mechanism of antihypelipemics.... - mayflower224

[ArchivalUser]

Guys i am really close to my exam .... I cant understand the mechanisms of antihyperlipidemics.... anyone please explain....
Thanks a lot in advance !

[ArchivalUser]

Ok

Lets keep it simple

First Cholesterol & LDL



Cholesterol LDL


Acceptable <170 <110
Borderline 170 - 199 110 - 129
High 200 130



Plan:

Whom to treat?

No risk factors / LDL > 190 / Dietary Rx failed after 6 months : Drug Rx
2 or > risk factors / No atherosclerosis / LDL >160 : Drug Rx
Atherosclerosis/ LDL >100 : Drug Rx

1. Bile Acid Binding Resins: Cholestyramine, Colestipol

-- Indication: Increased LDL , Normal TG
--MOA : Binds to bile acids in the gut, stops them going back to liver, excretes them in feces.
--CI: Nil
--SE: Constipation,

2. Nicotinic Acid : Niacin

--Indication: Increased LDL/ Tg or both
--MOA: Inhibits VLDL synthesis in liver by unknown mechanism
--CI: active liver disease, active PUD
--SE: cutaneous flushing, pruritis, abdomional discomfort, diarrhoea.

3. HMG Co A Reductase Inhibitors : Statins

--Indiacation; Increased LDL
--MOA: Inhibit HMG CoA Reductase the rate limiting enzyme in cholesterol synthesis
--CI: Active liver disease, Pregnancy, lactation. Avoid in females of reproductive age & childeren
--SE: rash, GIT, headache, insomnia, cancer risk ; except fluvastatin.

4. Fibric Acid Derivatives : Gemfibrozil, Clofibrate

--Indication: Increased TG also when LDL & TG increase
--MOA: Stimulated Lipoprotein Lipase ---> Breakdown of VLDL -----> Decreased LDL.
--CI: Liver & Kidney disease, Gall bladder disease
--SE: Mild GI discomfort most common

5. Probucol

--Indication: Increased LDL
--MOA: Increases catabolism of LDL
--CI : Prolonged QT, recent MI
--SE: Diarrheoea, flatulence, QT prolongation, Arrhthmias

[ArchivalUser]

Dr pardha,
well formatted for quick review...
i want to add two points
Niacin cause Insulin resistance and cause hypotension. so if it is a diabaetic then ohd needs increasing and antihypertensive dose to be decreased ( hypothetical)

[ArchivalUser]

Thanks a lot guys.....