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Drug Therapy for Lipid Disorders - Coggle Diagram
Drug Therapy for Lipid Disorders
Lifestyle
Diet based Strategies
Mediterranean diet, Portfololio diet, DASH, High Nut, legume, Olive oil, fibre, fruit/vegetable
Exercise
moderate to strenuous physical activity >150 min per week, >10 minutes per session +/- resistantce exercise 2x/week
Optimize Secondary Causes
Dietary
Disease (diabetes, hypothyroidishm, obesity, alcoholism, renal failure, nephrotic syndrome, liver disorders, HIV, glycogen storage disease, Cushing syndrome, acromegaly)
Pharmacotherapy
Goals
Decrease Triglycerides
Treatment Thresholds
History of TG induced Pancreatitis (Increased risk when TG>10 mmol)
If high risk for ASCVD with TG>5
Fibrates (fenofibrate)
Increase LPL activity, decrease ApoC3 (inhibitory signal), decrease hepatic VLDLc, Increase ApoA-1
Omega 3 Fatty Acids
Medium Chain TGs (avoid incorporation into CMs)
Downregulate TG-synthesizing enzymes and may stimulate LPL
Niacin
Decrease hepatic VLDLC production, and decrease TG synthesis and increase hepatic ApoB breakdown
Side efects: Flushing, abnormal liver biochemistry, Hyperglycemia, Hyperuricemia
Decrease LDL-C
Statins (Atorvastatin, rosuvastatin, simvastatin)
Mechanisms
Inhibits HMG-CoA Reductase (decreases hepatic cholesterol production)
Leads to increase hepatic LDL-R expression
Side effects
Myopathy (any muscle symptom sufficient), HyperCKemia (Elevated CK), Myalgia (muscle symptom without hyperCKemia), Myositis (any muscle symptom with hyperCKemia)
Risk Factor to Statin Induced Myopathy
Age, Small body frame, FHx, Systemic disease, Major surgery, CYp3A4 (lack of or accelerated metabolism)
Treatment approach
Rule out false +ves, stop statin, Education, Lower dose or different statin, Different agent
Cholesterol Absopriton Inhibitors (ezetimibe)
Mechanism
Inhibits absorption of dietary cholesterol and reabsorption of biliary cholesterol (often used with statin as 2nd line)
Bile acid Sequestrins (cholestyramine, colesevelam)
Mechanism of action
Bind to bile acids to prevent reabsorption
Divert hepatic cholesterol towards bile acid production, leads to LDL-R production and lowering of LDLC
PCSK9 Inhibitors (evolocumab)
Inhibits PCSK-mediated LDL-R Degradation
Leads to increase in LDL-R and decrease in LDLC