After reading this chapter, the pharmacy student, community practice resident, or pharmacist should be able to:
Describe lipids and lipoproteins and their associated disorders.
Identify the risk factors associated with the development of lipoprotein disorders.
Review prescription and over-the-counter (OTC) pharmacotherapy treatment options for lipoprotein disorders.
Apply patient case and pharmacist interviews to overcome barriers to implementation of lipid management services within the community pharmacy setting.
Analyze the business management aspects needed to create lipid management services in a community pharmacy.
Description of Lipids and Lipoproteins
Cholesterol, triglycerides, and phospholipids are transported through the blood in particles made up of lipids and proteins (lipoprotein complexes). Low-density lipoprotein (LDL), high-density lipoprotein (HDL), and very low-density lipoprotein (VLDL) are the three main types of lipoprotein complexes present in serum. Intermediate-density lipoprotein (IDL) is included in the LDL measurement in clinical practice but is located between VLDL and LDL. Chylomicrons are lipoproteins that are formed in the intestine and carry triglycerides from dietary fat.
LDL (60–70% of total cholesterol) contains the apolipoprotein (apo), apo B-100, and is the primary target of cholesterol-lowering agents due to its atherogenic properties, while HDL (20–30% of total cholesterol) carries cholesterol from lipid-rich foam cells to the liver and may protect against atherosclerosis. HDL contains apo A-I and apo A-II. VLDL (10–15% of total cholesterol) is rich in triglycerides and contains apo B-100, C-I, C-II, C-III, and E. Chylomicrons not only contain apo C-I, C-II, C-III, and E but contains B-48 in the place of B-100.
Overview of Lipid Disorders
Lipoprotein disorders are classified based on the specific lipoproteins involved resulting from primary or genetic defects (see Table 8-1). There are also many secondary causes of lipoprotein disorders that must be considered when suggesting, initiating, or modifying therapy (see Table 8-2).
Table 8-1. Definition, Classification, Characteristics, and General Treatment of Lipid Disorders |Favorite Table|Download (.pdf)
Table 8-1. Definition, Classification, Characteristics, and General Treatment of Lipid Disorders
1st Line: Statin
2nd Line: BAS and/or CAI, then niacin
1st Line: Statin
TG = Fish oil, fibrate
LDL = BAS, CAI
1st Line: Statin
2nd Line: Fibrate, niacin, CAI, or BAS
1st Line: Niacin, fibrate
If LDL ↑, then statin
III or IV or V
1st Line: Fibrate, niacin (if HDL ↓), or fish oil (if TG >400 mg/dL)
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