Lipid Lowering Agents Flashcards
How is hyperlipidemia described?
High levels of lipids in the blood
If a patient has hyperlipidemia what are they are at a major risk for?
Cardiovascular disease
If a patient has hyperlipidemia when do they tend to produce symptoms?
Typically asymptomatic until cardiovascular disease produces symptoms
How do genetics play a role in hyperlipidemia?
They determine the ability to metabolize lipids
How does diet and exercise effect hyperlipidemia?
Diets high in saturated fat and lack of exercise contribute to hyperlipidemia
What are the three types of lipids?
- Triglycerides
- Phospholipids
- Steroids
What do lipoproteins carry?
Lipid molecules
What do lipoproteins consist of?
- Cholesterol
- Triglycerides
- Phospholipids with protein carrier
What are the three types of lipoproteins?
- High-density lipoprotein (HDL)
- Low-density lipoprotein (LDL)
- Very low-density lipoprotein (VLDL)
What do Low-Density Lipoproteins (LDL) enter the circulation as?
Tightly packed cholesterol, triglycerides, and lipids
What is Low-Density Lipoproteins (LDL) carried by and what are they broken down for and stored as?
They are carried by proteins that enter circulation.
They are broken down for energy and stored for future energy
How do High-Density Lipoproteins (HDL) enter the circulation as?
As loosely packed lipids
What are High-Density Lipoproteins (HDL) used for?
Energy
Where are High-Density Lipoproteins (HDL) pick up?
They pick up remnants of fats and cholesterol left in the periphery by LDL breakdown
What is the normal or desirable range for total cholesterol?
Less than 200
What is considered borderline high range for total cholesterol?
200-239
What is considered high range for total cholesterol?
Greater than or equal to 240
What is considered optimal range for low-density lipoprotein (LDL)?
Less than 100
What is considered normal or desirable range for low-density lipoprotein (LDL)?
100-129
What is considered borderline high range for low-density lipoprotein (LDL)?
130-159
What is considered high range for low-density lipoprotein (LDL)?
160-189
What is considered very high range for low-density lipoprotein (LDL)?
Greater than or equal to 190
What is considered low range for High-density lipoprotein (HDL)?
Less than 40
What is considered high range for High-density lipoprotein (HDL)?
Greater than or equal to 60
What is considered normal or desirable range for triglycerides?
Less than 150
What is considered borderline high range for triglycerides?
150-199
What is considered high range for triglycerides?
200-499
What is considered very high range for triglycerides?
Greater than or equal to 500
How do many patients control their dyslipidemia?
Through nonpharmacologic means like lifestyle changes
What types of dietary changes can be made to keep blood-lipid levels in check?
- Reduce dietary saturated fats and cholesterol
- Increase soluble fiber in diet
What are the causes of hyperlipidemia?
- Excessive dietary intakes of fats
- Genetic alterations in fat metabolism leading to a variety of elevated fats in the blood
What are the actions of lipid lowering agents?
- Lower serum levels of cholesterol and lipids
- Prevention of CAD
What do statins interfere with?
The synthesis of cholesterol- they work at the cellular level
What are the statins the drug of choice for?
Reducing LDL levels
What are the CNS adverse effects of statins?
- Headache
- Dizziness
- Blurred vision
- Insomnia
- Fatigue
- Cataract development
What is an adverse effect of statins that effect the liver?
Liver failure
What is an adverse effect of statins that effect the GI tract?
- Flatulence
- Abdominal pain
- Cramps
- Nausea/vomiting
- Constipation
What is the contraindications to using statins?
- Active liver disease
- history of alcoholic liver disease
- Pregnancy or lactation
What do Bile Acid Sequestrants do?
Decrease plasma cholesterol levels
What is the indication that bile acid sequestrants need to be used?
Patients with primary hypercholesterolemia- reduces elevated serum cholesterol
What are the contraindications for using bile acid sequestrants?
- Complete bile obstruction
- Abnormal intestinal function
- Pregnancy and lactation
What is the prototype for bile acid sequestrants?
Cholestyramine
True or False:
Cholestyramine is absorbed systemically?
False it is not
What does HMG-CoA inhibitors block?
The enzyme HMG-CoA reductase decreasing serum cholesterol and LDL levels.
What is the contraindications to using HMG-CoA inhibitors?
Active liver disease
History of alcoholic liver disease
Pregnancy or lactation
What are the adverse effects of HMG-CoA inhibitors?
GI symptoms: Flatulence, abdominal pain
CNS: Headache, dizziness, blurred vision
Liver failure
What type of juice interacts with HMG-CoA inhibitors?
Grapefruit juice
What is the prototype for HMG-CoA inhibitors?
Atorvastatin
What is the route, onset, peak, and duration for Atorvastatin?
- Oral
- Slow
- 1-2 hours
- 20 -30 hours
What does cholesterol absorption inhibitors do?
-Works in the brush border of the small intestine to inhibit the absorption of cholesterol
What should you use caution with if administering cholesterol absorption inhibitors?
- Elderly patients
- Liver disease
- Pregnancy or lactation
What are the adverse effects associated with cholesterol absorption inhibitors?
- Abdominal pain and diarrhea
- Headache, dizziness, fatigue
- URI
- Back pain
- Muscle aches and pain
What is the prototype for cholesterol absorption inhibitors?
Ezetimibe
What is the route, onset, and peak of Ezetimibe?
Oral
Moderate
4-12 hours
What three agents are used to lower lipid levels?
- Niacin
- Fenofibrates
- Gemfibrozil
