Term
Lipid Lowering Meds:
First Line Therapy |
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Definition
1.Statins (of choice in DM)
2.Cholesterol absorption inhibitor in addition can enhance lowering LDL
-Fibrate can lower TG and raise HDL
3.2+ meds may be needed
-Liver enzymes must be monitored |
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Term
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Definition
-HMG-CoA reductase inhibitors (statins)
-Selective intestinal absorption inhibitors
-Fibric acid derivatives (fibrates)
-Bile acid resins
-Niacin
-Omega 3 FA |
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Term
Lipid lowering meds:
Omega 3 FA Compound |
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Definition
-Decrease TG, Increase HDL (high doses)
-Reduces FFA available TG syntheses |
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Term
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Definition
| -Dosing: 1-2, 1000mg caps each day or 4 grams a day with food. |
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Term
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Definition
Note Used:
-Pregnancy
-Renal or Liver disease
-Elderly
-Increased hemmorrhage risk |
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Term
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Definition
-Dizziness, GI, N/V, Abd pain
-Increase INR w/ Coumadin use
-Monitor baseline lipids/liver fx test |
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Term
Lipid Lowering Meds:
Bile Acid Sequestrants Compounds |
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Definition
-Cholestryamine, colesevelam, Colestipol
-Lowers LDL
-Modest increase in HDL.
(Not commonly prescribed 2/2 can increase TG)
(Not used as monotherapy with TG >/250) |
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Term
Lipid Lowering Meds:
Bile Acid Sequestrants MOA |
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Definition
| -Bind to bile acids and increase elimination of fecal acidic steroids, thus lowering LDL |
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Term
Lipid Lowering Meds:
Bile Acid Sequestrants Dosing |
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Definition
-Powder/Tab, 1-2 q day. Lower doses initially
-Give other meds 1 hour before, OR, 4 hours after |
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Term
Lipid Lowering Meds:
Bile Acid Sequestrants Caution |
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Definition
-Renal insufficiency
-Volume depletion
-Chronic constitpation |
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Term
Lipid Lowering Meds:
Bile Acid Sequestrants Side effects |
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Definition
-GI, N/V
-Check electrolytes |
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Term
Lipid Lowering Meds:
Types of Medications |
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Definition
-Niacin: Nicotinic acid immediate release (initial therapy)
-Niaspan: Niacin sustained release
-Slo-Niacin: Nicotinic acid sustained release |
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Term
Lipid Lowering Meds:
Do Not use with |
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Definition
-Pregnancy
-GOUT
-Increased ETOH
-Renal Dysfunction
-Liver Disease
-PUD
-Arterial Bleeding |
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Term
Lipid Lowering Meds:
Side Effects |
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Definition
*Side effects decrease w/ continuous use
-H/A
-Hypotension
-GI
-Dermatological: flushing, pruritis, rash
-Can increase BGL, esp in pre-DM and newly dx DM
-No Hot Drinks
-Doses >2/d have increased risk of Liver toxicity. Discontinue when liver tests are 3x normal
-Increase chance of RHABDO w/ statins: Monitor BS and Uric Acid |
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Term
Lipid Lowering Meds:
Brand/Generic (statins) |
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Definition
-Atorvastatin (Lipitor)
-Flucastatin (Lescol)
-Lovastatin (Mevacor)
-Pravastatin (Pravachol)
-Rosuvastin (Crestor)
-Simvastatin (Zocor) |
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Term
Lipid Lowering Meds:
Brand/Generic (others) |
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Definition
-Fenofibrate (Tricor)
-Gemfibrozil (Lopid)
-Colesevelam (Welchol)
-Cholestyramine (Questran)
-Colestipol (Colestid)
-Ezetimibe (Zetia)
-Omega 3 FA (Omacor)
-Plant Sterols (Benecol)
-Plants Sterols (Take Control) |
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Term
Lipid Lowering Fibrates
Action |
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Definition
-Fenofibrate (Tricor), Gemifibrozil (Lopid)
-Work on lowering TG w/ additional benefits of increased HDL |
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Term
Lipid Lowering Fibrates
Dosing |
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Definition
-1-2 PO q day
-Often prior to meals (30 min prior)
-Initial therapy starts low and titrates up |
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Term
Lipid Lowering Fibrates
Do Not Use With |
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Definition
-Pregnancy
-Renal
-Elderly
-Gallbladder dx
-Hepatic dx
-Renal dx |
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Term
Lipid Lowering Fibrates
Side Effects |
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Definition
-GI, N/V, Abd Pain, Diarrhea
-Rare: rash, fever, weight gain, mm weakness
-Muscle Pains/aches |
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Term
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Definition
-Lowering LDL
-Lowering TG
-Increase HDL
-Reduces but does not block total cholesterol synthesis |
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Term
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Definition
-1 PO/d in evening (Cholesterol synthesis is at night)
-Start low and titrate PRN |
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Term
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Definition
-Pregnancy, BF
-renal, liver Dx
-NO GrapeFruit Juice |
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Term
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Definition
-H/A
-Mm/Joint pain
-GI, N/V, Abd pain
-Increased Liver enzymes- D/C if 3x normal.
-Myopathy/Rhabdomyolosis risk: Report Mm weakness, tenderness, pain or fever |
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Term
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Definition
-Best taken in evening with Supper or HS
-With or without food
-Monitor q 12 weeks initially
-Know S/S myopathy
-NO grapefruit juice |
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Term
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Definition
-Baseline Lipid Profile, CPK enzyme, LFT and Renal function tests
-Liver + Lipid profiles done every 12 weeks during the first 6 months and periodically after.
-CPK levels should be monitored if c/o mm pain or discomfort |
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Term
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Definition
Risk LDL goals Drug therapy
-High: CHD <100 or <70 >/ 100
-Moderate/Hi
2+ risk factors <130 >/ 130
-Moderate
2+ risk factors <130 >/ 160
-Low Risk <160 >/ 190
*All PWDs have either <100 or <70 goal.
*Those w/ underlying CHD will have more stringent <80 goal |
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Term
| Lipids/Cholesterol Monitoring |
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Definition
-CVD is leading cause of death for DM
-Monitor annually |
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Term
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Definition
-Total: <200
-LDL: <100
-HDL: >40 (M), >50 (W)
-Trig: <150 |
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Term
Lipid Lowering Meds
Cholesterol Absorption Inhibitors
Action |
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Definition
-Ezetimibe (Zetia)
-Primary Lowering of LDL, Some lowering of TG and Increasing HDL
-Often prescribed in combination w/ statins to enhance LDL decrease
- 1 PO daily (10mg) |
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Term
Lipid Lowering Meds
Cholesterol Absorption Inhibitors
Do Not Use With |
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Definition
-Pregnancy
-Hepatic Dysfunction |
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Term
Lipid Lowering Meds
Cholesterol Absorption Inhibitors
Side Effects |
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Definition
(Minimal)
-GI/N/V/Abd Pain |
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Term
Lipid Lowering Meds
Cholesterol Absorption Inhibitors
Dose |
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Definition
- 1 PO daily (10mg)
-Take separate from Bile Acid Sequestrants
-Monitor INR on Coumadin
-Monitor baseline Liver/Renal
-With/without food |
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