Lipid medication Flashcards
CV Risk Factors
Non-modifiable Risk Factors
Genetic Predisposition
Age
Gender -More common in male than female (until women get menopause)
Modifiable Risk Factors
Metabolic Syndrome
Cigarette Smoking
Sedentary Lifestyle
High Stress Levels
Hypertension
Obesity
Diabetes
Untreated Bacterial Infections
Low-Density Lipoproteins (LDL)
Bad Cholesterol
Enter circulation as tightly packed cholesterol, triglycerides, and lipids
Carried by proteins that enter circulation; broken down for energy or stored for future use as energy
High-Density Lipoproteins (HDL)
Good Cholesterol
Enter circulation as loosely packed lipids
Used for energy; pick up remnants of fats and cholesterol left in the periphery by LDL breakdown
Triglycerides
Bad (since increases with LDL)
Composed of free fatty acids and glycerol
Stored in adipose tissue
Cholesterol and Triglyceride Levels
Total Cholesterol-
> 200 (desired level)
200-239 (board line high)
240 + (high)
LDL-
>130 (desired level)
130-159 (board line high)
160+ (high)
HDL-
50 + (desired level)
40-49 (board line high)
>40 (high)
Triglycerides-
>200 (desired level)
200-399 (board line high)
400+ (high)
HMG CoA Reductase Inhibitors
Medications: “Statins”
- First line treatment
-Block synthesis of cholesterol in the liver
-Decreases levels of LDL by 25% to 65%
-Modest decreases in triglycerides (10% to 40%) and very modest increases in HDL (5% to 17%) may occur
-Category X- Do not give to pregnant women.
People who should be on a Statin
Adults with a history of cardiovascular disease
Those with LDL-C level of greater than 190 mg/dL
Adults 40-75 years with diabetes
Adults 40-75 years with LDL-C level of 70-189 mg/dL and a 5% to 20% 10-year risk of developing cardiovascular disease
MEDS for HMG CoA Reductase Inhibitors
Start with lower dose and increase as needed
Rosuvastatin (Crestor):
Most potent: 5 to 20 mg day
Atorvastatin (Lipitor):
10 mg/day initially, increase no fewer than 2 to 4 weeks
Simvastatin (Zocor):
20 to 40 mg/day
May need to decrease dose occasionally.
When adding potentially interacting drug
Profound drop in LDL
Pravastatin:
40 mg/day
Lovastatin (IR): (Less potent) 20 mg/day (XR) 40 to 60 mg
-Pediatric dosing for children 8 to 13 years: 20 mg/day
-Meds given in the evening/bedtime
(Except Rosuvastatin and Atorvastatin -can be given in the morning)
-Check lipid panel 4-6 weeks after starting medication
Statin Adverse Effects
Most common side effects:
headache, dizziness, insomnia, fatigue, flatus (gas), abdonimal pain, Nausea/Vomiting, constipation
Myopathy:(muscle weakness) Reduced by using lowest effective dose
May cause rhabdomyolysis (break down of muscle)
Cautiously combining statins with fibrates
Avoiding drug interactions
Increase in liver enzymes
DO Not give to clients with Active liver disease
Can also cause Coenzyme Q10 deficiency – contribute to myopathy. Helps decrease the side effects
PCSK9 Inhibitors
PCSK9- (Cholesterol over 300+) high risk clients
A protein produced by the liver, plays a role in regulating LDL
Reduces inflammation and stress on the plaque.
Decreases risk of cardiovascular events (heart attack or Stroke)
Often given in conjunction with statins
Medications:
Are monoclonal antibodies
Administration by injection-expensive meds
Evolocumab (Repatha)
Given SQ either every 2 weeks or monthly
Monthly injection
Alirocumab (Praulent)
Given SQ either every 2 weeks (75mg) or every month (300mg dose is given as 2 injections)
STATIN
S-sore muscles
T-Toxic (increase when drinking grapefruit)
A-ALT/ AST (liver enzymes) monitored
T-Therapeutic effects (lowered LDLs and Increased HDSs)
I- Increase glucose
N- Not a cure!
Bile Acid Sequestrants
2nd line of treatment
Bind with cholesterol in the intestine and increase excretion of bile acids in stool
By promoting an increase in bile acid excretion, they enhance the conversion of cholesterol to bile acids by the liver
May use with patients with active liver disease
Lower Total cholesterol, triglyceride, and LDL levels and elevate HDL
Strong record of efficacy and safety
Not used routinely
Can be used with pregnant women
Can be used together with fibrates.
Side effects:
Constipation
Abd pain
Bloating
Diarrhea
Heartburn
Gallstones
Can inhibit absorption of fat soluble vitamins (A, D, E, and K) Getting rid of fat
Niacin (vitamin B3)
Inhibits the release of free fatty acid release from adipose tissue
Increases rate of triglyceride removal from plasma
Lower Total cholesterol, triglyceride, and LDL levels and elevate HDL
Given at bedtime
Not used much anymore-research proved it didn’t work well
Adverse Effects
Flushing,
Nausea
Abdominal pain
Increase uric acid levels
Can cause liver toxicity
Drug interactions
Alcohol
Statins, fibrates
Often take with an ASA to help prevent flushing
Fibrates
Lower Cholesterol level
Inhibition of cholesterol and synthesis
Decreased triglyceride synthesis
Inhibition of lipolysis in adipose tissue
Lower Total cholesterol, triglyceride, and LDL levels and elevate HDL
Pharmacokinetics
Absorbed in GI tract, metabolized by the liver, and excreted in urine
Drugs:
Fenofibrate (Tricor)
Gemfibozil (Lopid)
Fenofibric acid (Tripipix)
Adverse effects
Increase uric acid levels
Increase risk of rhabdomyolysis (rare)
GI tract
Headache
Drug interaction
Warfarin
Statins
Monitoring:
-Lipid levels in 4 to 6 weeks then every 3 to 4 months until control established
-LDL levels most important to watch
-LFTs before starting and as needed
Adverse reactions: constipation or flatulence
Lifestyle changes:
Diet/Exercise
Ezetimibe (Zetia)
Inhibits absorption of cholesterol in small intestine
Lowers LDL
Side effects: abdominal pain, diarrhea and arthralgias
Don’t give to pregnant or liver disease
