Lipid levels monitoring

Hyperlipidemia, dyslipidemia PO 5 to 40 mg/day. Usual starting dosage is 10 mg/day, with adjustments based on lipid levels monitor q2-4wk until desired level is achieved. Maximum 40 mg/day. 

Microalbuminuria Close monitoring of blood pressure, blood glucose and blood lipid levels Monitor urinary protein Aim for BP <125/75 mmHg Add further antihypertensive drugs if necessary Add ACE I/ARB if possible Aim for total cholesterol <3.5 mmol/L... 

Monitor for hyperlipidemia (elevated blood lipid levels). 

Crystalline niacin tablets are available over the counter in a variety of strengths. To minimize the flushing and pruritus, it is best to start with a low dose fe.g., 100 mg twice daily taken after breakfast and supper). The dose may be increased stepwise every 7 days by 100—200 mg to a total daily dose of 1.5—2 g. After 2—4 weeks at this dose, transaminases, serum albumin, fasting glucose, and uric acid levels should be measured. Lipid levels should be checked and the dose increased further until the desired effect on plasma lipids is achieved. After a stable dose is attained, blood should be drawn every 3-6 months to monitor for the various toxicities. 

Therefore it seems that ciclosporin can greatly raise ezetimibe levels, possibly resulting in an increased effect on lipid reduction, and that ciclosporin levels can be raised, possibly significantly in some patients, by ezetimibe. If concurrent use is necessary, until the effects of concurrent treatment are better established, it would seem prudent to monitor both ciclosporin levels and the effects on lipid levels, anticipating the need to reduce the dosage of either drug. The authors of the case report cited sug-... 

A 35% reduction in the steady-state plasma levels of the active metabolite of clofibrate, ehlorophenoxyisobutyric acid (CIPB), was seen in 5 healthy subjects after they took rifampicin 600 mg daily for 7 days. This appears to occur because the metabolism of CIPB by the liver and/or the kidneys is inereased. On the basis of this study it would now be prudent to monitor serum lipid levels of patients taking clofibrate if rifampicin is added, and to increase the elofibrate dosage if necessary. More study is needed to establish this interaction. 

A comparative study in men, women, and women taking combined oral contraceptives found that the clearance of clofibrate was increased by 48% in those taking combined oral contraceptives, apparently due to an increase in clofibrate glucuronidation. Another study found that combined oral contraceptives increased the excretion of clofibric acid glucuro-nide (the pharmacologically active form of clofibrate) by 25%. None of these studies addressed the question of whether concurrent use significantly reduces clofibrate efficacy, but it would seem prudent to monitor for increases in blood lipid levels. It should be noted that combined oral contraceptives themselves can have various adverse effects on lipid levels, and these may impair the effects of treatment. 

As with urine, saliva (spumm) is easy to collect. The levels of protein and lipids in saliva or spumm are low (compared to blood samples). These matrices are viscous, which is why extraction efficiency of xenobioties amoimts to only 5 to 9%. By acidifying the samples, extraction efficiencies are improved as the samples are clarified, and proteinaceous material and cellular debris are precipitated and removed. Some xenobioties and their metabohtes are expressed in hair. Hair is an ideal matrix for extraction of analytes to nonpolar phases, especially when the parent xenobioties are extensively metabolized and often nondetectable in other tissues (parent molecules of xenobioties are usually less polar than metabolites). Hair is a popular target for forensic purposes and to monitor drug compliance and abuse. Human milk may be an indicator of exposure of a newborn to compounds to which the mother has been previously exposed. The main components of human milk are water (88%), proteins (3%), lipids (3%), and carbohydrates in the form of lactose (6%). At present, increasing attention is devoted to the determination of xenobioties in breath. This matrix, however, contains only volatile substances, whose analysis is not related to PLC applications. 

The detection and quantification of one or more of the above lipid peroxidation produas (primary and/or secondary) in appropriate biofluids and tissue samples serves to provide indices of lipid peroxidation both in ntro and in vivo. However, it must be stressed that it is absolutely essential to ensure that the products monitored do not arise artifactually, a very difiScult task since parameters such as the availability of catalytic trace metal ions and O2, temperature and exposure to light are all capable of promoting the oxidative deterioration of PUFAs. Indeed, one sensible precaution involves the treatment of samples for analysis with sufficient levels of a chainbreaking antioxidant [for example, butylated hydroxy-toluene (BHT)] immediately after collection to retard or prevent peroxidation occurring during periods of storage or preparation. 

The development of CHD is a lifelong process. Except in rare cases of severely elevated serum cholesterol levels, years of poor dietary habits, sedentary lifestyle, and life-habit risk factors (e.g., smoking and obesity) contribute to the development of atherosclerosis.3 Unfortunately, many individuals at risk for CHD do not receive lipid-lowering therapy or are not optimally treated. This chapter will help identify individuals at risk, assess treatment goals based on the level of CHD risk, and implement optimal treatment strategies and monitoring plans. 

PCCD/PCDFs have been found to be present in Arctic air samples, e.g. during the winter of 2000/2001 in weekly filter samples (particulate phase) collected at Alert in Canada. PCDD/PCDFs have been monitored since 1969 in fish and fish-eating birds from the Baltic. The levels of PCDD/PCDFs in guillemot eggs, expressed as TEQ, decreased from 3.3 ng/g lipids to around 1 ng/g between 1969 and 1990. Since 1990, this reduction seems to have levelled off and today it is uncertain whether there is a decrease or not. Fish (herring) show a similar picture. 

Terrestrial BMOs have also been widely used for monitoring environmental contaminants. In particular, the lipid-like waxy cuticle layer of various types of plant leaves has been used to monitor residues of HOCs in the atmosphere. However, some of the problems associated with aquatic BMOs apply to terrestrial BMOs as well. For example, Bohme et al. (1999) found that the concentrations of HOCs with log KoaS < 9 (i.e., those compounds that should have attained equilibrium) varied by as much as 37-fold in plant species, after normalization of residue concentrations to levels in ryegrass (Lolium spp.). These authors suggested that differences in cuticular wax composition (quality) were responsible for this deviation from equilibrium partition theory. Other characteristics of plant leaves may affect the amount of kinetically-limited and particle-bound HOCs sampled by plant leaves but to a lesser extent (i.e., <4-fold), these include age, surface area, topography of the surface, and leaf orientation. 

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