Adequate lifestyle changes trial?
restrict cholesterol and sat fats
inc'd leafy green veggies
inc'd fiber intake
What are the Bile Acid Sequesterants? what do they specifically help with?
1. Cholestyramine Granules
2. Colestipol Granules and tablets
Lowering LDL! - they bind bile acid in the intestines
What is the problem with Bile Acid Seq?
You will poop out any other drug you take
bind to many drugs, vitamins, nutrients
HMG-CoA Reductase inhibitors ("statins")
MOA: rate limiting step in cholesterol production is conversion of HMG-CoA to mevalonate
what is the MOA for the muscle aches? Risk factors
ubiquinone (coenzyme Q10) deficiency
advanced age, female, renal insuf, liver dysfunction, small body frame, frail, multiple meds
marked inc'd CK (> 10 x UL of NL)
usually w/ creatinine elevation, brown urine, urinary myoglobin
When do you d/c statin therapy?
if 10x upper limit of normal
or symptomatic and CK continues to rise
can consider switching to different statin- switch to a less lipophilic (fluva, rosuva, prava)
what should you not drink with a statin?
not as big of problem with fluva, rosuva, prava - less lipophilic
Drug Interxns with Statins
Grapefruit juice (rhabdo)
Niacin, Fibric Acid Deriv. (hepatotox.)
BAS (dec'd absorption)
Niacin (nicotinic acid)? MOA? max dose?
Niaspan (sustained release)
reduces production of VLDL in liver - primarily biotransformation in liver (dec'd syn of LDL, TGs, inc'd HDL!)
max dose 2 g/day due to hepatoxicity
Niacin side effects
Inc'd uric acid - gout attack
inc'd blood sugar
Fibric Acid Derivatives? MOA?
increase lipoprotein lipase = reduce VLDL - used to treat TGs only
dec'd TGs 20-50%!
side effects of fibric acid derivatives?
myositis/myopathy - usually if combined with niacin or statin
what drug interaction is a problem with fibric acid derivatives?
Statins - inc'd hepatotoxicity and inc'd risk of rhabdomyolysis
Cholesterol Absorption inhibitors? MOA?
inhibits cholesterol abs in small intestine, inc'd syn of LDL receptors decreasing LDL levels
- inhibs ~54% of all intestinal cholesterol absorption
what is the best combination therapy?
Simvastin + Ezetimibe (Vytorin)
can be controversial, we don't recommend right off the bat - inc'd risk of side effects
What do omega 3 fatty acids do?
prevent heard disease
Omega 3 FA agents
Eicosapentaenoid acid (EPA)
Docosahexaenoic acid (DHA)
Alpha-Linolenic acid (vegan option, not as good)