Lipids Medication Mod 10 PDF

Lipids ● What are the major lipoproteins and what is their physiologic role? ○ Serve as carriers for cholesterol and TG’s (lipids) ○ Have a hydrophilic shell and hydrophobic core ○ Chylomicrons, IDL, vLDL, LDL, HDL ● What classes of medications are influencers on hyperlipidemia? ○ BC pills, steroids...

Lipids ● What are the major lipoproteins and what is their physiologic role? ○ Serve as carriers for cholesterol and TG’s (lipids) ○ Have a hydrophilic shell and hydrophobic core ○ Chylomicrons, IDL, vLDL, LDL, HDL ● What classes of medications are influencers on hyperlipidemia? ○ BC pills, steroids, cyclosporine, tx of HIV, BBs, thiazide diuretics ● List the classes of medications that primarily impact LDL. ○ Statins, PCSK9, CAI, BAS ● List the classes of medications that primarily impact Triglycerides (TG). ○ Fibrates, niacin Statin ● MOA ○ Competitively inhibit HMG-CoA reductase in the liver→ limits cholesterol synthesis ● SE ○ N/V/D ○ Myalgias ● Indications ○ Lower LDL ● Contraindications ○ Severe chronic liver dz ○ Pregnancy, lactation ● Monitoring ○ LFTs, lipid panel Q 6 wks after tx then Q 3 mon ○ BG ● Facts ○ If taking a BAS, must take statin 1 hr before or 4 hrs after BAS PSCK9 Inhibitors—”mab” Alirocumab, evolocumab ● MOA ○ Bind to LDL in the liver ● SE ○ Hypersensitivity→ rash, vasculitis, urticaria ○ Risk for developing antibodies ● Indications ○ Lower LDL ● Contraindications ○ Pregnancy ● Monitoring ○ LFTs, lipid panel ● Facts ○ For pts with familial HLD; subQ injection; very $$$ Cholesterol Absorption Inhibitors–Ezetimibe (zetia) ● MOA ○ Inhibits enterocyte from absorbing cholesterol in the small bowel ● SE ○ Gallstones, hepatitis, pancreatitis, thrombocytopenia, myopathy ● Indications ○ Lower LDL ● Contraindications ○ With fibrates, BAS ○ Avoid dual use with cyclosporine ● Monitoring ○ LFTs; CBC ● Facts ○ Best used with statins, but can be used alone for ppl who can’t tolerate statins Bempedoic Acid ● MOA ○ Target ATP-citrate lyase (ACL) & enzyme that is upstream to lower LDL ● SE ○ Back pain, abd piano tendon rupture ● Indications ○ Lower LDL ● Contraindications ○ Gout ○ Joint pain ○ Liver dz ○ Pregnant ● Monitoring ○ LFTs, uric acid, lipid panel Bile Acid Sequestrants—Colesevelam, Cholestyramine, colestipol ● MOA ○ Prevent reabsorption of bile acids so they can bind to cholesterol ● SE ○ GI–constipation, bloating, abd pain, gas ● Indications ○ Lower LDL ● Contraindications ○ Interacts w/ dig, warfarin, diuretics, BBs, cyclosporine, fat sol. Vitamins ● Monitoring ○ Dose 1 hr before meds or 4 hrs after ● Facts ○ Safe in pregnancy Fibric Acid Derivatives (Fibrates)---Gemfibrozil, Fenofibrate ● MOA ○ Act in the liver & brown adipose tissue which activates PPAR-alpha and induces LPL→ increases lipolysis in the liver & muscles → decrease lipoprotein and triglycerides ● SE ● ● ● ● ○ GI→ N/D; abd pain ○ Increase effects of oral diabetic meds Indications ○ Lower triglycerides Contraindications ○ Adjust dose if CrCl < 50 ○ Myopathies ○ Liver injury ○ Previous gallstones (use cautiously with ezetimibe) ○ Never give the ER version of gemfibrozil with statins Monitoring ○ BG; increased risk for gallstones; may increase effects of warfarin or diabetic oral meds; CBC for leukopenia Facts ○ Must be given with food ○ 3rd line tx if cholesterol mgmt Nicotinic Acid—Niacin ● MOA ○ Acts on liver & adipose tissue to stop synthesis of TG→ lower LDL ● SE ○ flushing*** ○ Liver toxic ○ GI upset ○ Hyperglycemia ○ Less frequent: afib ● Indications ○ Best med to improve HDL ● Contraindications ○ Liver disease ○ Poorly controlled DM ● Monitoring ○ LFTs; BG; uric acid levels→ increases risk for gout ● Facts ○ Used as a vitamin in lower doses ○ s/s should decrease if you use med for about 3 wks