Hyperlipidemia

mainly to HDL LDL And to TG

-To reduce the risk of atherosclerosis and CHD events Hypolipidemics

ACTION -LDL -Small TG -Small HDL SO USED for -Hypercholesterolaemia 1stline -1st prev. based on other risks -2nd prev. all patients SE -Generally well tollerated -GI upset - Hepatitis - Muscle aches - Myositis - Angio-oedema - Sleep disturbance -Mainly GI( drug not absorbed systemically) -Abdominal fullness, Constipation, Nausea -Reduce absorption of Vitamin A and D -Drug malabsorption: including folic acid and statins (give other drugs 1 hour before / 4hours after) -Hypertriglyceridemia -Abdominal pain -nausea -Myositis (In combination with Statins) -Raised liver enzymes -gallstones NOTE Reduce -cholesterol by up to 30-40% -incidence of CAD by 25-60% -risk of death from any cause by 30% -risk of stroke

DRUG GROUP Statin = HMG-CoA Reductase Inhibitors

EX -Simvastatin, -Pravastatin, -Lovastatin, -Atorvastatin -Fluvastatin -Cerivastatin

M.A Competitively Inhibits HMG-CoA reductase ==> hepatic synthesis of cholesterol ==> LDL receptors ==> clearance of LDL

Bile Acid Binding Resins

-Cholestyramine Colestipol

- Anion exchange resins - Prevent reabsorption of bile salts and exogenous cholesterol (enterohepatic circulation) ==> conversion of endogenous chol to bile salts==> LDL receptors ==> clearance of LDL

-LDL SO USED for -patients with cholesterol but normal TG -addition to a statin if patient fails to respond to statin alone

- Combination therapy can reduce the risk of events related to heart disease by more than 50%

Fibrates

-Clofibrate -Fenofibrate -Bezafibrate -Gemfibrozil

- activity of peripheral LPL - VLDL production and -increase hepatic LDL uptake -Decrease TG by 50% and mild increase in HDL

-LDL -TG -Small HDL SO USED for - treatment-resistant dyslipidemia , combination with HYPOLIPIDIMC -LDL(10-25%) -TG -HDL (15-35%) -HDL -LDL -TG -but LDL -LDL -TG

- Fibric acid derivatives

Nicotinic Acid

Probucol

Probucol Fish Oils Stanols / Sterols

-Inhibits mobilization of free fatty acids from peripheral tissues - hepatic TG synthesis, ==> secretion of VLDL ==> LDL indirectly -Ancillary effects antioxidant lower HDL - VLDL synthesis -inhibit cholesterol absorption in intestine

-Flushing -rash -GI upset

-Vitamin used as a lipid lowering drug

-GI disturbances -sudden death

Not prescribed w-3 fatty acids containing eicosapentaenoic acid cause -Cholesterol-like plant extracts - as ester (sterol ester) can be mixed in margarine spread

04-05

J.A.M. Musallam