Lipid drugs Flashcards
At what LDL level is seen as high?
> 200mg/dL
Below what level of HDL is considered low?
< 45mg/dL
- Little evidence that raising low levels reduces risk
What is a normal TG level?
< 150mg/dL
What is the main risk associated with elevated triglycerides?
Pancreatitis
What are statins used to treat specifically?
Elevated LDL-C
- Rarely used to treat elevated TG or low HDL-C
What is usually used as a guidline for whether to start a patient on statins?
QRISK score (>5%) - Old guidelines mainly based on LDL and risk factors
When would high TG or low HDL be treated?
Triglycerides
- > 500
- High non-HDL cholesterol (TC-HDL)
Low HDL
- Patients w. established CAD
What are all the lipid lowering drugs?
- Statins
- Niacin
- Fibrates
- Absorption blockers
- Bile acid resins
- Omega-3 fatty acids
What are the effects of statins?
HMG-CoA reductase inhibitors
- Decrease cholesterol synthesis in liver
- Increase LDL receptors in liver
- Decrease LDL (to a lesser degree TG and increase HDL)
What is thought to be the mechanism behind muscle aches with statins?
Low levels of coenzyme Q in muscles
- People can take supplements
How can you differentiate muscle conditions as a side-effect of statin therapy?
Myalgias
- Normal CK levels
- Weakness, soreness
Myositis
- Increased CK
Rhabdomyolysis
- Weakness, pain, dark urine
- CKs in 1000s
What can statins cause which may result in death?
Rhabdomyolysis
- Acute renal failure, leading to death
What drugs may increase the risk of Rhabdomyolysis in combination with statin therapy?
- Cyclosporine
- Gemfibrozil (fibrate)
What are the hydrophilic statins?
- Pravastatin
- Fluvastatin
- Rosuvastatin
What are the lipophilic statins?
- Atorvastatin
- Simvastatin
- Lovastatin