Lipid Flashcards
A major cause of coronary artery disease
atherosclerosis
CVD is a major cause of death in the US ____ people die each ehar from heart attacks, most commoly realted to ____
500,000
coronary artery disease
Atherosclerosis is characterized by
deposits of cholesterol and lipoproteins in artery walls. Three major classes of lipoproteins are found in the serum of fasting individuals
Three major classes of lipoproteins
low-density lipoproteins (LDL, “bad cholesterol”), high-density lipoproteins (HDL, “good cholesterol”), and very low-density lipoproteins (VLDL).
High concentrations of LDLs are associated with an increased risk of
CVD
Serum lipoproteins are formed via two pathways
dietary (exogenous) and liver synthesis (endogenous).
Exogenous pathway
involves absorption of lipids via intestine
Endogenous pathway
lipids originate from liver
Lipoproteins
Change in the lipid guidelines for 2018
. In this guideline there is no ideal target blood level of LDL, however, the guidelines do recognize that lower is better. The guideliens ustilize a isk calculator and has reocmmendations for primary prevention and secondary prevention
aims to prevent disease or injury before it ever occurs
Primary prevention
screening to identify diseases in the earliest. stages, before the onset of signs and symptoms, through measures such. as mammography and regular blood pressure testing
Secondary Prevention
Childhood screening - Risk factors
DM
Obesity
Family history of familial hypercholesterolemia
what should be emphasized with children
diet and exercise
Lifestyle Modifications
exercise 30 minutes a day
dietary therapy
dietary therapy recomendations
Reduced intake saturated fats not as strong
Consuming plant sterols (2 g/day)
Increased soluble fiber intake (10 to 25 g/day)
Dietary fiber of 20 to 30 g/day
Total calories to maintain or lose weight
3-hydroxyl-3-methyl-glutaryl-coenzyme A (HMG CoA) reductase inhibitors EXAMPLES
Lovastatin, pravastatin, simvastatin, fluvastatin, atorvastatin, rosuvastatin
Fibrates: fibric acid derivatives - EXAMPLES
Gemfibrozil, micronized fenofibrate, clofibrate
Bile acid sequestrants EXAMPLES
Cholestyramine, colestipol, colesevelam
Drug most effective in combination with statin
ezetimibe (Zetia)
drug that has lost popularity
Niacin
Vitamins/antioxidants/herbs/natural products
Vitamin E, vitamin C, folic acid, garlic, fish oils, fiber, coenzyme Q10, flaxseed
Active liver disease is a contraindication for all treatments for hyperlipidemia except
bile acid sequestrants
Statins MOA
Block synthesis of cholesterol in the liver by competitively inhibiting HMG CoA reductase activity
Statins decrease levles of LDL by
25 to 65%
Statins Modest decres in ___ and very modest increase in ___ may occur
Modest decreases in TGs (10% to 40%) and very modest increases in HDL (5% to 17%) may occur
Statins preganacy
old category X; fully contraindicated
All statins are metabolized a lease in part by _____ (except)
CYP3A
except fluvastatin and rosuvastatin
CYP3A inhibitors may increase statin
concentrations.
Verapamil, diltiazem, azole antifungals, erythromycin, fluoxetine, nefazodone, protease inhibitors
CYP3A inducers may (statin)
decrease statin concentrations.
Rifampin, phenytoin, phenobarbital
Statins may also interact with other
CYP channel substrates; for example, cyclosporine
Statin side effects
HA, myalgia, fatigue, GI intolerance, flu-like symptoms
Statin Myopathy occurrence and avoidance
occurs in 0.2% to 0.4% of patients, some agents more likely
Reduced by using lowest effective dose
Cautiously combining statins with fibrates
Avoiding drug interactions
Statins can have
myalgia (muscle aches)
Active liver disease is a contraindication in
statins
Active liver disease in statins occurs in
Occurs in 0.5% to 2.5% of cases and is dose-dependent.
Serious liver problems are rare.
Liver side effects statin managment
reducing dose or stopping until levels return to normal.
Clinical studies of statins have demonstrated a 0.5 to 3.0 percent occurrence of persistent elevations in aminotransferases in patients receiving
statins
Statins start with
lower dose and increase, as needed, according to LDL response; absolute levels of LDL not as closely monitored now
Rosuvastatin most potent - Dose
5 to 20 mg day
Atorvastatin next most potent - Dose
10 mg/day initially, increase no fewer than 2 to 4 weeks
What statin has the best ADR profile
Atorvastin
Simvastain dose
20 to 40 mg/day
Lovastatin (IR) 20 mg/day (XR) - Dose
40 to 60 mg a day
Statin test liver function every
4 to 6 weeks then every 3 to 4 months until control established
Statin liver function tests
before starting therapy and 3 to 6 months later only if suspected issues or underlying hepatic issues
