Info

(more than one) risk factors

<70 mg/dL

In rare instances, for patients who cannot tolerate medication therapy, surgical creation of an ileal bypass may be necessary to accelerate the loss of bile acids in the stool and lower plasma cholesterol levels. For children with severe disease, surgery to create a portacaval shunt may be performed as a last resort to decrease plasma cholesterol levels. Plasma exchanges may also be used to reduce cholesterol levels.

Pharmacologic Highlights

Medication or Drug Class

Dosage

Description

Rationale

Drugs that lower low-density lipoprotein cholesterol (LDL-C)

Varies with drug

Bile acid sequestrant resins (cholestyramine, colestopol); nicotinic acid (niacin); 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins such as levostatin, pravastatin, simvastatin, flu-vastatin, atorvastatin); estrogen in postmenopausal women

Lower the plasma concentration of lipoproteins, either by decreasing their production or by increasing their removal from plasma

Drugs that increase high-density lipoprotein cholesterol (HDL-C)

Varies with drug

Nicotinic acid (niacin), estrogen in postmenopausal women

Lower the plasma concentration of lipoproteins, either by decreasing their production or by increasing their removal from plasma

Independent

Teach the patient about ways to manage diet to control the disorder. Urge the patient to adhere to a 1000- to 1500-calorie per day diet and avoid excess sugar intake. Explain the components of the lipid profile and their ramifications and discuss various means of lowering very low density lipoprotein (VLDL) and LDL levels and increasing high-density lipoprotein (HDL) levels.

Explain the prescribed medication regimen, by providing verbal and written information to the patient or significant others. Refer to effective programs or support groups for controlling cigarette and alcohol use. Teach alternate methods of contraception to the female patient who can no longer use oral contraceptives.

A patient faces significant health threats unless he or she makes permanent lifestyle changes. Encourage him or her to verbalize fears, such as those concerning CAD. Offer support and provide clear explanations for the patient's questions about the lifestyle changes and consequences.

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