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24 Cards in this Set

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Lipid:
Fat-like compound characterized by relative insolubility in water.
Cholesterol:
Type of lipid required for normal life functions
Triglyceride (TG):
Molecule composed of fatty acids and glycerol
Used as one of the major energy substrates
Lipoprotein:
Particle consisting of a protein conjugated with lipids to form a carrier for transport of nonpolar lipids in the plasma.
Includes: Chylomicrons, VLDL, IDL, LDL, and HDL
Chylomicron:
Transports exogenous (dietary) TG and cholesterol
Absent in blood after 12-14 hour fast
Lipoprotein
Composed of LDL and a protein called apo(a)
Linked to heart disease
Lp(a) levels are almost entirely inherited
Hard to remove from the blood stream
Intermediate density lipoprotein (IDL):
Derived from VLDL breakdown in capillaries, converted into LDL or removed from blood by liver
Low density lipoprotein (LDL):
“Bad cholesterol”
Lipoprotein responsible for atherosclerosis
-Excess LDL sticks to blood vessel walls and penetrates the walls
Contributes to the formation of hard, fatty deposits or plaques
High density lipoprotein (HDL):
“Good Cholesterol”
reverse transport of cholesterol from peripheral cells to the liver and aids metabolism of TG-rich lipoproteins
Model for plasma TG and Cholesterol transport
Exogenous pathway
These cells convert the cholesterol and TGs into chylomicrons then transported into the blood through the lymphatic system
Model for plasma TG and Cholesterol transport exogenous
Lipoprotein lipase converts chylomicrons into remnant particles taken up by the liver the cholesterol-rich remnants are transformed into bile salts or redistributed to other body tissues
Etiology of Hyperlipidemia
Primary: genetic predisposition
Secondary: lifestyle, diet, disease states, medications
Bile Acid Binding Resins
Drugs:
Cholestyramine (Questran, LoCholest, Prevalite)
Colestipol (Colestid)
Colesevelam (Welchol
Bile Acid Binding Resins
Mechanism of Action:
Bind bile acids in the intestinal lumen to form a nonabsorbable complex that is excreted in the feces
Liver compensates by converting more cholesterol to bile acids, causing a drop in cholesterol concentration
Bile Acid Binding Resins
effectson lipids
LDL: decrease 15%-30%
HDL: increase 3%-5%
TG: usually not affected, may increase
Bile Acid Binding Resins
Cautions/Contraindications:
severe GI dysfunction/constipation
Biliary obstruction
Hyperchloremic acidosis
Single therapy for elevated TGs
Absolute: TG > 500 mg/dl
Relative: TG > 200 mg/dl
Pregnancy and lactation
Bile Acid Binding Resins
Drug Interactions:
May bind to other (anionic) drugs decreasing their absorption
Administer drugs 1-2 hours before or 4 hours after resin dose
Bile Acid Binding Resins
adverse effects
Frequent gi symptoms:
Constipation, Bloating
Epigastric fullness
Flatulence, Nausea
Prevention:Maintain adequate fluid intake and high fiber diet
Nicotinic Acid
Drugs:
Nicobid®, Niacor®, Nicolar®, Niaspan®
Nicotinic Acid
MOA
Inhibits secretion of VLDL from the liver causing decrease in production of LDL
Inhibits lipolysis in adipose tissue
Increases lipoprotein lipase activity
Decreases esterification of TG in the liver
Nicotinic Acid
Effect on Lipids:
LDL: decrease 10%-25%
HDL: increase 15%-35%
TG: decrease 30%-50%
Nicotinic Acid
Cautions/Contraindications:
Relative:
Severe hypotension
Gout or significant hyperuricemia
Diabetes mellitus
History of peptic ulcer disease
Absolute:
Liver disease
Active peptic ulcer disease
Nicotinic Acid
Drug Interactions:
Insulin or oral hypoglycemic
Bile acid binding resins
Statins, Myopathy
Rhabdomyolysis
nicotinic acid
Adverse Effects:
Flushing, Pruritis, Tingling
Headache, Urticaria
aspirin or ibuprofen 30 minutes before AM dose
Take with food Avoid heavy alcohol use and hot drinks