lipid lowering agents

what are the two sources for us to get cholesterol?

exogenous (diet) & endogenous (made in liver with HMG-CoA reductase enzyme)

what are the 3 main types of lipoproteins?

VLDL, LDL, HDL → differ in how they package cholesterol and deliver it to body tissues; “L for lethal; LDL” and “H for healthy; HDL”

what is the primary management for blood cholesterol?

lifestyle modifications → diet, exercise, smoking cessation d/t most if not all cholesterol lowering meds have significant side effects; really only want to use meds if pt is at risk for developing atherosclerotic disease

how do bile acid sequestrants work?

bind to bile acids with high amounts of cholesterol in intestine and form a complex to then be excreted in feces → works after bile has been deposited into small intestine from gallbladder

how do HMG-CoA reductase inhibitors/statins work?

inhibit endogenous synthesization of cholesterol in liver

what are the names of some bile acid sequestrants?

cholestyramine, colesevelam → powder mixed with water or juice; used for hypercholesterolemia (incr cholesterol and incr LDL) → works on the liver so need hepatic function tests q3-6 months

what are the adverse effects of bile acid sequestrants?

constipation, headache, fatigue, dizziness, vitamin deficiencies (impairs absorption), risk of bleeding (impairs absorption of vitamin K) → want to educate pt on using non-oral contraceptives

what are the names of some HMG-CoA reductase inhibitors/statins?

atorvastatin, simvastatin, lovastatin, pravastatin → dosed PO at night; used for hypercholesterolemia (incr cholesterol, incr triglycerides, incr LDL) and prevention of ACSD in pts with T2DM & heart disease

what are the adverse effects of HMG-CoA reductase inhibitors?

headache, constipation, myalgias, renal or liver injury, rhabdomyolysis

what is the name of a cholesterol absorption inhibitor?

ezetimibe → dosed PO; used for hypercholesterolemia (incr total cholesterol and incr LDL), usually adjunct with other meds

what are some adverse effects of cholesterol absorption inhibitors?

headache, abdominal pain, myalgias, liver injury