Hypertriglyceridemia

Question 1

Indication for drugs for Hypertriglyceridemia

Answer 1

-Pancreatitis
-not so strong evidence for reducing ASCVD
-Causes: sugar, carbohydrates, alcohol, overweight, genetics, drugs

Question 2

Therapy approach lowering Triglycerides

Answer 2

1-499: lifestyle changes: diet, exercise, weight loss

> 500: Fibrates, Omega-3-FA, Niacin

Question 3

Lifestyle intervention effectiveness

Answer 3

-reducing weight: 5-10% can reduce TG by 20%

-lowering sugar: can reduce TG by 10-20%

-diet (healthy fats intake: like salmon, tuna, mackerel, sardine): can reduce TG by 5%

Question 4

Administration of Fibrates

Answer 4

Tablets

Gemfibrozil: 600 mg BID with food (30 min before eating)

Fenofibrate: daily with or w/o food (prodrug converted into fenofibric acid)

Fenofibric acid (Trilipex): 135 mg daily with or w/o food

Question 5

Effectiveness of Fibrates

Answer 5

TG reduction: 30-50%
Role: 1st line for Hypertriglyceridemia
Fenofibrate over Gemfibrozil (mainly bc of DDI with statins)

-Contraindication: dyspepsia, liver toxicity, renal damage

Question 6

DDI Gemfibrozil with Statins

Answer 6

gemfibrozil inhibits the glucuronidation of statins (Phase II metabolism)
-> higher concentration -> increased risk of side effects (myopathy, rhabdomyolysis)

-use with fenofibrate is more safe

Question 7

Adverse effects of Fibrates

Answer 7

dyspepsia, liver toxicity (Fenofibrate), renal damage (fenofibrate)

Contraindication: active liver disease, SCr: <30

Question 8

If a patient needs a fibrate and has kidney or liver disease

Answer 8

use gemfibrozil instead of fenofibrate due to liver and renal toxicity

Question 9

Administration Omega-3-FA

Answer 9

Capsule

Omega-3-ethyl-ester (lovaza)
4g daily or 2g 2x daily

Icosapent ethyl (Vascepa)
2g twice daily

Fish oil (OTC)
2-4g daily -> might have less Omega-3-FA in OTCs

Question 10

Effectiveness of Omega-3-FA

Answer 10

TG reduction: 20-50%
Role: 2nd line,
Icosapent ethyl (Vascepa)also reduces ASCVD event

Question 11

Side effect of Omega-3-FA

Answer 11

Fishy breathe, fishy burbs (refrigerate the capsules might help)

DDI: blood thinner (DOACs, warfarin), increased risk for bleeding, antiplatelets, aspirin, NSAIDs

Question 12

Administration of Niacin

Answer 12

2-4g a day

Question 13

Effectiveness of Niacin

Answer 13

-TG reduction: 30-50%
-no evidence of reducing ASCVD
-Role: not used

Question 14

Side effects of Niacin

Answer 14

-Flushing (aspirin prior to niacin helps bc it has a prostaglandin-mediated effect)
-uric acid (gout)
-increases blood glucose
-liver toxicity