【醫(yī)學(xué)課件】選擇正確的降脂治療方案ppt課件-展示頁(yè)
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【正文】 – GI intolerance: constipation, bloating, abdominal pain, flatulence – Lack systemic toxicity ? Drug interactions (colestipol and cholestyramine) – Bind other negatively charged drugs – Impede the absorption of drugs and/or fatsoluble vitamins – Must give other drugs 1 hour before or 4–6 hours after Nicotinic Acid: Mechanism of Action Liver Circulation HDL Serum VLDL results in reduced lipolysis to LDL Serum LDL VLDL Decreases hepatic production of VLDL and of apo B VLDL secretion Apo B Hepatocyte Systemic Circulation Mobilization of FFA TG synthesis VLDL LDL Effect of Niacin on Lipoproteins Adapted from Knopp RH. N Engl J Med 1999。81:333335. Endpoints +20 –35 –30 –25 0 –5 –10 –15 –20 Relative Risk Reduction (%) –40 –45 –50 Major coronary events Coronary deaths Cardiovascular deaths Noncardiovascular events Total mortality Strokes Intermittent claudication Angina Potential Time Course of Statin Effects * Time course established Days Years LDLC lowered* Inflammation reduced Vulnerable plaques stabilized Endothelial function restored Ischemic episodes reduced Cardiac events reduced* Statin Adverse Events ? Common side effects ? Headache – Myalgia – Fatigue ? GI intolerance – Flulike symptoms ? Increase in liver enzymes ? Occurs in to % of cases in dosedependent manner ? Serious liver problems are exceedingly rare ? Manage by reducing statin dose or discontinue until levels return to normal ? Myopathy ? Occurs in to % of patients ? Rare cases of rhabdomyolysis ? Reduce by ? Cautiously using statins in patients with impaired renal function ? Using the lowest effective dose ? Cautiously bining statins with fibrates ? Avoiding drug interactions ? Careful monitoring of symptoms ? Presence of muscle toxicity requires the discontinuation of the statin Bile Acid Resins: Mechanism of Action Net Effect: ? LDLC Gall Bladder ? LDL Receptors ? VLDL and LDL removal ? Cholesterol 7? hydroxylase ? Conversion of cholesterol to BA ? BA Secretion Liver ? BA Excretion Terminal Ileum Bile Acid Enterohepatic Recirculation Reabsorption of bile acids 20%15%10%5%0%Effect of Colesevelam on LDLC Davidson MH et al. Expert Opin Investig Drugs 2021。282:23402346. | Crouse JR III et al. Arch Intern Med 1997。285:17111718. | Pitt B et al. N Engl J Med 1999。335:10011009. | LIPID Study Group. N Engl J Med 1998。333:13011307. | Scandinavian Simvastatin Study Group. Lancet 1994。 **isch
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