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Antihyperlipidemic drugs rahul sharma

1) Antihyperlipidemic drugs, also called lipid-lowering drugs, are a diverse group of pharmaceuticals used to treat high levels of lipids like cholesterol in the blood. 2) Lipids originate from endogenous sources synthesized in the liver and exogenous sources ingested in the diet. 3) Major classes of antihyperlipidemic drugs are statins, fibrates, bile acid sequestrants, and niacin, which lower lipids through various mechanisms like inhibiting cholesterol synthesis or absorption.

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ANTIHYPERLIPIDEMIC DRUGS SUBMITTED BY: DR.RAHUL SHARMA DEPARTMENT OF VETERINARY PHARMACOLOGY AND TOXICOLOGY
INTRODUCTION • Hypolipidaemic agents, or antihyperlipidaemic agents • A diverse group of pharmaceuticals used in T/t of high levels of fats (lipids), such as cholesterol, in the blood (hyperlipidaemica). • They are also called lipid-lowering drugs.
LIPID TRANSPORT AND METABOLISM • Lipids originate from two sources: ▫ Endogenous lipids : synthesized in the liver, ▫ Exogenous lipids: ingested and processed in the intestine. • Dietary cholesterol & triglycerides : packaged into chylomicrons in the intestine into bloodstream via lymphatics. • Liver synthesizes TG and cholesterol packages them as VLDLs before releasing them into the blood
• • During this process, the VLDLs become progressively more dense • and turn into LDLs • • Most LDLs taken up by Liver for disposal, • • some circulate and distribute cholesterol to the rest of the body • tissues. • • HDLs, which are also secreted from the liver and intestine, have the • task of preventing lipid accumulation. • • They remove surplus cholesterol from tissues and transfer it to • LDLs that return it to the liver.
DIAGRAM
Hyperlipidaemia Elevated concentrations of lipid i.e, Hyperlipidaemia -> development of atherosclerosis and CAD. • Dyslipidaemia can be primary or secondary. • Primary forms : genetically determined • Secondary forms : Consequence of other conditions such as Diabetes mellitus, Alcoholism, Nepherotic syndrome, Chronic renal failure, Administration of drug…
Management of Dyslipidaemia • Drug therapy to lower plasma lipids is only one approach to treatment • Used in addition to dietary management And • Correction of other modifiable cardiovascular risk Factors • Several drugs are used to decrease plasma LDL-CHO
CLASSIFICATION 1 HMG - Co A Reductase inhibitors ( Statins ) : Atorvastatin, Simvastatin, Lovastatin, Pravastatin, Fluvastatin, Rosuvastatin • Bile acid binding resins : Cholestyramine, Colestipol, Colesavelam. • Inhibitors of intestinal absorption of cholesterol : Stanol esters , Ezetemibe
CLASSIFICATION 2 • Activators of Lipoprotein lipase(Fibrates): Gemifibrozil, Bezafibrate, Fenofibrate, and Ciprofibrate • Inhibitor of VLDL secretion and lipolysis : Niacin (Nicotinic acid) • New drugs (CETP Inhibitors) : Torcetrapib, Anacetrapib
Class: HMG-CoA reductase inhibitors • Mechanism: ↓rate-limiting step in cholesterol synthesis. • Clinical use: ↓ LDL, ↓ triglycerides • Side effects: H : Hepatotoxicity M : Myositis,rhabdoMyolysis G : ↑ FPG C : ↑ Creatinine phosphokinase A : HeadAche, Joint pain R : Rash
Diagram how statins work
Class: Fibrates • • Mechanism: binds with PPAR α • ↑ lipoprotein lipase → ↓ VLDL • ↓TG • • Clinical use: Elevated TG and remnants. • • Side effects: GI upset (dyspepsia), • Cholelithiasis, • Myositis • Hepatitis Rare • • Drug interaction: Warfarin ,OHA
Interactions • Increased risk of myopathy when combined with statins.(fenofibrate) • Displace drugs from plasma proteins( e.g. oral anticoagulants and oral hypoglycemic drugs). Contraindications: • 1- Patients with impaired renal functions. • 2- Pregnant or nursing women. • 3-Preexisting gall bladder disease
Class : Nicotinic Acid • Mechanism: ↓ fatty acid release from adipose tissue, ↓ hepatic synthesis of LDL • Clinical use: ↑ HDL, ↓ LDL, ↓TG • Side effects: Skin flushing, paresthesias, pruritus, GI upset, ↑LFTs, hyperglycemia, hyperuricemia • Prevention of side effects: Aspirin
Class: Bile acid resins • Mechanism: Bind intestinal bile acids → ↓bile acid stores & ↑ catabolism of LDL from plasma. • Clinical use: ↓ LDL • Side effects: Constipation, ↑ Gallstone formation, GI upset, LFT abnormalities, Myalgias. ↓ Absorption of drugs ADEK vitamins from the small intestine. k
Dose : 4 to 8 g OD/BD, max dose 24 g/d. • Contraindication ▫ 1- Complete biliary obstruction( because bile is not secreted into the intestine). ▫ 2- Chronic constipation. ▫ 3-Severe hypertriglyceridemia(TG >400 mg/dL)
Antihyperlipidemic drugs rahul sharma