Lipid drugs
Terms
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- This apoprotein enable VLDL and LDL to bind to vessel walls
- B-100
- Chylomicron's contain this unique apopprotein
- B-48
- HDL does not contain what apoprotein which limits its ability to bind to vessel walls
- B-100
- 6 Statins
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Atorastatin
Simvastatin
Pravastatin
Rosuvastatin
Flubastatin
Lovastatin - Method of acting for Statins
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competitive inhibit of HMG-CoA Reductase Inhibitors
decreas cholesterol synth and increases LDL-receptors - When statins should be taken
- At night b/c this is the time of highest cholesterol synthesis
- Main uses of statins
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Lower LDL
Smaller incrases in HDL and decreass in TG - Side Effects of statins
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Myopathy (rabdomyolysis)
increased with higher doses and combination of niacina and fibrates
Asymptomatic increase in liver enzymes - Contraindications for statins
- active or chronic liver disease
- 3 bile sequestrants
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cholestyramine
colestipol
colsevelam - Method of action for cholestyramine, colestipol and colsevelam
- Bind bile acids and prevent their recirculation. Failure to reabsorp bile acids causes shunting of cholesterol to the producting of new bile salts
- Net effect of bilesquestrants
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reduces LDL
some increase in HDL - Side Effects of cholestyramine, colestipol and colsevelam
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GI effects secondary to reduced fat absorption
Lower vitamin ADEK uptake
Interactions with CHF meds - Bile sequestrants interactions
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Digoxin, Coumadin, Thiazides, beta blocker and thyroxine
Give them 1 hour before or 4 hours after bile sequestrant - Contraindications of bile sequestrant
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Can cause dangerous increases in TG's if patients with already eleveated TG's.
High TG's cause pancreatitis
Do not give if TG>400 - Effects of Niacin
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lower TG
Lower LDL
Raise HDL - Method of action of niacin
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decrease VLDL synthesis
secondary increases in HDL synth and lowered HDL removal - Side effects of niacin
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Flushing and skin issues
GI distress
arryhtmia, hyperuricemia, glucose intolerance and lazy eye - contraindications of niacin
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liver disease
gout
diabetes
peptic ulcer disease - 3 fibrates
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Gemfibrozil
Fenofibrate
Clofibrate - Main effects of fibrates
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lower TGs
raise HDL - Side effects of fibrates
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myopathy
gallstones
dyspepsia - contraindications for fibrates
-
pregnant or nusing women
renal disease
hepatic disease - method of action for fibrates
-
increase oxidation of fatty acids
increases lipoprotein lipase (removal of TGs from VLDL's)
net effects if to lower TG's and shift depleted VLDLs to HDLs - Ezetimbie
-
Blocks cholesterol absorption from the gut
loweres plasma LDL
Combined with statins - gemfibrozil drug interactions
- inhibits glucouranidation of statins, increasing statin side effects
- This bile sequestrant only needs to be taking twice daily
- Colsevelam
- A patient has just taking some of his heart medication (digoxin, coumadin and thiazides). Which lipid drug must he now wait 4 hours to take
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Colestyramine
Colestipol
Colsevelam - Before prescribing this drug, you must check the patients TG levels
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Colestyramine
Colestipol
Colsevelam - You must check these levels before prescribing bile sequestrants
- Triglycerides > 400 is absolute contraindication
- Contraindicated in patients with severe gout
- Niacin
- Potential complication of this medicine in diabetic patient
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Niacin
causes hyperglycemia - Excellent for lowering TG levels
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Fibrates
Gemfibrozil
Fenofibrate - This drug increases the likelihood of myopathy in patients taking statins
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Gemfibrozil
Inhibits glucouranidation of statins - If a patient is on this statin, its is safe to take gemfibrozil
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Pravastatin
It is not metabolized by P450 - Recommended in CAD patients with primarily low HDL
- fenofibrate
- Your hyperlipidemia patient becomes pregrant. She should be taken off of this drug
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Gemfibrozil
Fenofibrate - Patients with severe renal disease should not take these drugs
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Gemfibrozil
Fenofibrate - Patients with peptic ulcer disease should note take this drug
- Niacin