Hyperlipidemia/Hypertriglyceridemia Flashcards Preview

Pharmacology > Hyperlipidemia/Hypertriglyceridemia > Flashcards

Flashcards in Hyperlipidemia/Hypertriglyceridemia Deck (33):
1

Cholesterol

steroid, component of cell membrane, precursor for bile acids required for fat absorption, adrenal steroids and sex hormones, 40-60% is endogenous rest is from diet

2

Phospholipids

lipid containing phosphoric acid residues in addition to fatty acids and alcohol, main lipid constituent of membranes and nerve tissue

3

Chylomicrons

formed in intestines, transport dietary fat to peripheral cells and liver, taken up by cells of vessel walls, utilizing macrophages with the end results of generation of foam cells

4

Chylomicrons transport what to where

fats from intestinal mucosa to liver

5

LDL carries what to where

fat and cholesterol to the body's cell

6

High density lipoproteins carry what to where

fat and cholesterol back to liver for excretion

7

What happens when oxidized LDL cholesterol gets high

atheroma formation in the walls of arteries occurs, causing atherosclerosis

8

Causes of hyperlipidemia

diet, hypothyroidism, nephrotic syndrome, anorexia, liver disease, obesity, diabetes, pregnancy, lupus, AIDS, HEREDITARY, antipsychotics

9

Familial hypercholesterolemia

codominant genetic disorder, occur in heterozygous form, 1 in 500, mutation in LDL receptor, result in elevated levels of LDL at birth and throughout life, high risk for atherosclerosis

10

Familial combined hyperlipidemia

autosomal dominant, increased secretions of VLDL

11

HMG CO-A Reductase inhibitors

Atrovastatin (Lipitor), Simvastatin (Zocor) Pravastatin (Pravachol), Rosuvastatin (Crestor), Pitavastatin (Livalo), Lovastatin (Mevacor), Fluvastatin (Lescol)

12

MOA of Statins

inhibitor of enzyme HMG CO-A, which is a rate limiting enymes in the synthesis of cholesterol

13

Clinical uses of statins

hypercholesterolemia, prevention and secondary prevention, familial, nonfamilial, mixed, ACS, CAD, Stroke, also Cancer, infection, Alzheimer's, antiinflammatory etc

14

ADRs of statins

increased LFT, myopathies, sparks muscle breakdown

15

Statins pearls

improved efficacy when given at bedtime (simvastatin, prevastatin, NOT atorvastatin or rosuvastatin)

16

Contraindication of Statins

pregnancy category X

17

Monitoring

baseline renal function, liver function, CK, regular LFTs, educate patient S/SZ of myopathy

18

DIs of statins

Simvastatin has several di's, less with rosuvastatin, pravastatin is best option for none

19

Statin safety recommendations

select approp. dose, keep potential ADRs and DIs in mind, if high or moderate intensity dosing not tolerated, settle for maximum dose tolerated, consider dec. dose for 2 consecutive LDL

20

Bile acid sequestrants

Cholestyramine (Questran), Colestipol (Colestid), Colesevelam (Welchol)

21

MOA of Bile acid sequestrants

binds bile in GI tract for excretion to stop enterohepatic cycling, decreases plasma LDL concentration

22

Clinical uses of Bile acid sequestrants

Hypertriglyceridemia, Diarrhea

23

ADRs of bile acid sequestrants

GI, can increase TG

24

DIs of bile acid sequestrants

can decrease absorption of several other drugs because it's a chelator, take 1 hour before, 4 hours after other meds, and before meals

25

Niacin

Vit. B3, inhibits VLDL synthesis and hepatic secretion and release of FFAs from adipose, immediate and slow release, Increases HDL*, facial flushing, monitor LFT, glucose and uric acid

26

Fibric acid derivatives

inhibit synthesis of VLDL and incr VLDL removal, management of hypergllyceridemia and prevent heart disease in pt with high LDL/low HDL, mainly reduction in TG, no pregnancy, GI and myopathy ADRs

27

Types of fibric acid derivatives

Fenofibrate (Tricor etc) and gemfibrozil

28

Ezetemibe (Zetia)

inhibits absorption of intestinal cholesterol, adjunct with statins, bad study done on it, well tolerated, but abd pain/diarrhea, contraindicated mild hepatic disease, avoid for serious hepatic

29

Simvastatin+ezetemibe combo

Vytorin

30

Best for dec LDL

statins

31

Best for incr HDL

Niacin

32

Best for decr TG

Niacin and fibric acid

33

4 major statin benefit groups

pt with clinical ASCVD, LDL>190, DM 40-75 YO with LDL 70-189 and no ASCVD, pt without ASCVD or DM with LDL 70-189 and esimated 10 year ASCVD risk >7.5%