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Chapter 27 FINAL PHARM!!!
Terms in this set (34)
-Produced by the liver
-Transports endogenous lipids (mostly triglycerides) from liver to adipose tissue and muscle cells to use as fuel
-↑ VLDS -> ↑ risk of pancreatitits
Very low density lipoprotein (VLDL)
-Transports cholesterol to non-hepatic tissue
-By-product of VLDL degradation
-Greatest contributor to coronary atherosclerosis•↑ level of LDL ->
↑ risk of Coronary Heart Disease (CHD)
•↓ level of LDL -> ↓ risk of CHD
Low density lipoprotein (LDL)
-Responsible for transporting cholesterol from peripheral tissues back to the liver
-Also known as "good cholesterol"
-↑ level of HDL -> ↓ risk of CHD
High density lipoprotein (HDL)
Male 45 years or older
Female 55 years or older
Family history of premature CHD
•Current cigarette smoker
BP 140/90 or higher, or on antihypertensive medication
•Low HDL levels: less than 40 mg/dL
Coronary Heart Disease Positive Risk Factors
Coronary Heart Disease Negative (Beneficial) Risk Factor?
High HDL ("good" cholesterol) RANGE?
Therapeutic Lifestyle changes OF choltesterol?
Diet, weight control , exercise, smoking cessation
-Drugs used to lower lipid levels
-Used as an adjunct to diet therapy
Antilipemics: HMG-CoA Reductase Inhibitors (HMGs, or statins)
•Most potent LDL reducers are?
DRUGS ends with STATIN!
HMG-CoA Reductase Inhibitors: Mechanism of Action
•Inhibit HMG-CoA reductase, which is used by the_____ to produce cholesterol
•Lower the rate of cholesterol production
MG-CoA Reductase Inhibitors: Indications
•First-line drug therapy for?
hypercholesterolemia, Atherosclerotic cardiovascular disease (CVD),Diabetics,LDL >70, metabolic syndrome
HMG-CoA Reductase Inhibitors: Adverse Effects
Headache, Myopathy, liver enzymes, rash
Bile Acid Sequestrants drugs are?
Also called bile acid-binding resins and ion-exchange resins
cholestyramine (Questran), colestipol hydrochloride (Colestid),colesevelam (tablet form only)
Prevent resorption of bile acids from small intestine
•Bile acids are necessary for absorption of cholesterol
Bile Acid Sequestrants Mechanism of Action
•Type II hyperlipoproteinemia
- Relief of pruritus associated with partial biliary obstruction (cholestyramine only )
•May be used alone or with a statin
Bile Acid Sequestrants Indications
Bile Acid Sequestrants: Adverse Effects
Constipation, Heartburn, nausea, belching, bloating
What drugs is Niacin?
Vitamin B3 (Nicotinic acid)
What class does treat dyslipidemia that
LOWERS LDL, TRIGLYCERIDES, and INCREASES HDL
stop the adipose from becoming free fatty acids,
Thought to increase activity of lipase, which breaks down lipids
•Reduces the metabolism or catabolism of cholesterol and triglycerides
Niacin mechanism of action
Adverse affects of Niacin
What drugs when taking NIACIN to REDUCE flushing that should take 30 minutes and take apple sauce
Fibric Acid Derivatives drugs are?
gemfibrozil (Lopid),fenofibrate (Tricor)
This class Decrease the triglyceride levels
Increase HDL by as much as 25%
GOOD for patient experience Hypertriglyceridemia.
Fibric Acid Derivatives
What the normal Triglycerides range?
Triglycerides and Cholesterol
____________________ that must be bound to apolipoproteins ( specialized lipid-carrying proteins)
The risk of CHD in patients with cholesterol levels of ______mg/dL is three to four times greater than that in patients with levels less than 200 mg/dL
Which Cholesterol Absorption Inhibitor drugs do?
-Inhibits absorption of cholesterol and related sterols from the small intestine
-Results in reduced total cholesterol, LDL, and triglyceride levels
-Also increases HDL levels
-Often combined with a statin drug
-Clinical usefulness has been questioned; new trials underway
-Currently recommended only when patients have not responded to other therapy
•Used as an antispasmodic, antihypertensive, antiplatelet, lipid reducer
•Adverse effects: dermatitis, vomiting, diarrhea, flatulence, antiplatelet activity
•Possible interactions with warfarin, diazepam
•May enhance bleeding when taken with NSAIDs
Herbal Product: used to:
-Both the seed and oil of the plant are used
•Uses: atherosclerosis, hypercholesterolemia, GI distress, menopausal symptoms
•May cause diarrhea and allergic reactions
•Possible interactions: antidiabetic drugs, anticoagulant drugs
Herbal products used to:
•Fish oil products
•Used to reduce cholesterol
•May cause rash, belching, allergic reactions
•Potential interactions with anticoagulant drugs
Omega 3 Fatty Acids
Obtain baseline liver function studies
•Patients on long-term therapy may need supplemental fat-soluble vitamins (A, D, K)
•Take with meals to decrease GI upset
•Counsel patient concerning diet and nutrition on an ongoing basis
•Instruct patient on proper procedure for taking the medications
•Powder forms must be taken with a liquid, mixed thoroughly but not stirred, and NEVER taken dry
•Other medications should be taken 1 hour before or 4 to 6 hours after meals to avoid interference with absorption
To minimize adverse effects of niacin, start on low initial dose and gradually increase it, and take with meals
•Small doses of aspirin or NSAIDs may be taken 30 minutes before niacin to minimize cutaneous flushing
•Inform patients that these drugs may take several weeks to show effectiveness
—it is believed that these drugs work by activating the lipoprotein lipase, an enzyme responsible for the breakdown of cholesterol.
Fibric acid derivative
Exact mechanism unknown; beneficial effects are believed to be related to its ability to inhibit lipolysis in adipose tissue, decrease esterification of triglycerides in the liver, and increase the activity of lipase
lipid lowering drug and vitamins
Reduces blood cholesterol by decreasing the rate of cholesterol production
HMG CoA reductase inhibitor
Binds bile, preventing the resorption of the bile acids from the small intestine. The insoluble bile acid and resin (drug)
Bile acid sequestrant
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