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Pharmacotherapy of Dyslipidemia
KHOI NGUYEN LAM
Disease State
Definition
• Premature CAD • Typically with first degree relative Epidemiology - 65 million quality for lifestyle changes
- 1/67 Ashkenazi Jews - 1/100 Afrikaners, South African Indians - Susceptible genotype (no gene discovered) physiology
- Aggravated by excessive saturated fat, trans - Decreased LDL cellular uptake - Diet high in fat/cholesterol decrease LDL Clinical
Presentation
- Premature Coronary artery disease (CAD) o Abdominal obesity (♂ > 40”; ♀ > 35”) Risk Factors
o Cigarette Smoking o HTN (>140/90) o HDL (< 40) o Family Hx o Age (♂ > 45; ♀ > 55) Diagnosis
Therapeutic
Outcomes*
*Reference of
Guidelines
Used
(ATP 3)
Pharmacotherapy Presentation – Pharmaceutical Care Rotation University of Maryland School of Pharmacy Happy Harry’s Pharmacy Patient Care Center, Perryville, MD
Treatment
Options**
o Eat Plant Stanols / Sterols (additive to margarines, salad dressin, mayonnaise) and Fiber (Non-drug
Therapy –
include all
therapeutic
classes/agents
available and
preferences
per treatment
guidelines)
**See
Treatment
Options Table
o Gemfibrozile (Lopid) o Clofibrate (d/c) o Cholestyramine o Colestipol (Colestid) o Colesevelam (Welchol) o Lovastatin + Niacin (Advicor) o Atorvastatin + Amlodipine (Caduet) o Pravastatin + ASA (Pravigard Pac) o Simvastatin + Ezetimibe (Vytorin) o Pharmacotherapy Presentation – Pharmaceutical Care Rotation University of Maryland School of Pharmacy Happy Harry’s Pharmacy Patient Care Center, Perryville, MD Pharmacological Treatment Options for Dyslipidemia
KHOI NGUYEN LAM

Statins Fibric
Lovastation (Mevacor, Altocor/Altoprave) Availability
Generic (Brand)
Cerivastatin (Baycol)***d/c 2001 Rosuvastatin (Crestor) Fluvastatin (Lescol) Pravastatin (Pravachol) Mechanism
• Analogue for cholesterol precursor (HMG CoA) of Action
• Binds to HMG CoA Reductase and destroys it • By lowering LDL, increase LDL receptor on Liver • Breaks down and remove chylomicron, VLDL EFFICACY
(Indication/Use,
Clinical Data
• Antiproliferation effects on smooth muscle cells Support)
o Dyspepsia 20%, ab pain 10%, diarrhea 7%, (Major Drug
o Constipation, flatulence, dyspepsia, ab pain Interactions,
o Similar to Placebo, abnormal LFT (FENO) Pre-cautions,
o Hepatitis, cholestasis, jaundice, cirrhosis, hep indications,
o Antidiabetic agents, hypoglycemia, incr insulin Adverse Effects,
o Infection, rhinitis, sinusitis, steve-johnson Pregnancy Risk
o GEM, Bile Acid Seq, take two hours apart Category)
o 3A4 substrate (amiodarone, barbiturates, St. John’s Wort, phenytoin, anti-retroviral protease o Ezetimibe, (w/GEM, ?, cause cholelithiasis) o 2C9 substrate for Fluvastatin (amiodarone, fluoxetine, zafirlukast, STI-571”Imatinib”, Pharmacotherapy Presentation – Pharmaceutical Care Rotation University of Maryland School of Pharmacy Happy Harry’s Pharmacy Patient Care Center, Perryville, MD Statins Fibric
o Digoxin toxicity (80mg/QD strength) o Erythomycin, Clarithromycin (Myopathy) o Exenatide (AUC, Cmax decr, clinical relevance o Fibric Acid (Myopathy) o Other Statins o Oral Contraceptives (Lipitor, Crestor) o Glitazone (Lipitor) o Repaglinide “Prandin” (Zocor) incr Prandin SE o Warfarin (Lovastatin, Fluvastatin, Crestor, o EtOH o Asians (Crestor) – 2X plasma o DM (renal dx) o Elderly o Renal defficient o Hepatic deficient o Alcoholism o Hepatic Disease o Manitol hypersensitivity (Baycol) Dosage &
Administration
(Include renal
and/or hepatic
adjustments)
Monitoring
• Toxicity :: CPK (creatine phoshokinase, • Tell your dr other medications you’re taking Education
• Cause blurred vision, dizziness (careful Lovastatin 40mg = $62.90 Pravachol 40mg = $147.03 Crestor 40mg = $116.57 Zocor Simvastatin References
Pharmacotherapy Presentation – Pharmaceutical Care Rotation University of Maryland School of Pharmacy Happy Harry’s Pharmacy Patient Care Center, Perryville, MD Pharmacological Treatment Options for Dyslipidemia
KHOI NGUYEN LAM
2-azetidinone compound
Nicotinic Acid
Bile Acid Sequesterates
Availability
Generic (Brand)
Mechanism
of Action
EFFICACY
(Indication/Use,
Clinical Data
Support)
• Not absorbed, safer toxicity profile (Major Drug
Interactions,
Pre-cautions,
indications,
Adverse Effects,
Pregnancy Risk
Category)
Dosage &
Administration
Pharmacotherapy Presentation – Pharmaceutical Care Rotation University of Maryland School of Pharmacy Happy Harry’s Pharmacy Patient Care Center, Perryville, MD 2-azetidinone compound
Nicotinic Acid
Bile Acid Sequesterates

