1. Drugs Used to Treat Dyslipidemias Chapter 22 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

2. Slide 2 Chapter 22 Lesson 22.1 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

3. Slide 3 Objectives Identify the four major types of lipoproteins Describe the primary treatment modalities for lipid disorders State the oral administration instructions for antilipemic agents Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

4. Slide 4 Hyperlipidemia Major cause of atherosclerosis Atherosclerosis characterized by fatty deposits in artery walls Caused by genetic abnormalities and secondary factors such as lifestyle, drugs, or underlying diseases Low levels of HDL and high levels of LDL are risks of atherosclerosis and coronary heart disease Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

5. Slide 5 Treatment of Hyperlipidemias NCEP recommends treatment regimens based on:  Presence of CAD  Level of total cholesterol  Level of HDL-C  Success of diet interventions Primary treatment is therapeutic lifestyle changes (TLCs)  Weight reduction  Exercise  Diet low in cholesterol and fat Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

6. Slide 6 Drug Therapy for Hyperlipidemias Bile acid resins Niacin HMG-CoA reductase inhibitors Omega-3 fatty acids  Antilipemic agents used only if diet and exercise are unsuccessful  Combining bile acid resin with niacin or statin can lower LDL by 40% to 50% Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

7. Slide 7 Patient Education and Health Promotion Consume high-bulk foods: whole grains, raw fruits and vegetables Lots of water to minimize constipation Avoid high cholesterol foods: liver, egg yolks, meats, fried foods, fatty desserts, nuts Decrease stress Importance of weight reduction and exercise Lifestyle changes: smoking cessation Pertinent drug information Long-term regular follow-up care Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

8. Slide 8 Drug Class: Bile Acid-Binding Resins Drugs: cholestyramine, colestipol, colesevelam Actions  Bind to bile acids, promote increased metabolism of cholesterol Uses  In conjunction with dietary therapy to decrease elevated cholesterol Common adverse effects  Constipation, bloating, fullness, nausea, flatulence Serious adverse effects  Vitamin K deficiency (rare) Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

9. Slide 9 Drug Class: Niacin (Nicotinic Acid) Actions  Inhibit VLDL synthesis by liver cells Uses  Treatment of dyslipidemias in conjunction with bile acid-binding resins; reduces risk of CAD Common adverse effects  Flushing, itching, rash, tingling, headache; nausea, gas, abdominal discomfort, pain; dizziness, faintness, hypotension Serious adverse effects  Hepatotoxicity, myopathy Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

10. Slide 10 Drug Class: HMG-CoA Reductase Inhibitors (Statins) Actions  Inhibit enzyme responsible for converting HMG- CoA to mevalonate, ultimately reduce liver cholesterol Uses  In conjunction with dietary therapy to reduce LDL and total cholesterol levels Common adverse effects  Headaches; nausea, abdominal bloating, gas Serious adverse effects  Liver dysfunction; myopathy, rhabdomyolysis; myoglobinuria Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

11. Slide 11 Drug Class: Fibric Acids Drugs: gemfibrozil (Lopid), fenofibrate (Tricor) Actions  Lowers triglyceride levels; mechanism of action unknown Uses  In conjunction with dietary therapy to treat hypertriglyceridemia Common adverse effects  Nausea, diarrhea, flatulence, bloating, abdominal distress Serious adverse effects  Fatigue, anorexia, nausea, malaise, jaundice Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

12. Slide 12 Miscellaneous Antilipemic Agents Drug: ezetimibe (Zetia) Actions  Block absorption of cholesterol from small intestine Uses  In conjunction with dietary therapy to decrease elevated cholesterol Common adverse effects  Abdominal pain, diarrhea Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

13. Slide 13 Miscellaneous Antilipemic Agents (cont’d) Drug: omega-3 fatty acids (Lovaza) Actions  Reduce synthesis of triglycerides in the liver; mechanism of action unknown Uses  In conjunction with dietary therapy to decrease elevated triglyceride levels Common adverse effects  Nausea, back and abdominal pain, bloating, bad taste in mouth, weakness, diarrhea Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.