Etoh increase rf hepatotoxicity o statins fibrates

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ETOH: increase r/f hepatotoxicity o Statins, fibrates: increases risk of hepatotoxicity and/or myalgias Monitoring: o Lipid levels in 4 to 6 weeks, then every 3 to 4 months until control established o LDL levels most important o LFTs, uric acid levels, blood glucose levels before starting therapy o Every 4 to 6 weeks during the first 3 months of therapy then every 3 to 4 months Patient education: o Take as directed o ASA 30 mins before niacin my prevent or reduce flushing o Flushing o Lifestyle modifications: diet and exercise Ezetimibe (Zetia) o MOA : selectively inhibits the intestinal absorption of cholesterol and related phytosterols o Has been shown to reduce TC, LDL, and TG while increasing HDL-C o No good outcome data yet but most effective in combo with statin o Dosing: 10 mg/day o Pregnancy category C, not for children less than 10 years old Clinical Use and Dosing o Increased LDL Niacin, bile-acid sequestrants, and reductase inhibitors all reduce LDL Reductase inhibitors are first line drugs in monotherapy and in combo
Traditionally given in the evening in a single dose o Elevated VLDL and Elevated Triglycerides Fenofibrate and gemfibrozil are the most potent triglyceride lowering agents because of their effect on VLDL Fenofibrate: do not use in patients with HLD and CVD symptoms Niacin: in large doses for those who do not responds to fibric acid derivatives Bile acid sequestrants and reductase inhibitors also produce marked reduction in triglyceride levels Omega 3 fatty acids can also be used for triglyceride care EPA and DHA are found in fish and ALA is found in plants and flax seed oil o Decreased HDL Niacin is an effective agent in increasing HDL near 30% improvement Gemfibrozil and fenofibrate are the next best at increasing HDL, followed by some reductase inhibitors Rosuvastatin, atorvastatin, and simvastatin can raise HDL 15% Low HDL is a recognized risk factor in heart disease Rational drug selection Degree of CVD risk o High risk: When baseline LDL is greater than 130 relatively high doses or combination with other Antilipidemics may be needed to achieve desired outcomes o Moderate risk: drug therapy is based on 10 year CV risk If risk is greater than 7 to 10% reductase inhibitors are appropriate o Low risk: dietary modifications o For isolated low HDL: aerobic exercise, smoking cessation, and weight loss added to dietary therapy o Elevated triglycerides are recognized as an independent risk factor for CVD (especially in women) Fibric acid derivatives are the drugs of choice when Tx is chosen o Fibric acid derivatives: Drug of choice for patients with very high triglycerides (>800) o Attention to LDL remains paramount because TG reduction comes with LDL reduction Older Adults: reductase inhibitors are the first line choice Well tolerated in older adults with minor diarrhea and occasional sleep disturbances being the most common problems Prudent to monitor LFTs in select older patients

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