Handbook of Pediatric Cardiovascular Drugs - part 10

Tác dụng điều trị của các can thiệp khác nhau trên các thông số lipid, được hiển thị trong phần trăm thay đổi thuốc mật axit nhựa ràng buộc HMG CoA reductase Niacin Ezetimibe chất ức chế Fibrates Chế độ ăn uống, ít chất béo chế độ ăn thấp carbohydrate chế độ ăn, hoạt động đường huyết thấp tải Aerobic | 13. Drug Therapy for Hypercholesterolemia and Dyslipidemia 323 Table 13-5. Therapeutic effects of various interventions on lipid parameters shown in percent change Medication TC LDL HDL TG Comments Bile acid binding resin ị 7-17 ị 10-20 T 2-8 T 6-12 T Homocysteine HMG CoA reductase inhibitors ị 13-30 ị 17-41 T 3-11 ị 2-18 Ezetimibe ị 15-20 T 1-2 ị 5 ị Plant sterol absorption Niacin ị 25 T 15-30 ị 35-50 ị Lipoprotein a 3o-5O Fibrates ị 13 ị 20 T 15 ị 30-50 Can see T LDL Fish oil T ị 25-45 Diet low fat ị17 ị 25 T 2 ị 6 Diet low carbohydrate ị 3 T 4 T 4 ị 48 Diet low glycemic load ị 10 ị 9 T 2 ị 35 Aerobic activity ị 5-30 T Source data extracted from references 1 12-16 and 18. Niacin and fibrate and low glycemic load data are taken from adult experience because of the lack of pediatric data reference 3 and 21 . Other dietary data are from reference 2 and 22. There is also evidence that statins may have a role in reducing the incidence of cancer26 and in cataract The response to statins is likely mediated in part by genetic polymorphisms although genetic testing is not yet used Dosing See Table 13-4 for HMG CoA reductase inhibitor dosing information. Atorvastatin levels are increased in those drinking more than 1 quart day of grapefruit juice. Pharmacokinetics Absorption in the upper intestines Metabolism in the liver with all but pravastatin being processed by the cytochrome P450 CYP450 system pravastatin is sulfonated in hepatic cytosol . Simvastatin and lovastatin are more lipophilic and are converted P-hydroxy acids whereas rosuvastatin atorvastatin pravastatin and fluvastatin are more hydrophilic Half-life for most statins the half-life is 1 to 4 hours aside from rosuvastatin and atorvastatin which have half-lives of approximately 20 hours29 Protein binding statins are primarily protein bound aside from pravastatin which is only half protein bound Elimination statins are primarily excreted through the gastrointestinal GI .