Anti-lipemics

• Anti-lipemics


  Agents that lower blood lipid levels when non-pharmacological means are ineffective in reducing cholesterol and lipoproteins (LDL & VLDL) levels
• Cholestyramine


  Bile-acid sequestrant that reduces LDL cholesterol (LDL-C) levels by binding with bile acids in the intestine, effective against hyperlipidemia type II, may be used as an adjunct to the statins
• Colesevelam


  Bile acid sequestrant agent that has fewer side effects and less effect on the absorption of fat-soluble vitamins than the older agents, usually the first-choice bile acid sequestrant drug
• Gemfibrozil


  Fibric acid derivative that is more effective for reducing triglyceride & VLDL levels than for reducing LDL, used primarily to reduce hyperlipidemia type IV & type II hyperlipidemia, highly protein bound and should not be taken with anticoagulant, dose should be reduced during antihyperlipidemic therapy, INR should be closely monitored
• Fenofibrate


  If taken with warfarin, bleeding might occur, both fenofibrate & gemfibrozil are highly protein bound
• Niacin (vitamin B3)


  Reduces VLDL and LDL, very effective at lowering cholesterol levels, but has numerous side effects and large doses are required, as few as 20% of patients can initially tolerate niacin
• Ezetimibe


  Cholesterol absorption inhibitor that acts on the cells in the small intestine to inhibit cholesterol absorption, decreases cholesterol from dietary absorption, reducing serum cholesterol, LDL, triglycerides & apoB levels, causes only a small increase in HDL, must be combined with a statin for optimum effect
• Statins


  Inhibit the enzyme HMG-CoA reductase in cholesterol biosynthesis, decreasing the concentration of cholesterol, decreasing LDL & slightly increasing HDL cholesterol, reduction of LDL cholesterol may be seen as early as 2 weeks after initiating therapy
• Peripheral Vasodilators


  Increase blood flow to the extremities, used in peripheral vascular disorders of venous and arterial vessels, more effective for disorders that result from vasospasm
• Cilostazol


  Antiplatelet that has a dual purpose of inhibiting platelet aggregation as well as causing vasodilation to treat intermittent claudication