Monitoring
(Efficacy and
Toxicity
Parameters)
• Take ezetimibe >2 hrs before or 4 Education
References
Pharmacotherapy Presentation – Pharmaceutical Care Rotation University of Maryland School of Pharmacy Happy Harry’s Pharmacy Patient Care Center, Perryville, MD Table B1. Estimate of 10-Year Risk for Men (Framingham Point Scores)
Total
Cholesterol
Age 20-39
Age 40-49
Age 50-59
Age 60-69
Age 70-79
Age 20-39
Age 40-49
Age 50-59
Age 60-69
Age 70-79
Nonsmoker
HDL (mg/dL)
Systolic BP (mmHg)
If Untreated
If Treated
Point Total
10-Year Risk %
Table B2. Estimate of 10-Year Risk for Women (Framingham Point Scores)
Total
Cholesterol
Age 20-39
Age 40-49
Age 50-59
Age 60-69
Age 70-79
Age 20-39
Age 40-49
Age 50-59
Age 60-69
Age 70-79
Nonsmoker
HDL (mg/dL)
Systolic BP (mmHg)
If Untreated
If Treated
Point Total
10-Year Risk %

LDL Cholesterol: The Primary Target of Therapy

Risk Assessment: First Step in Risk Management

Method of risk assessment: counting major risk factors and estimating 10-year CHD risk

Role of other risk factors in risk assessment

The link between risk assessment and cost effectiveness

Primary Prevention With LDL-Lowering Therapy

Secondary Prevention With LDL-Lowering Therapy

LDL-Lowering Therapy in Three Risk Categories

Multiple (2+) risk factors and 10-year risk •20%

Therapeutic Lifestyle Changes in LDL-Lowering Therapy

Drug Therapy to Achieve LDL Cholesterol Goals

Secondary prevention: drug therapy for CHD and CHD risk equivalents

LDL-lowering drug therapy for primary prevention

Benefit Beyond LDL Lowering: The Metabolic Syndrome as a Secondary Target of Therapy

Management of underlying causes of the metabolic syndrome

Specific Treatment of Lipid and Non-Lipid Risk Factors

Management of Specific Dyslipidemias

Special Considerations for Different Population Groups

Adherence to LDL-Lowering Therapy

Shared Features of ATP III and ATP II

Estimating 10-Year Risk for Men and Women

Source: http://www.abcforyourhealth.org/Pharmacotherapy/Dyslipidemia.pdf