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Statins are prescribed to primarily treat ____.
- *treat an elevation in LDLs and only a slight elevation in triglycerides
Fibric acid derivatives are indicated for the treatment of ____.
Low HDL levels and mild elevation in triglycerides
Which antihyperlipidemic drug is used to treat all kinds of high cholesterol or triglycerides?
*remember... can develop red mans syndrome. Take an aspirin 30 mins before Niacin to prevent. Avoid taking with hot fluids--can increase flushing
What is Lovaza or fish oil (omega 3's) used to treat?
in conjunction with diet, Lovaza is used to treat VERY HIGH >500 triglyceride levels in adults.
Name a few secondary causes of hyperlipidemia...
Disease states: Acute hepatitis, DM, hypothyroidism, Lupus, MI
Drugs: ETOH, Bblockers, glucocorticoids, oral contraceptives, thiazide diuretics, retinoids
What are two nonpharmacological treatment of high cholesterol?
Diet and Exercise (exercise is the only thing that will increase HDL levels)
*also should stop smoking, decrease BP, control DM, decrease weight!!
Fibric Acid Derivatives MOA
unsure of MOA
Decreases triglycerides and increases HDL concentrations .
What is the MOA of HMG-CoA Reductase Inhibitors?
And what are examples of drugs in this class?
- Blocks the synthesis of cholesterol to decrease LDL level but blocking the conversion of HMG-CoA Reductase to mevalonate, a cholesterol precursor.
- Also increase HDL and decrease triglycerides.
- examples -- STATINS!!!!
- Atorvastatin (Lipitor)
- Rosuvastatin (Crestor)
Bile Acid Sequestrants MOA
not absorbed systemically- can cause significant fluid loss from the rectum
Safest of drugs for hyperlipidemia because they are not systemically absorbed.
What is Niacin's MOA?
acts on lipase to inhibit the release of free fatty acids from adipose tissue, leads to decrease synthesis of VLDL causing a decrease in LDL.
What is the MOA for selective CHO absorption inhibitors?
decreases the amount of cholesterol absorbed from the diet.
it does not effect triglycerides
What is the MOA for Omega 3s?
Reduce up to 50% of hepatic production of triglycerides ---- decreases VLDL, HDL is unaffected and LDL may increase
What do you want baseline LDL levels to be?
Less than 100
What is the primary goal of CHO therapy?
What are the drugs preferred as first line treatment for high cholesterol?
- Statins (HMG-CoA reductase inhibitors)
What is the target LDL level for patients with CAD, DM or 10yr risk of developing CAD?
If triglycerides are greater than 500 you want to lower triglycerides to prevent pancreatitis by adding
fibrate or niacin
Treatment of patient with high LDL and no CHD is considered
Treatment of patients with CHD and high LDL is considered
Statins should be given to patients with CHD, PVD, or history of stroke as
If you reach your goal LDL and your triglycerides are 200 to 400 what should you do?
add niacin or fibrate to statin
If the max dose of statin does not reach your goal LDL what should you do??
add ezetimibe (Zetia) or bile acid sequestrant(Welchol)
What are the 2 most common ADRs with Statins?
hepatotoxicity and muscle toxicity
*all patients should report immediately any muscle discomfort or weakness and brown urine.
Which statin has the greatest LDL lowering potential?
Which hyperlipidemics are highly effective in decreasing triglycerides and increasing HDL?
Which are the most effective?
Fibric Acid Derivatives (tricor and lopid) & Niacin
Niacin is MOST EFFECTIVE
Niacin effects LDL but Lopid (fibric acid derivative) does not
Treatment with a statin and/or a fibrate (lopid) protects diabetic patients from what??
Nerve damage (neuropathy)
You should not prescribe Niacin to patients with ____. Why?
Gout --- Niacin causes hyperuricemia
Zetia decreases the intestinal CHO absorption by???
as a monotherapy, can decrease LDL, increase HDL and decrease triglycerides
works in as little as two weeks.
What labs should you obtain with treating patient with antihyperlipidemics?
Lipid profiles at baseline, 1 mo, 3 mo, and 6 mos.
if stable..can check yearly LDL
LFT's should be done at baseline and at 3 mos.
If a patient has myalgias (weakness) you should check what labs?
may need to check labs more frequently if using a combination of drugs to treat patient---as they have an increased risk of hepatotoxicity and myopathy.
What is the drug of choice in children for high CHO?
Bile Acid Sequestrant CHOLESTYRAMINE
although rarely used.. with children.. typically choose lifestyle modifications and diet to treat
Get GI specialist to help with tx in kids
What preggo category are statins?
When should you take Lovastatin?
with evening meal to increase absorption
Advicor is a combination of ____ and ___.
lovastatin and niacin