Antidyslipidemic Drugs Part 2

Cholestryramine

Colestipol

Colesevelam

Bile Acid Sequestrants drugs

Bile Acid Sequestrants

Increase fecal excretion of bile acid. Binds bile acid in gut prevents reabsorption, increases cholesterol catabolism and upregulates LDL receptors

Hypercholesterolemia

Cholestatic pruritus

Clinical indications of Bile Acid Sequestrants

Cholestatic pruritus

severe itching caused by liver disease

Constipation

Bloating

Fecal impaction

Adverse effects of bile acid sequestrants

Bile acid sequestrants

If statin is not suitable for the patient, what type of drug class is given to the patient

Clofibrate

Gemfibrozil

First generation fibric acid derivatives or fibrates

Fenofibrate

Bezafibrate

Second generation fibric acid derivatives or fibrates

Fibric acid derivatives/fibrates

most effective drug for lowering triglycerides

fibrates

primarily reduce VLDL and moderately increase HDL

Fibrates

it is a ppar-alpha agonist which refers to the activation of LPL, catalyzing the removal of TG from VLDL

Low VLDL

Low LDL-C

High HDL

Mechanism of action of fibrates in terms of lowering and increasing lipoproteins

Gemfibrozil, Fenofibrate

First line therapy for hypertriglyceridemia

Hypertriglyceridemia

Hypercholesterolemia

Dysbetalipoproteinemia

Clinical indications for Gemfibrozil and Fenofibrate

GI problems

Gallstones

Adverse effects of fibrates

Niacin or Nicotinic acid

Only hypolipidemic vitamin

Niacin

Decreases catabolism of apo AI and reduces secretion from liver

Hypertriglyceridemia

In high doses (500 to 2000 mg), what is the clinical indication of Vitamin B3Pe

Pellagra

in low doses (400mg), what is the clinical indication of vitamin b3

Dermatitis

Diarrhea

Dementia

Death

4Ds of pellagra

Niacin flush

Due to the PGD2 release, this is the adverse effect of vitamin b3

Aspirin or co-administered with NSAIDs

Prevention of niacin flush

Naproxen 220 mg

NSAID usually co-administered for prevention of niacin flush

Niacin Flush

Hepatotoxicity

Hyperglycemia

Hyperuricemia

Adverse effects of Vitamin B3

Eicosapentaenoic acid (EPA) ethyl ester and docohexaenoic acid (DHA) ethyl ester

Made of omega-3 fatty acids or alpha-linolenic acid

Hypertriglyceridemia in patient at risk of ischemic heart disease

Clinical indications of eicosapentaenoic acid ethyl ester and docosahexaenoic acid ethyl ester

4 capsules per day, either all at once or 2 capsules 2x daily

How many DHA and EPA should the patient at risk of ischemic heart disease take per day

Fishy after taste

Dyspepsia

Nausea

EPA and DHA adverse effects

Fish oil (Omega-3 fatty acids)

To lower triglyceride, cholesterol. Additional drug

Orlistat (Anti-obesity drug)

It is a lipase inhibitor that inhibits fat absorption

Steatorrhea

Adverse effect of orlistat. It means undigested fat