Hyperlipidemics Flashcards
Secondary disease
Risk factors
Diet
Drug induced (steroids, birth control, hormones, diuretics)
Lipoproteins encompass these 5 things
Chylomicrons VLDL ILDL LDL HDL
Total cholesterol should be under __ while triglycerides should be under __
200; 150
Lifestyle changes to lower lipids
Dietary modification
Lose weight
Exercise
Quit smoking
CHD risk factors
Men > 45 women > 55 DM Family he of CHD Smoking Low HDL
Obesity
Sedentary life
Poor diet
MOA for statins
Block rate limiting step in cholesterol biosynthesis lowering LDL and TG levels; raise HDLs
Statins are derived from
Red rice yeast
CI for statins
Pregnancy
Breast feeding
Can cause congenital abnormalities
Active hepatic dz
First line to reduce LDL
Statins
ADRs of statins
Ototoxicity Hepatotoxicity Nvd Rhabdomyolysis Dec cognitive fxn
Statin drug properties
Lipophilicity
High F
Limited protein binding
CYP 450 3A4 substrates
Statins with least DDIs
Pravastatin and rosuvastatin
What should be monitored with statins
Lipids- baseline, 4-8 wks later and 6-12 months later
LFTs
CPK
Statin examples
Atorvastatin Fluvastsatin Lovastatin Pravastatin Rosuvastatin Simvastatin Pitavastatin
Dosing statins
Give at bedtime
Have to get dose right initially
Bile sequestering agents MOA
Binds to bike acids and forms complex that gets excreted so less bile acids are around to emulsify fats
CI for bile sequestering agents
Hypertriglyceridemia
ADRs for bile sequestering agents
GI effects
DDIS for bile sequestering agents
Prevents absorption of most drugs so need to take I hr before or 4 hrs after
When to use bile sequestering agents
Pt does not reach LDL a goal with statins or pt cannot tolerate statins
Bile sequestering agents
Cholestyramine
Colestipol
Colesevelam
MOA fibric acid derivatives
Activates peroxisome proliferator activator to dec triglycerides and inc HDLS
Fibric acid derivatives used mostly for
Hypertriglyceridemia or marked HDL deficiency
CI for fibric acid derivatives
Severe renal or hepatic failure
Biliary or gallbladder disease
ADRs for fibric acid derivatives
GI, rash, urticaria, alopecia, impotence, myopathy
Nicotinic acid MOA
Inhibits lipolysis dec TG synthesis
DDIs for fibric acid derivatives
Compete with warfarin and sulfonylureas for protein binding sites
Examples of fibric acid derivatives
Gemfibrozil
Fenofibrate
ADRs for nicotinic acid
Flushing and pruritis-reduce by ASA pretreatment
GI upset, PUD, hepatic dysfunction hyperglycemia
When to use nicotinic acid
Statins fail to lower LDL or pt cannot tolerate statins
Ezetimibe MOA
Inhibits absorption of cholesterol at brush border of small intestine leading to dec delivery to liver and inc cholesterol clearance
Combo products
Ezetimibe/simvastatin Nicotinic acid/ lovastatin Nicotinic acid/ simvastatin Amlodipine/ atorvastatin Pravastatin/Asa Ezetimibe/ atorvastatin
Probuchol
Rarely used but lowers LDL and HDL
Misc agents
Vitamin E Garlic Dietary supplements Alternative therapies Fish oil
Primary disease
Familial disorder
