HLD Flashcards
HMG-CoA Reductase Inhibitors
Statins
MOA: Block the conversion of HMG-CoA to me also ate, which is the rate-limiting step in the production of cholesterol in the liver
Max effects: p 4-6 wks of therapy- dose adjustments should not be made more frequently than q 4 wks
Not to be used in pregnancy, cation in lactation, not used in active liver disease, unexplained LFT, or heavy ETOH use
Adverse effects: myopathies, CPK levels ⬆️ 10x normal level asses for rhabdo
Check baseline LFT and CK and repeat q 4-6wks with dose changes
Cholesterol absorption inhibitor
ezetimibe/Zetia
MOA: inhibits absorption of cholesterol (only one on the market)
Not to be used in pregnancy, liver disease, or in combo with a statin
Adverse effects: HA, diarrhea, abd pain, myopathy, rhabdo when used with a statin
Check lipid levels and LFTs
Bile Acid Resins
MOA: decrease cholesterol absorption through the exogenous pathway: can decrease LDL by 15 to 30%, increase HDL by 3%, increased triglycerides by 15%
Not absorbed in GI tract: binds to bile acids in intestines
Not to be used in fasting triglyceride levels > 300mg/dL. Use cautiously in tri levels 250-299
Adverse effects: GI related- flatulence, bloating, and abdominal pain, heartburn, and constipation
Take with food
Niacin
MOA: naturally occurring B vitamins that can improve cholesterol levels when dosed 100 to 300 times the recommended daily vitamin allowance. Can decrease LDL and triglycerides
Not to be used in hepatic dysfunction, severe hypertension, persistent hyperglycemia, acute gout, new onset a fib, or acute peptic ulcer‘s. Can Raise uric acid levels, use cautiously in DM or gout.
Adverse effects: increases prostaglandin activity (flushing to the face and neck (Can take 325 mg of aspirin 30 minutes before dose to reduce) this can worsen glucose control. GI effects, rash, hep tic, ACA this is nigricans
Fibric acid Derivatives
MOA: Principal effect of triglyceride lowering appears to result from the stimulation of lipoprotein lipase, when enhances is the breakdown of VLDL to LDL cholesterol. Can lower triglycerides by 60% and increase HDL by 30%
Not to be used in patients with history of gallstones, hepatic/renal dysfunction
Adverse effects: muscle toxicity with patients treated already with a Statin, Interfere with the metabolism of warfarin so lower doses, rhabdo, cholestatic jaundice, leukemia, anemia, or thrombocytopenia, hep tox
Check LFTs at 6 and 12 wks
Other meds should be taken 1 hr before or 4 hrs after what HLD Med?
Bile acid resins
Grapefruit juice is ok to take with which statin?
Pravastatin
Which HLD Med can cause flushing of the face and neck and what can the patient do about it?
Niacin (nicotinic acid)
They can take aspirin 325mg 30 min prior to niacin dose
What lipid marker level would be a contraindication for bile acid resins and why?
Fasting TG level >300 because bile acid resins can increase TG levels
Which HLD class mostly affects and is used for severe TG levels?
Fibric acid derivatives
