Hyperlipidemia, management

Medicaid is supervised by CMS but is administered by each individual state. In Medicaid, each state determines the list of health care professionals who can be considered as providers. For pharmacists to be considered providers of patient care services for Medicaid, the state can develop a Medicaid demonstration project (Snella, 1999). One example of a demonstration project is the Mississippi Medicaid project in which pharmacists were compensated for services such as asthma, diabetes, and hyperlipidemia management (Anonymous, 1998 Landis, 1998). 

Hyperlipidemia management can exist wherever pharmacists practice, including community pharmacies, institution-based or free-standing ambulatory clinics, or inpatient services. Despite these different settings, some universal requirements need to be addressed. 

Pharmacist practices in hyperlipidemia management have been shown to be effective in improving compliance, adherence to therapy, and LDL lowering. Studies that establish cost effectiveness are limited and are needed to support efforts to expand pharmacist involvement and justify reimbursement. 

On the other hand, in recent years there has been an increasing role for the use of certain vitamins in the prevention and management of specific diseases. The use of nicotinic acid in hyperlipidemia is an old but still a good example for such use. 

Prazosin may be particularly useful when patients cannot tolerate other types of antihypertensive agents or when blood pressure is not well controlled by other drugs. Since prazosin does not significantly influence blood uric acid or glucose levels, it can be used in hypertensive patients whose condition is complicated by gout or diabetes meUitus. Prazosin treatment is associated with favorable effects on plasma lipids. Thus, it may be of particular importance in managing patients with hyperlipidemia. 

The major steps in the management of patients with chronic heart failure are outlined in Table 13-3. The ACC/AHA 2005 guidelines suggest that treatment of patients at high risk (stages A and B) should be focused on control of hypertension, hyperlipidemia, and diabetes, if present. Once symptoms and signs of failure are present, stage C has been entered, and active treatment of failure must be initiated. 

Goldberg A, Alagona DP Jr, Capuzzi DM, Guyton J, Morgan JM, Rodgers J, Sachson R, Samuel P. Multiple-dose efficacy and safety of an extended-release form of niacin in the management of hyperlipidemia. Am J Cardiol 2000 85 1100-5. 

Fazio S, Linton MF. The role of fibrates in managing hyperlipidemia mechanisms of action and clinical efficacy. Curr Atheroscler Rep. 2004 6 148-157. 

Dietary measures are always initiated first and may obviate the need for drugs. Exceptions are patients with familial hypercholesterolemia or familial combined hyperlipidemia in whom diet and drug therapy should be started simultaneously. Cholesterol, saturated fats, and trans fats are the principal factors that influence LDL levels, whereas total fat and calorie restriction is important in management of triglycerides. 

Furmaga EM. 1993. Pharmacist management of a hyperlipidemia clinic. Am J Hosp Pharm 50 91. 

Renaud, S.C., Beswick, A.D., Fehili, A.N., Sharp, D.S., andElwood, P.C. 1992. Alcohol and platelate aggregation the Caerphilly prospective heart diseases study. Am. J. Clin. Nutr. 55, 1012-1017. Rivlin, R.S. 1998. Patient with hyperlipidemia who received garlic supplements. Lipid management. 

Six patients with new-onset diabetes mellitus in patients taking olanzapine (from 10 mg for 2 months to 25 mg for 22 months) were switched to quetiapine (170). Five of the six had known risk factors for diabetes mellitus (positive family history, obesity, race, and hyperlipidemia) only one gained significant body weight with olanzapine. There was a close temporal relation between the onset of therapy and the appearance of diabetes in three patients. The authors made recommendations about the detection and management of this effect in patients taking... 

Fellstrom B (2000) Impact and management of hyperlipidemia posttransplantation. Transplantation 70 S51-S58. 

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