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46 Cards in this Set
- Front
- Back
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High total cholestrol is...
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>240
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Lowering cholestrol has what 4 effects?
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1. Reduces cardiovascular morbidity and mortality
2. slows progression of atherosclerosis 3. Reduce CHD events and CHD mortality 4. Reduce morbidity and mortality from CHD in pts with CHD |
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Cholestrol is...
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A type of lipid required for cell fxn. Obtained from diet or synthesized from liver
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Triglycerides are...
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Molecules made of fatty acids and glycerol. Found in diet and made from CHO in liver, excess fats are stored as triglycerides. Packaged into VLDL for transport in bloodstream.
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Lipoprotein
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particle made of a protein with lipids to form a carrier for transport of nonpolar lipids in plasma. Includes Chylomicrons, VLDL, IDL, LDL and HDL
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Cholymicrons...
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Transport dietary TG and cholestrol, originate from intestines, deliver TG to fat tissue and cholestrol to liver, absent in blood after 12-14 hour fast.
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VLDL:
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Very low dinsity lipoprotein: transports endogenous TG, originate from intestines and liver
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Lipoprotein A...
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composed of LDL and protein called apo(a).
Linked to heart disease Lp(a) lvls are inherited Hart to remove from blood stream |
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Intermediate density lipoprotein (IDL)
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Derived from VLDL breakdown in capillaries and converted into LDL OR removed from blood by liver
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LDL...
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Bad cholestrol
Transports cholestrol to peripheral tissues Mostly responsible for atherosclerosis and CHD. |
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HDL:
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Good cholestrol...transports cholestrol from tissues to liver, natural antioxidant.
Comes from liver and intestine |
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What is primary etiology of hyperlipidemia?
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Genetic predisposition
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What is secondary etiology of hyperlipidemia?
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lifestyle
diet disease states meds |
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What meds can cause hyperlipidemia?
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Alcohol
progestins thiazide diuretics beta blockers glucocorticoids cyclosporine |
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What are risk factors for CHD?
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Male >45 y.o. female >55 y.o
family history of CHD Cigarette smoking Hypertension HDL<40 If HDL >60 subtract 1 risk factor |
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How many risk factors are needed to be considered high risk?
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2 or more
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What is the goal cholestrol?
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<200 with HDL>40
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If pt is 200-239 with >40 HDL and 2RF or <40 HDL or 2RF, what should be done>
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Educate, recheck in 102 years. Lipoprotein analysis
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If pt has high cholestrol (>240), what should be done?
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Lipoprotein analysis.
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What is the goal for pt with no CHD or any risk factors? When would you start diet/drug?
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LDL<160
Diet at 160, drug at 190 |
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What do you want LDL to be for pt with no CHD but at least 2 RF?
Diet at? Drug at? |
Goal is LDL of 130
Diet at 130 Drug at 160 |
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What do you want LDL to be for pt with CHD?
Diet at? Drig at? |
Goal: LDL<100
Diet at 100 Drug at 130 |
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What is the new LDL goal for all pts?
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LDL<70
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Bile acid binding resins
MOA: |
MOA: Bine bile acids in intestinal lumen to form nonaborbable complex that is excreted in feces. Liver compensates by converting more chol to bile acids causing a drop in chol concentration.
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Bile acid binders Effect on lipids:
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LDL: Decrease 15-30%
HDL: Increase 3-5% TG: not affected |
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Cautions with Bile acid binders?
Rx interactions? |
History of GI probs
Biliary obstruction Pregnancy and lactation Hypercholremic acidosis Don't give with rx absorbed through gut, space administration. |
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A/e of bile acid binders?
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GI: constipation, bloating, gas, nausea
Prevent with high fiber diet and fluid intake. |
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How long do bile acid binders take to work?
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About a month so be patient!
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Nicotinic acid
MOA: |
MOA: Inhibits secretion of VLDL from liver causing decrease in produciton of LDL. This lowers triglycerides.
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Nicotinic acid effects on lipids?
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LDL: decrease 10-25%
HDL: increase 15-35% TG: decrease 30-50% |
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Do NOT give nicotinic acid to pts with...
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liver disease
active PUD OR TO PTS TAKING STATINS |
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A/e of nicotinic acid?
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Vasodiliatino leading to flushing, itching, tingling, headache, urticaria. Take with food to avoid.
GI |
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Should you take with food? When will you see lower numbers?
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Yes, with food.
See lower TC in several days Lower TG in hours |
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Statins
MOA: |
Inhibits HMG CoA reductase which interferes with the rate limiting step in chol synthesis
Increases LDL receptors on cell surfaces Enhanced clearance of LDL and VLDL Modest decrease in TG |
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Statins effects on
LDL: HDL TG: |
LDL: Decrease 20-55%
HDL: increase 5-22% TG: Decrease 10-43% |
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Cautions?
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Pregnancy and liver disease (DO NOT GIVE WITH EITHER)
No grapefruit juice with Statins. |
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A/e of statins?
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GI (constipation, abd pain, farts)
Headache Insomnia, Increased liver enzymes Myopathy, rhabdomyolysis |
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Fibric acid derivatives
MOA: |
MOA: Decreased activity of lipopritein lipase thereby enhancing catabolism of TGs
Decreases hepatic VLDL Increases biliary chol excrestion |
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Fibric acid effects on lipids
LDL: HDL: TG: |
LDL: decrease 10-15%
HDL: Increase 10-15% TG: Decrease 20-50% |
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Rx interactions:
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Warfarin and statins
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A/E of fibric acids?
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GI
Gallstones Increased hepatic enzymes Myopathy |
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Intestinal absorption inhibitors (Zetia)
MOA: |
MOA: Selectively inhibits intestinal absorption of chol.
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Intestinal absorption inhibitors effects on lipids
LDL: HDL: TG: |
LDL: decreased 19%
HDL: Increase 6% TG: Decrease 7-10% |
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A/e?
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Very well tolerated
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After therapy, when should lipid panel be checked again?
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4-6 weeks after therapy started. 12 weeks
And every 6mo-1yr after |
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should estrogen be used as antihyprelipidemic therapy?
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NO!
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