Pharm: Hyperlipidemia Flashcards
4 leading conditions associated with secondary (acquired) dyslipidemia
- Diabetes Mellitus (both types)
- HYPOthyroidism
- Cholestatic Liver Disease
- Nephrotic Syndrome
What HDL level measured on lipid panel can act as a negative risk factor for high cholesterol?
> 60 mg/dL
What are 4 Pleiotropic (when 1 thing has an influence on multiple other things) effects of statin therapy in people with high cholesterol?
- Decreased Inflammation
- Decreased endothelial dysfunction
- Decreased Thrombus formation
- More stable atherosclerotic plaque
What are the desireable or optimal levels for: Total cholesterol, LDL, HDL, and TGs according to the ATP (Association of Tennis Professionals) III classification.
Adult Treatment Panel (ATP) Total < 200 LDL < 100 HDL > 60 TGs <150
Mechanism of Statins
Inhibit HMG-CoA reductase inhibiting endogenous cholesterol production.
Which 3 statins are the most effective at lowering HDL?
Pitavastatin
Rosuvastatin
Atorvastatin
What levels of total cholesterol, LDL, HDL, and TGs are considered high cholesterol according to the ATP III classification?
Total > 240 mg/dL
LDL > 160
HDL < 40
TGs >200
Fenofibrate
MOA: fibric acid derivative that increases LPL and Apo E production to lower TGs, LDL, raises HDL.
Use: Type III hyperlipidemia
Contraindications: caution with statins, gallbladder, hepatic, or renal disease
Gemfibrozil
MOA: fibric acid derivative that increases LPL and Apo E production to lower TGs, raises HDL. (less effective at lowering LDL so Fenofibrate is better)
Use: Type III hyperlipidemia
Contraindications: caution with statins, gallbladder, hepatic, or renal disease
Lovaza
MOA: omega-3-acid ethyl ester that inhibits liver cholesterol production. Supplement approved to lower TGs and raise HDL.
Simlar to Omega 3 fish oil.
Ezetimibe (Zetia)
MOA: Inhibits NPC1L1 lipid transporter to prevent absorption of cholesterol at the small intestine brush border.
Use: mainly decreases LDL, moderate increase in HDL
Colestipol
MOA: bile acid binding resin preventing reabsorption of bile salts
Use: high cholesterol in combination with niacin.
Adverse Effects: constipation, bloating
Containdications: familial hypercholesterolemia (no functioning LDL receptors).
Cholestyramine
MOA: bile acid binding resin preventing reabsorption of bile salts
Use: high cholesterol in combination with niacin.
Adverse Effects: constipation, bloating
Containdications: familial hypercholesterolemia (no functioning LDL receptors).
Colesevelam
MOA: bile acid binding resin preventing reabsorption of bile salts
Use: high cholesterol in combination with niacin.
Adverse Effects: constipation, bloating
Containdications: familial hypercholesterolemia (no functioning LDL receptors).
Niacin/Nicotinic Acid
MOA: Raises HDL, moderately lowers LDL
Use: high cholesterol, Gout (combined with allopurinol)
Adverse Effects: acanthosa nigrans, skin flushing
Coenzyme Q10
MOA: component of the electron transport chain that is made from cholesterol
Use: prevent mitochondrial dysfunction when using statins
How does Garlic help with high cholesterol?
Inhibits HMG-CoA reductase
Antiplatelet activity
Enhanced fibrinolytic activity
Antioxidant properties
Psyllium
MOA: bulk stool forming laxative, prevents reabsorption of components from feces including cholesterol
What are the:
Goal Levels
Therapeutic Lifestyle Change Levels
Drug therapy levels
recommended by ATP III regarding high cholesterol. High risk, moderately high, moderate,low.
High:
Goal 100
DT > 100
Moderately High
Goal < 130
TLC > 130
DT > 130
Moderate
Goal < 130
TLC > 130
DT > 160
Low
Goal < 160
TLC > 160
DT > 190
