Treatment of Lipid Disorders Flashcards
What is hypertriglyceridemia?
Elevated triglycerides >150 mg/dL
What does cholesterol make?
Cell membranes
Organelle membranes
Adrenocortical hormones
Estrogen and testosterone
What cholesterol levels puts a patient at risk for cardiovascular disease?
Elevated plasma levels of total cholesterol and LDL, and/or Low levels of HDL
What controls the plasma cholesterol concentration?
Plasma cholesterol concentration controlled by plasma LDL concentration
What are some causes of hypercholesterolemia?
Diet
Lack of insulin or thyroid hormone
Genetic disorder
What are the NIH guidelines for healthy cholesterol levels?
Total cholesterol 60 mg/dL
What are the primary treatments for hypercholesteremia?
Dietary regulation
Weight reduction
Exercise
What are the actions of statins?
Lowers LDL concentration while increasing HDL concentration
Decreases oxidative stress and vascular inflammation
Stabilizes atherosclerotic lesions
What is the mechanism of action of statins?
HMG-CoA reductase inhibitors (prevents conversion of cholesterol)
What are the major side effects of statins?
GI upset, fatigue, headache
Hepatic Dysfunction
Myopathy
Rhabdomyolysis (rare)
How can statins effect coagulation in patients taking anticoagulants?
PT can be increased in pts taking warfarin
What does Niacin do to help patients with hyperlipidemia?
Inhibits synthesis of VLDLs
Inhibits release of free fatty acids from adipose tissue
resulting in a decrease in LDLs and triglycerides and increased HDLs
How can statins induce myopathies?
From medication interaction with amiodarone or verapamil
How does niacin affect blood glucose levels in a healthy individual?
It can cause hyperglycemia and abnormal glucose tolerance in nondiabetic patients
What causes the cutaneous flushing seen with large doses of niacin administration?
Intense prostaglandin-induced cutaneous flushing
How does niacin affect the use of antihypertensives?
Prostaglandin release causes exaggerated vasodilation therefore possible potentiation of antihypertensives
What is a bile acid binding resin?
Chloride salt of an ion exchange resin
What is the mechanism of action of bile acid binding resins?
Resins bind bile acids in intestines, increase fecal excretion, and increase hepatic bile acid synthesis from cholesterol stores
Results in more LDL receptors = increased uptake and decreased plasma concentrations
What is a drawl back to utilizing acid bile resins?
Poor palatability
What metabolic disturbance may be seen in patients that use acid bile resins?
Hyperchloremic acidosis
What drug’s absorption may be impaired by acid bile resins?
Thiazides, warfarin, digitalis, beta blockers
In order to avoid drug interactions, when should other drugs be given in combination with acid bile resins?
Other drugs should be given 1 hr before or 4 hrs after
What is the mechanism of action of fibrates?
Drug-induced increases in activity of lipoprotein lipase
When are vibrates indicated?
Most effective drugs for decreasing plasma triglycerides
Increase HDL, variable effects on LDL
How might fibrates affect patients taking anticoagulants?
They can potentiate anticoagulant effect of warfarin
How do omega-3 fatty acids affect patients with hyperlipidemia?
Decreases plasma levels of triglycerides but no significant effects on HDL/LDL
Why is it important to know that omega-3 fatty acids are not considered drugs?
Not regulated by FDA
Safety of long term use unknown
How do omega-3 fatty acids affect bleeding during surgery?
Patients seem to be more oozy or at an increased risk for bleeding
