医学课件选择正确的降脂治疗方案ppt课件.ppt

Selecting Successful Lipid-Lowering TreatmentsJames M. McKenney, Pharm.D. Treatment Categories, LDL-C Goals and Cutpoints Treatment of Hyperlipidemia Statins: Mechanism of Action The LDL-C–Lowering Efficacy of the Currently Available Statins The Triglyceride-Lowering Effects of Statins Endpoint Trials with the Statins CHD Risk Reduction with Statin Therapy Potential Time Course of Statin Effects Statin Adverse Events Common side effects Headache – Myalgia – Fatigue GI intolerance – Flu-like symptoms Increase in liver enzymes Occurs in 0.5 to 2.5% of cases in dose-dependent manner Serious liver problems are exceedingly rare Manage by reducing statin dose or discontinue until levels return to normal Myopathy Occurs in 0.2 to 0.4% of patients Rare cases of rhabdomyolysis Reduce by Cautiously using statins in patients with impaired renal function Using the lowest effective dose Cautiously combining 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 Effect of Colesevelam on LDL-C Clinical Features of BARs Nicotinic Acid: Mechanism of Action Effect of Niacin on Lipoproteins Clinical Features of Nicotinic Acid Progression of Drug Therapy for LDL-C Lowering Simvastatin Alone and with Colesevelam:Percent Change in LDL-C The Effect of Adding Niaspan? to a Stable Dose of a Statin Triple-Drug Regimen Targets for Therapy after LDL-C Goal in Patients with TG ?200 mg/dL Treatment of Mixed Hyperlipidemia Change in LDL-C and Non-HDL-C by Statins after 54 Weeks of Therapy Pravastatin and Niacin Alone and Together Fish Oils Fibric Acid Derivatives Effects of Fenofibrate on Plasma Lipids Trials of Fibrates: Effects on Cardiac Events Statin + Fibrate Steps to Minimize the Risk of Muscle Toxicity with Fibrate–Statin Combination Therapy Guidelines that aren’t implemented don’t work Selecting successful l