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  1. 1. Hyperlipidemia
  2. 2. Cross Section normal & clogged artery
  3. 3. Acronyms <ul><li>HDL </li></ul><ul><ul><li>High density lipoproteins </li></ul></ul><ul><li>LDL </li></ul><ul><ul><li>Low density lipoproteins </li></ul></ul><ul><li>VLDL </li></ul><ul><ul><li>Very low density lipoproteins </li></ul></ul><ul><li>HMG-CoA </li></ul><ul><ul><li>3-hydroxy 3 methylgultaryl-coenzyme A </li></ul></ul>
  4. 4. Cholesterol: Bad, Good & Ugly <ul><li>Desirable </li></ul><ul><ul><li>Total Cholesterol < 200mg/dL </li></ul></ul><ul><ul><li>LDL cholesterol < 130 mg/dL </li></ul></ul><ul><li>LDL (the bad) + </li></ul><ul><li>HDL (the good) + </li></ul><ul><li>VLDL (the neither) = total cholesterol </li></ul>
  5. 7. Risk Factors <ul><li>) </li></ul>
  6. 8. Risk Factors <ul><li>Cigarette smoking, inactivity </li></ul><ul><li>Family History of CHD </li></ul><ul><li>Hypertension, Diabetes, Obesity </li></ul><ul><li>Age and Gender </li></ul><ul><ul><li>Men >45yo </li></ul></ul><ul><ul><li>Women >55yo </li></ul></ul><ul><li>Low HDL <40mg/DL </li></ul>
  7. 9. Pathophysiology <ul><li>Definitions </li></ul><ul><li>Overview </li></ul><ul><li>Risk factors </li></ul><ul><ul><li>Non drug therapy </li></ul></ul><ul><li>TRAVELS with HDL </li></ul>
  8. 10. Intestine
  9. 11. Therapeutic Agents <ul><li>NIACIN </li></ul><ul><li>MOA </li></ul><ul><li>SE </li></ul><ul><li>Dose </li></ul><ul><li>Patient Education </li></ul><ul><li>Why not Niacinamide? </li></ul><ul><li>Fibric Acid </li></ul><ul><li>MOA </li></ul><ul><li>SE </li></ul><ul><li>Dose </li></ul><ul><li>Patient Education </li></ul><ul><li>Gemfibrozil (Lopid) </li></ul><ul><li>Fenofibrate (Tricor) </li></ul>
  10. 12. Bile Acid Resins “Statins” <ul><li>MOA </li></ul><ul><li>Dose </li></ul><ul><li>Toxicity </li></ul><ul><li>Agents </li></ul><ul><ul><li>Colestipol (Colestid) </li></ul></ul><ul><ul><li>Cholestyramine (Questran) </li></ul></ul><ul><li>Competitive inhibitors of HMG-CoA Reductase </li></ul><ul><li>Toxicity </li></ul><ul><li>Agents </li></ul><ul><ul><li>Atorvastatin (Lipitor) </li></ul></ul><ul><ul><li>Fluvastatin (Lescol) </li></ul></ul><ul><ul><li>Lovastatin (Mevacor) </li></ul></ul><ul><ul><li>Pravastatin (Pravachol) </li></ul></ul><ul><ul><li>Simvastatin (Zocor) </li></ul></ul>
  11. 13. Major Side Effects *muscle pain, weakness, fatigue, brown urine, acute renal failure Myalgia, ↑ liver enzymes, rhabdomyolysis* Statins GI complaints, decrease absorption of other drugs Bile Acid Sequestrants GI complaints, increase risk of gallstones Fibric Acid GI complaints, flush, gout, increase glucose Niacin
  12. 14. “ STATINS” Lovastatin (Mevacor) Atorvastatin (Lipitor) <ul><li>Ezetimibe </li></ul><ul><li>(Zetia) </li></ul>
  13. 15. Additional Therapies <ul><li>Intestinal absorption inhibitor </li></ul><ul><ul><li>ZETIA (ezetimide) </li></ul></ul><ul><li>Combination </li></ul><ul><ul><li>Vytorin </li></ul></ul>
  14. 16. <ul><li>Fiber </li></ul><ul><li>Dietary </li></ul><ul><li>Intake </li></ul><ul><li>Psyllium </li></ul><ul><li>(Metamucil, </li></ul><ul><li>Fiberall) </li></ul>What's your number?
  15. 20. The TRAPEZOID !
  16. 23. Overall Dietary Management <ul><li>Optimize Weight </li></ul><ul><li>Restrict fat intake </li></ul><ul><li>Restrict alcohol intake </li></ul><ul><li>Limit intake of sweets </li></ul><ul><li>Increase fiber intake </li></ul><ul><li>Increase fish consumption </li></ul>
  17. 24. Summary Slide <ul><li>Acronyms </li></ul><ul><li>Cholesterol: Bad, Good & Ugly </li></ul><ul><li>Risk Factors </li></ul><ul><li>Therapeutic Agents </li></ul><ul><li>Major Side Effects </li></ul><ul><li>Additional Therapies </li></ul><ul><li>Overall Dietary Management </li></ul>
  18. 25. Lipids CASE STUDY
  19. 26. <ul><li>BB is a white male, 15kg over ideal body weight. He presents a prescription for Lipitor 20mg qd #30 with 6 refills. His HMO does not prefer the choice. He is irritated that the doctor has to be called. He must come back. He attempts to berate the ancillary and is cut off during his tirade by the pharmacist. She offers to have him use the pharmacy phone to call his doctor’s office himself. He responds, “No, that is your job” and leaves. The orders are changed to Pravachol 20mg qd. On consultation the patient remarks, “Just give me the cream cheese and pasta pills and let me go!” </li></ul><ul><li>Three months later the physician adds Questran Lite 1 pak po mixed with juice TID #60 with 6 refills. Upon consultation the patient is no longer glib. He is genuinely concerned and scared that his cholesterol number is 310. He wants information from you. </li></ul>
  20. 27. Points to Ponder <ul><li>Where should BB’s cholesterol number be? Why? </li></ul><ul><li>Define LDL, HDL, VLDL. </li></ul><ul><li>List some dietary options in BB’s management </li></ul><ul><li>What are the risks of non-treatment? </li></ul><ul><li>Provide BB with patient education regarding Questran and Pravachol. </li></ul>