Treatment Guidelines w/Low HDL – Low HDL is an independent risk factor
on
9.6.08
with
0 comments
You are here: Home » Endocrinology Notes , Pharmacology Notes » Treatment Guidelines w/Low HDL – Low HDL is an independent risk factor
If HDL <>
If HDL < id="m11t10397" class="western">
These drugs are all cost-effective based on cost of preventive treatment vs cost of treatment of vascular disease.
| Drug / Indications | Pharm | MOA | Effectiveness | Side Effects |
| HMG-CoA Reductase Inhibitors Lovastatin (Mevacor) Pravastatin (Pravachol) Simvistatin (Zocor) Fluvastatin (Lescol) Atorvastatin (Lipitor) Elevated LDL
| Oral doses at supper time Peak action occurs at 6 hrs or sooner Duration extends to ~12 hrs Drugs have roughly equivalent efficacy & side effects w/different potency and pharmacokinetics | Competitive inhibitors of HMC-CoA reductase (rate-limiting enzyme of C synthesis) Lower [C]i \ increase LDL Rs ® increased uptake \ decreases [LDL] in serum | ¯¯ VLDL ¯¯¯ LDL ¯¯¯ Total C ¯ TG HDL
¯¯¯¯¯¯¯ | Reversible LFTs Check LFTs every 6 wks in 1st few mths Myositis – flu-like muscle pain May be associated w/ CK levels – measure them & change drug if needed Do not combine w/fibrates – increased change of myositis |
| Bile-acid binding resins Cholestyramine (Questran) Colestipol (Colestid) Colesevelam (WelChol) Elevated LDL | Non-absorbable granular powder taken orally Response apparent w/in 3-4 wks; max usually seen at 6-8 wks Package doses, tablets, bulk (much lower cost) | Bind bile acids in the SI – ¯enterohepatic return of bile acids to liver \ accelerate hepatic bile acid synthesis ® ¯of [pre-C]i & up-regulation of LDL Rs in liver Þ LDL R mediated removal of LDL \ decrease [LDL]circulating
| ¯¯¯ LDL ¯¯¯ Total C ® ¯ TG ® HDL ® VLDL | Constipation Abdominal discomfort Bloating Flatulence At high doses, may induce malabsorption of fat-soluble vitamins |
| Nicotinic acid
Elevated TG, elevated LDL-C, and/or low HDL
| Natural vitamin available in unaltered and slow release form Completely absorbed and hepatically detoxified Usual dose is 1-3g/day
Very inexpensive | Inhibits VLDL synthesis and release in 2 ways: Inhibits peripheral lipolysis \ decreasing available FFAs as substrate for hepatic TG synthesis Inhibits VLDL synthesis directly ¯VLDL ® ¯LDL | ¯¯¯ LDL ¯¯¯ Total C ¯¯¯TG HDL ¯¯¯ VLDL | Facial flushing – treat w/aspirin Gastric irritation Exacerbation of glucose intolerance Hyperuricemia / gout Reversible increase LFT (w/old extended release form) Contraindications: PUD Asthma Cardiac dysrhythmias Hyperuricemia DM |
| Fibric Acid Derivatives Gemfibrozil (Lopid) Fenofibrate (Tricor)Elevated TG, elevated LDL-C, and/or low HDL | Max response usually seen @ 4 wks Usually taken ĉ breakfast | ¯ [VLDL]plasma \ ¯ [LDL]plasma ¯ Synthesis & release hepatic VLDL Also, stimulate TG-rich lipoprotein clearance by LPL activity [HDL]plasma Stimulate the synthesis of apo- A-1 (primary apo-lipoprotein associated ĉ HDL) | ¯ LDL ¯ Total C ¯¯¯TG HDL ¯¯¯ VLDL | Myalgia Skin rash GI bloating or cramping
Drug interations: Potentiates warfarin action Its absorption is diminished by bile acid resins Lowers cyclosporine levels in transplant patient |
| Omega 3 Fatty Acids
HyperTG pts who cannot tolerate or do not respond to 1st line drugs
| Capsules of fish oil containing eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) | Unknown, but reported decrease synthesis of LDL in the liver
Also have anti-platelet activity that can inhibit formation of platelet thrombi
| ¯¯¯TG ¯¯¯ VLDL | Bloating Flatulence Diarrhea Deterioration of glycemic control in diabetics Potential hemostasis effect |
| Antioxidants (Vitamins – E, C, beta carotene)
|
| Decrease oxidation of LDLs \ decrease formation of atherosclerotic plaques | Results are not conclusive of any definite protection | No known side effects, except for mega dosing…May as well take them. |
Category: Endocrinology Notes , Pharmacology Notes
Subscribe to:
Post Comments (Atom)
POST COMMENT
0 comments:
Post a Comment