Drugs for Lipid Disorders

Question 1

what are the three main types of lipids?

Answer 1

• triglycerides
• phospholipids
• steroids

Question 2

triglycerides

Answer 2

• account for 90% of total lipids in the body

- important source of energy

Question 3

phospholipids

Answer 3

• essential for the formation of plasma membranes

Question 4

steroids

Answer 4

• building block for bile acids, vitamin D, cortisol, estrogen and testosterone
• cholesterol

Question 5

what are the three lipoproteins?

Answer 5

• high density lipoprotein (HDL)
• low density lipoprotein (LDL)
• very low-density lipoprotein (VLDL)

Question 6

high-density lipoprotein

Answer 6

• transports cholesterol from tissues back to the liver

Question 7

low-density lipoprotein

Answer 7

• transports cholesterol from the liver to tissues

Question 8

very low-density lipoprotein

Answer 8

• primary carrier of triglycerides

Question 9

dyslipidemia

Answer 9

• increases risk for atherosclerosis and coronary artery disease
• occurs predominantly in men compared to non-menopausal women
• after menopause, risk becomes higher because the protective effects of estrogen are gone
• associated with generic alterations in fat metabolism and with excessive dietary intake of fats
• moderate alcohol consumption increases “ good: cholesterol (HDL) levels

Question 10

what are some non pharmacological management of lipid disorders?

Answer 10

• eliminate smoking
• moderate alcohol consumption
• maintain weight
• regular exercise and stress
• reduce dietary saturated fat, trans-fat, and cholesterol
• increase consumption of plant sterols/stanols and soluble fibre (nuts, olive oil, corn, rye, oats, rice, wheat)

Question 11

statins (HMG-CoA reductase inhibitors mechanism of action

Answer 11

• blocks cholesterol synthesis
• increase the number of LDL receptors in the liver and stimulates removal of LDL From the blood
• can be combined with other cholesterol lowering medications and antihypertensive medications
• contraindicated in women who are pregnant

Question 12

what are some adverse effects of statins?

Answer 12

• headache, GI upset, heartburn

Question 13

what are some drug-drug & drug-food interactions with statins?

Answer 13

• avoid alcohol and grapefruit juice
• risk of rhabdomyolysis increased with drugs that inhibit CYP 450 enzymes
• potentiate the effects of warfarin and increase estrogen levels in women using combination oral contraceptives
• proton pump inhibitors and H2RA antagonists increase bioavailability of some statin drugs

Question 14

selective cholesterol absorption inhibitors

Answer 14

• inhibits intestinal cholesterol absorption; blocks absorption up to 50%
• often co administered with statin therapy for clients that fail to reach their LDL targets with statin therapy alone
• combination tablets available

Question 15

what are some adverse effects/contraindications selective cholesterol absorption inhibitors?

Answer 15

• GI distress
• cannot be co-administered with bile acid resins; as they reduce efficacy of selective cholesterol absorption inhibitors

Question 16

bile acid resins

Answer 16

• bind to bile acids and increase the excretion of cholesterol
• reduction in cholesterol levels induces the formation of additional LDL receptors in the liver, increasing the rate at which LDL is removed from the blood
• about 20% drop in LDL cholesterol levels

Question 17

contraindications of bile acid resins

Answer 17

• interferes with absorption of other drugs; thiazide diuretics, warfarin, thyroid hormones, corticosteroids
• take other meds 1 hour before or 4 hours after
• may induce vitamin deficiency; vitamin A, D, E and vitamin K deficiency leads to increase bleeding

Question 18

PCSK9 inhibitors

Answer 18

• inhibits PCSK9 proteins that target the liver LDL receptors for degradation, more LDL receptors are on the liver and LDL gets brought into the liver
• lower LDL levels by 50-70%
• inject subcutaneously every 2 weeks, or once a month

Question 19

Niacin

Answer 19

• no longer recommended for the routine management of hypercholesterolemia
• may still have a role for those clients at a very high risk for cardiovascular events with contraindications for satins or bile-acid sequestrants
• toxicity profile for most patients