Pharm- Hyperlipidemia

Pharm II, Exam III
Optimal LDL level
< 100 mg/dL
Optimal total cholesterol
< 200 mg/dL
minimum level for HDL
< 40 mg/dL

what to have at least 60 mg/dL
NL level for triglycerides
<150 mg/dL
What are the CHD risk equivalents?
What is in the clinical def'n of CHD?
angina, MI, angioplasty or stent placement, CABG
what is the CHD risk equivalent in CAD?
history of stroke, TIA, carotid stenosis
what is the CHD risk equivalent in PAD?
Adequate lifestyle changes trial?
12 weeks

restrict cholesterol and sat fats
regular exercise
weight reduction
inc'd leafy green veggies
inc'd fiber intake
What are the Bile Acid Sequesterants? what do they specifically help with?
1. Cholestyramine Granules
2. Colestipol Granules and tablets
3. Colesevelam

Lowering LDL! - they bind bile acid in the intestines
Are the bile acid seq. systemically absorbed?
no (ADRs are GI)
ADRs for Bile Acid Seq?
flatulence, constipation, bloating, fullness, nausea

inc'd TGs
What is the problem with Bile Acid Seq?
You will poop out any other drug you take

bind to many drugs, vitamins, nutrients
HMG-CoA Reductase inhibitors ("statins")
Atorvastatin (lipitor)
Fluvastatin (Lescol)

MOA: rate limiting step in cholesterol production is conversion of HMG-CoA to mevalonate
What is great about statins?
Affect All 3 lipid componenents!
What are the potencies of statins?
rosuva > atorva = pitava > simva = prava > lova > fluva
What is the most potent statin?
Rosuvastatin, then Atorvastatin
Which statin do we no longer dose to 80mg bc of inc'd adrs?
Side Effects of Statins
inc'd LFTs
DM - may inc blood sugar, HgA1C
what is the MOA for the muscle aches? Risk factors
ubiquinone (coenzyme Q10) deficiency

advanced age, female, renal insuf, liver dysfunction, small body frame, frail, multiple meds
general term for muscle complaint
most common!
muscle complaints without elevation in CK
muscle complaints with elevation of CK
marked inc'd CK (> 10 x UL of NL)

usually w/ creatinine elevation, brown urine, urinary myoglobin
When do you d/c statin therapy?
if 10x upper limit of normal

or symptomatic and CK continues to rise

can consider switching to different statin- switch to a less lipophilic (fluva, rosuva, prava)
what should you not drink with a statin?
Grapefruit Juice!!!

not as big of problem with fluva, rosuva, prava - less lipophilic
Drug Interxns with Statins
Grapefruit juice (rhabdo)
Niacin, Fibric Acid Deriv. (hepatotox.)
BAS (dec'd absorption)
When should we not use statins?
chronic liver disease
Niacin (nicotinic acid)? MOA? max dose?
Niaspan (sustained release)

reduces production of VLDL in liver - primarily biotransformation in liver (dec'd syn of LDL, TGs, inc'd HDL!)

max dose 2 g/day due to hepatoxicity
Niacin side effects
cutaneous flushing
Inc'd uric acid - gout attack
inc'd blood sugar
liver dysfunction
When should you not take niacin?
Gout, DM, PUD, chronic liver disease
which drug can cause a gout flare?
Fibric Acid Derivatives? MOA?
Fenofibric Acid

increase lipoprotein lipase = reduce VLDL - used to treat TGs only

dec'd TGs 20-50%!
which drug lowers TGs only?
Fibric acid derivatives
side effects of fibric acid derivatives?
myositis/myopathy - usually if combined with niacin or statin
what drug interaction is a problem with fibric acid derivatives?
Statins - inc'd hepatotoxicity and inc'd risk of rhabdomyolysis
When do you need to use caution with fibric acid derivatives?
gallstone patients
Cholesterol Absorption inhibitors? MOA?
Ezetimibe (Zetia)

inhibits cholesterol abs in small intestine, inc'd syn of LDL receptors decreasing LDL levels
- inhibs ~54% of all intestinal cholesterol absorption
what does Zetia primarily Lower?
what is the best combination therapy?
Simvastin + Ezetimibe (Vytorin)

can be controversial, we don't recommend right off the bat - inc'd risk of side effects
Red Yeast Rice has same MOA as what?
What do omega 3 fatty acids do?
prevent heard disease
decrease triglycerides
anti-inflammatory properties
Omega 3 FA agents
Eicosapentaenoid acid (EPA)
Docosahexaenoic acid (DHA)

Alpha-Linolenic acid (vegan option, not as good)
What is the RX only Omega 3 FA drug?
what is the recommended amount of omega 3?
What is a potential problem with too high of a dose of omega 3?
risk of bleeding (anticoagulant)

important to know before surgery if ppl are on these!