Lipid Management Flashcards
Familial Hypercholesterolemia
Genetic disorder, 1:500 individuals
Mutated or absent LDL receptor
High risk for atherosclerosis
Familial combined hyperlipidemia
Autosomal dominant
Increased secretion of VLDLs
Dysbetalipoproteinemia
1:10,000 ppl
Defective chylomicron catabolism
Atherosclerosis, PVD
Tuberous xanthomas, striae palmaris
When to test lipids?
Starting at 20
Test every 5 years for normal values
Statins
Lipid lowering drugs HMG-CoA Reductase inhibitors Well tolerated by most patients Very effective in lowering LDL Lipitor, crestor, zocor They all end in statin
Statin MOA
Block conversion of HMG-CoA to mevalonate, which is rate limiting step in production of cholesterol in liver.
Increases LDLs receptors in liver
Liver takes up LDLs, decreasing LDL in blood
Statins decrease ______ along with LDL levels.
triglyceride levels
Statin CI
Pregnancy
Active liver dz
Unexplained ALTs
Alcoholism
Statin SE
GI upset HA Elevated LFTs Muscle pain, weakness Proteinuria, renal failure (specific to crestor)
When should statins be taken?
Evening or bedtime
Cholesterol production occurs during sleep
All statins have an _______ effect.
Anti-inflammatory
What is the most potent statin?
Rosuvastatin (Crestor)
Bile acid resins
Decreased cholesterol abs through exogenous path
Not absorbed in GI tract
Bind bile acids in intestines, forming insoluble molecule that is excreted in feces
Increased LDL receptors in lover
Maximum effect of Bile acid resins?
dose related
3 weeks
Take with meals
Types in bile acid resins.
Cholestyramine (Questran)
Colestipol (Colstid)
Niacin
Naturally occurring B vitamin
at 100-300x normal daily dose can improve cholesterol levels
Lowers triglycerides by 50%
Niacin Contraindications
Hepatic dysfxn Hypotension Peptic ulcers Elevated uric acid levels (gout) can worsen glucose control
Niacin SE
Pruritis and flushing of face and neck
ASA 30 mins before dose helps
Hepatotoxicity
Uric acid, glucose increase
Ezetimibe (Zetia)
Cholesterol absorption inhibitors
Acts on brush border to decrease abs
Increase in clearance of cholesterol from blood
Effective if taken with a statin
Zetia SE
HA, nausea, diarrhea, abd pain
Fibric acid derivatives
Gemfibrizol (lopid), fenofibrate (tricor)
Minimal effect of LDL
Good for lowering triglycerides
Monitor LFT’s
Elevated triglyceride Tx
Fish oil supplements (omega-3)
Soluble fiber
Soy protein
What is the goal LDL in diabetic pt’s?
Less than 100
Optimal LDL Level
Less than 100
Desirable total cholesterol
Less than 200
Normal HDL
40-60
Normal serum triglycerides
Less than 150
What is the % gain with each dose doubling of a statin?
6%
Best drug to decrease triglycerides?
Tricor
