This document discusses hyperlipidemia and cholesterol. It defines important acronyms like HDL, LDL, VLDL and cholesterol levels. It lists major risk factors for high cholesterol like smoking, family history, age and obesity. It discusses therapeutic agents to treat high cholesterol like statins, fibric acids, niacin and bile acid resins. It provides an overview of their mechanisms of action, dosages and side effects. It emphasizes the importance of dietary changes like reducing fat and alcohol intake and increasing fiber for overall cholesterol management.

1. Hyperlipidemia

2. Cross Section normal & clogged artery

3. Acronyms HDL High density lipoproteins LDL Low density lipoproteins VLDL Very low density lipoproteins HMG-CoA 3-hydroxy 3 methylgultaryl-coenzyme A

4. Cholesterol: Bad, Good & Ugly Desirable Total Cholesterol < 200mg/dL LDL cholesterol < 130 mg/dL LDL (the bad) + HDL (the good) + VLDL (the neither) = total cholesterol

7. Risk Factors )

8. Risk Factors Cigarette smoking, inactivity Family History of CHD Hypertension, Diabetes, Obesity Age and Gender Men >45yo Women >55yo Low HDL <40mg/DL

9. Pathophysiology Definitions Overview Risk factors Non drug therapy TRAVELS with HDL

10. Intestine

11. Therapeutic Agents NIACIN MOA SE Dose Patient Education Why not Niacinamide? Fibric Acid MOA SE Dose Patient Education Gemfibrozil (Lopid) Fenofibrate (Tricor)

12. Bile Acid Resins “Statins” MOA Dose Toxicity Agents Colestipol (Colestid) Cholestyramine (Questran) Competitive inhibitors of HMG-CoA Reductase Toxicity Agents Atorvastatin (Lipitor) Fluvastatin (Lescol) Lovastatin (Mevacor) Pravastatin (Pravachol) Simvastatin (Zocor)

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

14. “ STATINS” Lovastatin (Mevacor) Atorvastatin (Lipitor) Ezetimibe (Zetia)

15. Additional Therapies Intestinal absorption inhibitor ZETIA (ezetimide) Combination Vytorin

16. Fiber Dietary Intake Psyllium (Metamucil, Fiberall) What's your number?

20. The TRAPEZOID !

23. Overall Dietary Management Optimize Weight Restrict fat intake Restrict alcohol intake Limit intake of sweets Increase fiber intake Increase fish consumption

24. Summary Slide Acronyms Cholesterol: Bad, Good & Ugly Risk Factors Therapeutic Agents Major Side Effects Additional Therapies Overall Dietary Management

25. Lipids CASE STUDY

26. 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!” 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.

27. Points to Ponder Where should BB’s cholesterol number be? Why? Define LDL, HDL, VLDL. List some dietary options in BB’s management What are the risks of non-treatment? Provide BB with patient education regarding Questran and Pravachol.