LDL-C uptake to promote the production of bile acids in the liver
What are common side effects of bile-acid sequestrants?
GI disturbances
What is the most common bile-acid sequestrant?
Colesevelam
What is a common drug interaction with bile-acid sequestrant?
They can bind to other medications, thus rendering them ineffective by preventing their absorption. Take medications 1 hour prior to or 4 hours after
What is the mechanism of action of niacin?
inhibits free fatty acid absorption in the tissues, inhibits cAMP and reduces VLDL and LDLs
Why is niacin not used as much anymore?
It has increased cardiovascular risks such as stroke
What is the most common medication used as a second line therapy with statins?
Ezetimibe (Zetia)
What is the mechanism of action of Zetia?
Inhibits dietary cholesterol absorption and inhibits reabsorption of cholesterol secreted in bile
What is a severe adverse effect of Zetia?
Gallstones
What are other side effects of Zetia?
Myopathy/Rhabdo, pancreatitis, hepatitis, thrombocytopenia
When is Zetia contraindicated?
Hepatic impairment as it can increase bioavailability
What is the mechanism of action of the PCSK-9 Inhibitors?
Binds to and inhibits the PCSK-9 enzyme to free LDL receptors to promote LDL-C reduction
What are the side effects of the PCSK-9’s?
hypersensitivity reactions and immunogenicity due to the development of antibodies
When are the PCSK-9 indicated for use?
When patients are adherent to lifestyle modifications and on maximal stain therapy
What is the mechanism of action for fibrates?
Inhibits cholesterol and triglyceride synthesis thus decreasing VLDL and LDL production and levels in the body
What is the side effects of fibrates?
N/V/D, rash, abdominal pain, gallstones
What medications are fibrates contraindicated with use?
Zetia as both increase the risk for gallstones
What medications are fibrates cautioned with?
Warfarin as it displaces warfarin from plasma albumin and can increase free warfarin levels and increase anticoagulabiity
Statins as the two can increase myopathy risk
What is an OTC treatment for hyperlipidemia?
Omega-3 Fish oil, CoQ-10
