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46 Cards in this Set

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High total cholestrol is...
>240
Lowering cholestrol has what 4 effects?
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
Cholestrol is...
A type of lipid required for cell fxn. Obtained from diet or synthesized from liver
Triglycerides are...
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.
Lipoprotein
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
Cholymicrons...
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.
VLDL:
Very low dinsity lipoprotein: transports endogenous TG, originate from intestines and liver
Lipoprotein A...
composed of LDL and protein called apo(a).
Linked to heart disease
Lp(a) lvls are inherited
Hart to remove from blood stream
Intermediate density lipoprotein (IDL)
Derived from VLDL breakdown in capillaries and converted into LDL OR removed from blood by liver
LDL...
Bad cholestrol
Transports cholestrol to peripheral tissues
Mostly responsible for atherosclerosis and CHD.
HDL:
Good cholestrol...transports cholestrol from tissues to liver, natural antioxidant.
Comes from liver and intestine
What is primary etiology of hyperlipidemia?
Genetic predisposition
What is secondary etiology of hyperlipidemia?
lifestyle
diet
disease states
meds
What meds can cause hyperlipidemia?
Alcohol
progestins
thiazide diuretics
beta blockers
glucocorticoids
cyclosporine
What are risk factors for CHD?
Male >45 y.o. female >55 y.o
family history of CHD
Cigarette smoking
Hypertension
HDL<40
If HDL >60 subtract 1 risk factor
How many risk factors are needed to be considered high risk?
2 or more
What is the goal cholestrol?
<200 with HDL>40
If pt is 200-239 with >40 HDL and 2RF or <40 HDL or 2RF, what should be done>
Educate, recheck in 102 years. Lipoprotein analysis
If pt has high cholestrol (>240), what should be done?
Lipoprotein analysis.
What is the goal for pt with no CHD or any risk factors? When would you start diet/drug?
LDL<160
Diet at 160, drug at 190
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
What do you want LDL to be for pt with CHD?
Diet at?
Drig at?
Goal: LDL<100
Diet at 100
Drug at 130
What is the new LDL goal for all pts?
LDL<70
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.
Bile acid binders Effect on lipids:
LDL: Decrease 15-30%
HDL: Increase 3-5%
TG: not affected
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.
A/e of bile acid binders?
GI: constipation, bloating, gas, nausea
Prevent with high fiber diet and fluid intake.
How long do bile acid binders take to work?
About a month so be patient!
Nicotinic acid
MOA:
MOA: Inhibits secretion of VLDL from liver causing decrease in produciton of LDL. This lowers triglycerides.
Nicotinic acid effects on lipids?
LDL: decrease 10-25%
HDL: increase 15-35%
TG: decrease 30-50%
Do NOT give nicotinic acid to pts with...
liver disease
active PUD
OR TO PTS TAKING STATINS
A/e of nicotinic acid?
Vasodiliatino leading to flushing, itching, tingling, headache, urticaria. Take with food to avoid.
GI
Should you take with food? When will you see lower numbers?
Yes, with food.
See lower TC in several days
Lower TG in hours
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
Statins effects on
LDL:
HDL
TG:
LDL: Decrease 20-55%
HDL: increase 5-22%
TG: Decrease 10-43%
Cautions?
Pregnancy and liver disease (DO NOT GIVE WITH EITHER)
No grapefruit juice with Statins.
A/e of statins?
GI (constipation, abd pain, farts)
Headache
Insomnia,
Increased liver enzymes
Myopathy, rhabdomyolysis
Fibric acid derivatives
MOA:
MOA: Decreased activity of lipopritein lipase thereby enhancing catabolism of TGs
Decreases hepatic VLDL
Increases biliary chol excrestion
Fibric acid effects on lipids
LDL:
HDL:
TG:
LDL: decrease 10-15%
HDL: Increase 10-15%
TG: Decrease 20-50%
Rx interactions:
Warfarin and statins
A/E of fibric acids?
GI
Gallstones
Increased hepatic enzymes
Myopathy
Intestinal absorption inhibitors (Zetia)
MOA:
MOA: Selectively inhibits intestinal absorption of chol.
Intestinal absorption inhibitors effects on lipids
LDL:
HDL:
TG:
LDL: decreased 19%
HDL: Increase 6%
TG: Decrease 7-10%
A/e?
Very well tolerated
After therapy, when should lipid panel be checked again?
4-6 weeks after therapy started. 12 weeks
And every 6mo-1yr after
should estrogen be used as antihyprelipidemic therapy?
NO!