Hyperlipidemia drug therapy

Glueck, C.J. Stern, E.A. Managing children with hyperlipidemias. Drug Therapy 1978, 117-26. 

Provide patient education in regard to CHD, hyperlipidemia, therapeutic lifestyle modifications, drug therapy, and therapy adherence. 

Minority and low socioeconomic communities may be targets for more widespread CKD screening programs. Other factors, such as hyperlipidemia, are not directly proven to cause CKD, but can be modified by drug therapies. 

The cornerstone of treatment in primary hyperlipidemia is diet restriction and weight reduction. Limit or eliminate alcohol intake. Use drug therapy in conjunction with diet, and after maximal efforts to control serum lipids by diet alone prove unsatisfactory, when tolerance to or compliance with diet is poor or when hyperlipidemia is severe and risk of complications is high. Treat contributory diseases such as hypothyroidism or diabetes mellitus. 

Hyperlipidemia, secondary causes Prior to initiating therapy, exclude secondary causes of hyperlipidemia (eg, poorly controlled diabetes mellitus, hypothyroidism, nephrotic syndrome, dysproteinemias, obstructive liver disease, other drug therapy, alcoholism) and measure total-C, HDL-C, and triglycerides. 

Dietary measures are initiated first—unless the patient has evident coronary or peripheral vascular disease—and may obviate the need for drugs. Patients with familial hypercholesterolemia or familial combined hyperlipidemia always require drug therapy. Cholesterol and saturated and trans-fats are the principal factors that increase LDL, whereas total fat, alcohol, and excess calories increase triglycerides. 

The decision to use drug therapy for hyperlipidemia is based on the specific metabolic defect and its potential for causing atherosclerosis or pancreatitis. Suggested regimens for the principal lipoprotein disorders are presented in Table 35-2. 

Combined drug therapy is useful (1) when VLDL levels are significantly increased during treatment of hypercholesterolemia with a resin (2) when LDL and VLDL levels are both elevated initially (3) when LDL or VLDL levels are not normalized with a single agent, or (4) when an elevated level of Lp(a) or an HDL deficiency coexists with other hyperlipidemias. 

Most of the drugs used to treat hyperlipidemia are well tolerated. Some gastrointestinal distress (nausea, diarrhea) is common with most of the drugs, but these problems are usually minor and do not require the discontinuation of drug therapy. 

Hyperlipidemia can lead to atherosclerosis and subsequent cardiovascular incidents such as thrombosis and infarction. This condition is often treated by a combination of drug therapy and diet and life-style modifications. Pharmacologic interventions are typically targeted toward decreasing the synthesis of harmful (atherogenic) plasma components, including certain lipoproteins (IDL, LDL, VLDL) that are associated with atherosclerotic plaque formation. 

Treatment Low fat diet. No drug therapy is effective for Type I hyperlipidemia. 

Which one of the following hyperlipidemias is characterized by elevated plasma levels of chylomicrons and has no drug therapy available to lower the plasma lipoprotein levels ... 

Correct answer = A. Type l hyperlipidemia (hyperchylomicronemla) is treated with a low fat diet. No drug therapy is effective for this disorder. 

Hyperlipidemia, diabetes mellitus, and severe osteoporosis are relative contraindications for oral isotretinoin. The drug may very occasionally produce significant mood changes, depression, and other significant psychiatric adverse effects. Although relationship to drug therapy is controversial, current recommendations are that patients be counseled about and screened for depression during therapy. ... 

A 58-year-old man with a history of hyperlipidemia was treated with a drug. The chart below shows the results of the patient s fasting lipid panel before treatment and 6 months after initiating drug therapy. Normal values are also shown. Which of the following drugs is most likely to be the one that this man received (All values represent mg/dL.)... 

Three examples of the clinical applications are presented alteration of lipoprotein distribution for a patient with acute hepatitis according to recovery of disease (Fig. 23), change of HDL subfractions for a patient with coronary heart disease by a drug therapy (Fig. 24), and diagnosis of the type for hyperlipidemia by HPLC patterns (Fig. 25). 

Brown, B.G., Bardsley, J., Poulin, D., Hillger, L.A., Dowdy, A., Maher, V.M., Zhao, X.Q., Albers, J.J., and Knopp, R.H., 1997. Moderate dose, three-drug therapy with niacin, lovastatin, and colestipol to reduce low-density lipoprotein cholesterol < 100 mg/dl in patients with hyperlipidemia and coronary artery disease. American Journal of Cardiology. 80 111-115. 

Which of the following points would the nurse include when teaching a patient about drug and diet therapy for hyperlipidemia ... 

Short-term evaluation of therapy for hyperlipidemia is based on response to diet and drug treatment as measured in the clinical laboratory by total cholesterol, LDL-C, HDL cholesterol, and triglycerides. 

Compared with previously available therapy, the adverse effects associated with cyclosporine are much less severe but still worthy of concern. Nephrotoxicity, which can occur in up to 75% of patients, ranges from severe tubular necrosis to chronic interstitial nephropathy. This effect is generally reversible with dosage reduction. Vasoconstriction appears to be an important aspect of cyclosporine-induced nephrotoxicity. Hypertension occurs in 25% of the patients and more frequently in patients with some degree of renal dysfunction the concomitant use of antihypertensive drugs may prove useful. Hyperglycemia, hyperlipidemia, transient liver dysfunction, and unwanted hair growth are also observed. 

Niacin has been used clinically to lower serum cholesterol levels (see Chapter 23). It is used as adjunctive therapy in patients with hyperlipidemia. It is one of the drugs of first choice for patients who do not respond adequately to diet and weight loss. 

The answer is a. (Hardman, pp 875-898.) In type I hyperlipoproteinemia, drugs that reduce levels of lipoproteins are not useful, but reduction of dietary sources of fat may help. Cholesterol levels are usually normal, but triglycerides are elevated. Maintenance of ideal body weight is recommended in all types of hyperlipidemia. Clofibrate effectively reduces the levels of VLDLs that are characteristic of types 111, IV, and V hyperlipoproteinemia administration of cholestyramine resin and lovastatin in conjunction with a low-cholesterol diet is regarded as effective therapy for type 11a, or primary, hyperbetalipoproteinemia, except in the homozygous familial form. 

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