pharm-cardio

<100 mg/dl

<200mg/dl

> 60 mg/dl

<150 mg/dl

Cholestyramine granules, colestipol, colesevelam

binds bile acids in the liver which disrupts the recirculation stimulates the live to break down the cholesterol to bile acids, increase the update of LDL and then reduce the LDL concentration

NO

GI problems and a small tranient low percentage of patients saw an increase in triglycerides

they bind to other drugs and vitamens so patients need to take the medication at a seperate time from other medications

LDL only!

it does not raise HGL or significantly change TG

• statins
• atorvastin, fluvavastin, pravastatin, simvastatin, rosuvastatin, pitavastatin

HMG-CoA reductase is the enzyme that is responsible for voncerting HMG-CoA to mevalonate which is the early rate limiting step in cholesterol synthesis.

it works at the first rate limiting step to lower the production of cholesterol. works like a bottle neck, stop the production from the top

should be taken at night because thats when the body produces most of the cholesterol

increased LFTs and myopathy/myalagia/myositis/rhabdomyolysis (muscle aches and pains)

the higher the dose the most likely that you are to experience the side effects

niacin and HMG-CoA reducatse inhibitors

generally unknown but believed to be a ubiquinone deficiency where the ubiquinone is replaced by coenzyme coq10

general term related to any muscle complaint

muscle complaints without elevation in creatine kinase

• muscle complaints with elevtion of creatine kinase
• this is more severe because there is muscle inflammation
• creatine kinase breaking down is a possible proble problem if it causes liver damage and breakdown

elevated levels of creatine kinase which are greater than ten times the upper limits of normal. also brown urine and urinary myoglobin-looks like there is blood in the urine

grapefruit juice-it inhibits the metabolism of the statin, thus more of it is left in the system than is supposed to. this can leave to overdosing as well as muscle achines and pains, breakdown adn renal failure

niacin

reduces the production of VLDL in the liver- decreases the snthesis of LDL as well as decreases tri glycerides and increases HDL. it works by decreasing cholesterol biotransformation in the liver

start by titrating a dose of immediate release adn then working up to sustained release. sustained release medications have a more likely side effect, such as hepatotoxicity however it is easier for the patient to take the medication once a day versus several times

cutaneous flushing for the skin from the neck up (cosmetically only), pruritis and liver dysfunction

gemfibrozil, fenofibrate, fenofibric acid

lowers triglycerides only

gall stones and cholecystitis