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What is elevation of blood conc. of lipid such as cholesterol or triglycerides?
What are 4 major classification of lipids?
total cholesterol, low density lipoprotein(LDL), high density lipoprotein (HDL), and triglycerides
What is friederwald equation to calculate LDL?
LDL= total cholesterol - (HDL +TG/5)
What is artherosclerosis?
- fatty substance form deposit of plaque in arterial walls
- foam cells are the initial lesion
What should the levels be for: total cholesterol, HDL, TG?
What is familial hypercholesterolemia?
What is polygenic hypercholesterolemia?
LDL 160-250 mg/dL
What is familial combined hyperlipidemia?
- LDL 160-250
- TG 200-800mg/dL
What are secondary causes of lipid disorders?
- renal failure
- obstructive liver disease
- drugs: BB, thiazide, oral contraceptive, oral estrogen, cyclosporine, glucocorticosteroids
What are the major nonlipid risk factors for coronary artery disease (CAD)?
- cigarette smoking
- family history of premature CHD
- low HLD <40
- age men greater or equal to 45;women age greater or equal to 55
- LDL <130 (2 or more risk factors)
- LDL<160 (0-1 risk factors)
Goal LDL is <100 for who?
- pt. with CHD or sumptomatic carotid artery disease
- peripheral carotid disease
- abdominal aortic aneurysm
What are the drug classes used to treat high cholesterol?
statins, bile acids (resins), nicotinic acid, fibric acids, cholesterol inhibitor, omega-3 fatty acids, combo drugs
What are the common statins? (generic/brand)
- atrovastatin (Lipitor)
- fluvastatin (Lescol)
- lovastatin (Mevacor) lovastatin ER (Altoprev)
- pravastatin (Pravachol)
- simvastatin (Zocor)
- rosuvastatin (Crestor)
What is the MOA of statins?
- inhibit HMG-CoA (3hydroxy-3methyl-glutaryl-CoA) reductase
- enzyme responsible for conversion of HMG-CoA to mevalonate
Statins are usually administered when?
- at bedtime because that is when most hepatic cholesterol production happens
- atrovastatin can be taken anytime due to longer 1/2life
What statin needs to be adjusted for renally impaired pt.?
What are the most common SE with statins?
myopathy (muscle damage), myalgia, rhabdomyolysis
Which statin is not metabolized by CYP450?
pravastatin (no drug interactions)
What are the common bile acids?
- cholestyramine (Questran)-powder
- colestipol (Colestid)-powder/tabs
- colesevelam (Welchol)-tabs
Bile acids are contraindicated when TG are?
TG >400 (caution when TG>200)
What is the MOA of bile acids?
exchange chloride for bile acids, bile excretion to decrease cholesterol
What are the SE of bile acids?
GI distress, constipation
Seperate what drugs with bile acids by 1hr before use or 4hrs after?
digoxin, levothyroxine, tetracycline, warfarin, fat soluble vitamin, minerals
What does nicotinic acid (niacin,niaspan) do?
decrease LDL and TG and increase HDL
What can you take with niacin to decrease flush?
- aspirin 325mg
- ibuprofen 200mg
What are the SE of niacin?
flush, hyperglycemia, hyperuricemia
What are examples of fibric acids?
- gemfibrozil (Lopid)
- fenofibrate (Tricor)
What is the MOA of fibric acid?
- fibrates reduce TG by reduction of apolipoprotein B
- (main role is to decrease TG)
What are the SE of fibric acids?
dyspepsia (impaired digestion), gallstones, myopathy
Fibric acids increase what drug?
- warfarin (monitor prothrombin time)
- decrease anticoagulation drug
What is the MOA cholesterol inhibitor ezetimibe(Zetia) and SE and drug interactions?
- inhibit intestinal absorption og cholesterol ay brush border of small intestine
- GI distress
- Cyclosporine (may increase zetia conc)
When is omega-3 fatty acid used?
- brand name is Lovaza
- used when TG are greater or equal to 500
- (if drug in not effective in 2months then stop Lovaza)
What are the SE of Lovaza?
burping, taste alteration, backache
What are the combo. products used?
- aspirin +pravastatin (Pravigard pack)
- ezetimibe +simvastatin (Vytorin)
- lovastatin +niaspan (Advicor)
What classes of drugs are used to decrease LDL, LDL and TG, TG?
- LDL: statins (alone or with niacin, zetia, resins)
- LDL +TG: statin with niacin or fibric acid
- TG: fibric acid or niacin
What is the only class of agents to control hyperlipidemia that is NOT contraindicated in pt. with active or chronic liver disease?
bile acids (resins)
T/F: Advicor should not be substituted for equivelent doses of immediate relase niacin?