lipid Flashcards
LDL
low density lipid
HDL
hight density lipid
Trig
triglycerides
MI
Myocardial infarction, the technical term for a heart attack
ACS
acute coronary syndrome
CAD
Coronary artery disease
LFT
Liver function tests
Atherosclerosis
Hardening of the arteries
Primary prevention
preventing the first event
Secondary prevention
preventing relapse or second event
Hepatic
dealing with the liver
Dyslipidemia
abnormal amounts of, lipids and lipoproteins in the blood
3 Major Lipids in the Body
cholesterol, triglycerides, phospholipids
Dyslipidemia/Hyperlipidemia
Defined as: Elevation in LDL Elevation in triglycerides Elevation in total cholesterol Reduced HDL Caused by: Diet Genetics Risks: Predisposition to coronary, cerebrovascular, and peripheral vascular arterial disease Constitutes one of the majorrisk factorsfor coronary heart disease (CHD)
Non Pharmacologic Alternatives
Diet
Exercise
Both strategies should CONTINUE to be employed even if the patient requires medication to lower cholesterol
HMG-CoA Reductase Inhibitors
Fluvastatin, Pravastatin, Lovastatin, Simvaststin, Atorvaststin, Rosuvaststin, Pitavastatin. end in STATIN
STATIN MOA
Blocks HMG-CoA enzyme (first step in cholesterol synthesis)
Leads to a decrease in total cholesterol and LDL
STATIN indications
Hyperlipidemia
Primary and secondary prevention of CAD
STATIN adverse effects
Myalgia GI upset Diarrhea Elevated liver enzymes Hepatotoxicity Rhabdomyolysis
STATIN contraindications
Pregnancy/lactation
Active liver disease
Elevated transaminases
STATIN pregnancy category
X
STATIN interactions
Warfarin Gemfibrizol Cyclosporine Amiodarone Verapamil/Diltiazem/Amlodipine
STATIN counseling
For most drugs in the class, take the drug at bedtime
Avoid grapefruit juice due to enzyme inhibition
If unexplained muscle weakness or pain occurs, contact your physician immediately
Most potent LDL lowering agents available
Fibric Acid Derivatives
Gemfibrizol, Fenofibrate
Gemfibrizol, Fenofibrate dosing
Capsule
Gemfibrizol, Fenofibrate MOA
Blocks triglyceride synthesis in the liver
Results in a decrease in triglycerides and total cholesterol
Gemfibrizol, Fenofibrate indicationd
Hyperlipidemia
Hypertriglyceridemia
Gemfibrizol, Fenofibrate adverse effects
Dyspepsia Abdominal pain Gallstones Hepatotoxicity Myalgias
Gemfibrizol, Fenofibrate contraindications
Severe renal impairment including dialysis
Severe hepatic impairment with elevated transaminases
Gallbladder disease
Lactation
Gemfibrizol, Fenofibrate interactions
Warfarin
HMG-CoA reductase inhibitors
Gemfibrizol, Fenofibrate counseling
Should be used in combination with a diet and exercise program
If unexplained muscle pain or weakness occurs, stop drug and contact physician
Niacin – Niaspan drug class
Nicotinic Acid
Niacin – Niaspan MOA
Inhibits release of free fatty acids from adipose tissue and increases lipoprotein activity
Decreases triglycerides and LDL and increases HDL
Niacin – Niaspan indications
Hypertriglyceridemia
Hyperlipidemia
Niacin – Niaspan adverse effects
Flushing Hyperglycemia Hyperuricemia Headache Hepatotoxicity
Niacin – Niaspan contraindications
Active peptic ulcer
Arterial bleeding
Lactation
Hepatic impairment
Niacin – Niaspan interactions
Bile acid sequestrants
Niacin – Niaspan counseling
Take at bedtime
Take aspirin or NSAID 30 minutes prior to niacin administration to decrease flushing
Take on a full stomach
Flushing may worsen with hot, spicy foods/beverages and hot showers/baths
Ezetimibe – Zetia, Vytorin MOA
Blocks cholesterol absorption in the small intestine
Increases cholesterol clearance from blood
Ezetimibe – Zetia, Vytorin indications
Hyperlipidemia- with statins
Ezetimibe – Zetia, Vytorin adverse effects
Diarrhea Elevated transaminases Fatigue Myopathy Rhabdomyolysis Hypersensitivity
Ezetimibe – Zetia, Vytorin contraindications
Active hepatic disease
Pregnancy/Lactation
Unexplained persistent elevation in LFTs
Ezetimibe – Zetia, Vytorin interactions
Cyclosporine
Fibrates
Bile acid sequestrants
Ezetimibe – Zetia, Vytorin counseling
Does not replace diet and exercise
Report any N/V/D, abdominal pain, muscle pain, fever to physician
Omega-3 Fatty AcidsLovaza - capsule MOA
Inhibits liver enzyme system leading to decrease in triglyceride synthesis
Lower triglycerides
Omega-3 Fatty AcidsLovaza - capsule indications
Hypertriglyceridemia
MI prophylaxis
Omega-3 Fatty AcidsLovaza - capsule adverse effects
Erucatation
Fishy aftertaste
Infection
GI upset
Omega-3 Fatty AcidsLovaza - capsule interactions
Warfarin
Antiplatelets
Omega-3 Fatty AcidsLovaza - capsule counseling
Refrigerate/freeze capsules to minimize “fishy” taste
Similar to “fish oil” products obtained OTC
Amount of DHA/EPA in each capsule is increased
Content of capsule is regulated
Lower pill burden than OTC products
Colesvelam, Cholestyramine, colestipol drug class
Bile Acid Sequestrants
Colesvelam, Cholestyramine, colestipol MOA
Binds bile acid in the intestine leading to fecal excretion
Reduces total cholesterol and LDL
Colesvelam, Cholestyramine, colestipol indications
Dyslipidemia
Type 2 diabetes mellitus (in combination) – Colesevelam only
Pruritis/Diarrhea associated with increased bile acid
Binding toxicologic agents
Colesvelam, Cholestyramine, colestipol adverse effects
Flatulence
Dyspepsia
Steatorhhea
Constipation +/- fecal impaction
Colesvelam, Cholestyramine, colestipol contraindications
Biliary/bile obstruction
Elevated triglycerides >400
Colesvelam, Cholestyramine, colestipol interactions
Orally administered medications
Fat soluble vitamins
Colesvelam, Cholestyramine, colestipol counseling
Mix powder with 4-6 ounces of liquid
Take capsules individually with full glass of water
To avoid drug-drug interactions, take at least 1 hour prior to other medications or 4-6 hours following other medications
Current Go-To Guidelines
The National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III)
Lipids and Cholesterol
The American Heart Association
ACS/MI, etc.
