Management of Hyperlipidemia Flashcards
What are hereditary causes of hyperlipidemia?
familial hypercholesterolemia: Mutation in LDL receptor results in unregulated synthesis of LDL. Familial combined hyperlipidemia: increased secretions of VLDLs. Dysbetalipoproteinemia: defective form of apoE involved in catabolism of VLDL
What is recommended as initial therapy in patients with acute coronary syndrome?
intensive statin therapy or if unable to tolerate statins than treated with another lipid lowering agent
In what patient population is the target LDL below 70?
patients at very high risk for CHD events
Which patients are at very high risk for CHD events?
established coronary heart disease plus: DM, smoking, metabolic syndrome, or acute coronary syndrome
When should lipid panels be checked?
Beginning at age 20: obtain a fasting serum lipid profile of total cholesterol, LDL, HDL and triglycerides. Repeat testing every 5 years for acceptable values
What are ranges for HDL?
< 40 low, > 60 high
What are ranges for serum triglycerides?
< 150 normal, 150-199 boderline, 200-499 high, > 500 very high
What are ranges for total cholesterol?
< 200 desirable, 200-239 borderline, > 240 high
Name the 7 main statins
rosuvastatin (Crestor), Atorvastatin (Lipitor), Simvastatin (Zocar), Lovastatin (Mevacor), Pravastatin (Pravachol), Fluvastatin (Lescol), Simvastatin/Ezetimibe (Vytorin)
How do statins work?
HMG-CoA reductase inhibitors. Lower LDL and decrease morbidity/mortality. Well tolerated.
What are contraindications to statins?
pregnancy, active liver disease, unexplained elevated aminotransferase levels (ALTs), alcoholics
What are SE of statins?
GI upset, HA, elevated LFTs, muscle pain/weakness, protenuria and renal failure.
What drugs increase the SE of myopathy associated with statins?
erythromycin, niacin, gemfibrozil, cyclosporine
Why should statins be taken in the evening or at bedtime?
Significant amount of cholesterol production seems to occur during sleep. Lovastatin (Mevacor) and Atorvastatin (Lipitor) are exceptions
How do bile resins reduce hyperlipidemia?
Decrease cholesterol absorption through exogenous pathway. Are NOT absorbed through the GI tract. bind bile acids in the intestines, forming a complex that is excreted in the feces.
How can niacin be used to reduce hyperlipidemia?
improve cholesterol levels when used at doses 100-300 times the recommended daily allowance. decreases VLDL synthesis in liver and increase lipoprotein lipase activity
Name the bile acid resins
cholestryamine (Questran) and Colestipol (Colstid)
What are CI to niacin?
hepatic dsyfxn, hypotension, peptic ulcer, gout, can worsen glucose control
What are SE of niacin?
pruritis and flushing of face and neck, hepatotoxicity, uric acid and glucose increases
How does Ezetimibe (Zetia) a cholesterol absorption inhibitor work to reduce hyperlipidemia?
Inhibits the absorption of cholesterol and causes a reduction of hepatic cholesterol store. complementary to that of the STATINS
What are CI of ezetimibe (Zetia)?
if used with a statin hepatic disease or elevated ALTs
What are SE of ezetimibe (Zetia)?
HA, diarrhea, abdominal pain
What are the fibric acid derivatives?
Gemfibrozil (Lopid) and fenofibrate (Tricor)
How are fibric acid derivatives used?
Good for lowering triglycerides from the stimulation of lipoprotein lipase, which enhances the breakdown of VLDL to LDL, but have minimal effect on LDL
