(精选)【医学课件】 他汀类药物的副作用教学课件.ppt

他汀类副作用:除了停药还能作些什么？ 非他汀降脂药物的替换应用 Nonstatin alternatives Adverse effects of statins: Strategies beyond discontinuation 非他汀降脂药物替换应用的临床选择 烟酸 多廿烷醇 Red yeast rice （血脂康） ?–3- 脂肪酸 依折麦布 Clinical selection of nonstatin lipid-lowering drugs 烟酸类调脂药物的作用特点与应用 B族维生素(vitamin B3), 大剂量有降脂作用；适用高TG 血症，低HDL-C血症或以TG升高为主混合型高脂血症 速释剂烟酸不良反应明显，现已不用。缓释型烟酸不 良反应明显减轻，较易耐受 临床试验CDP,CLAS-I,FATS,HATS,ARBITER2 等证实，烟酸降低主要冠脉事件减少总死亡率 常见不良反应：颜面潮红、高血糖、高尿酸（或痛风）、上消化道不适等。绝对禁忌证为慢性肝病和严重痛风；相对禁忌证为溃疡病、肝毒性和高尿酸血症 Clinical features and application of Niacin-derived drugs Study on extended niacin application Design: Randomized, double-blind, placebo controlled multicenter, 24-week trial Drug: Combination of Niacin 2000mg/laropiprant 40mg Results: LDL-C –18% Incidence and intensity of flushing were significantly reduced compared with Niacin 2000mg alone. Conclusion: Combination of Niacin/laropiprant was generally well tolerated by adults with dyslipidemia. Perry CM. Drugs 2009;69:1665-1679. 多廿烷醇调脂治疗临床应用文献汇总 作用机制：通过腺苷酸激酶选择性阻断HMG-CoA还原 酶的活性（他汀完全阻断HMG-CoA合成酶） 调脂作用：10 mg/d: LDL-C –17%; HDL-C +5% 20mg/d: LDL-C –24%; HDL-C +18% 证据：1）肝酶异常者（ALT45U/L）应用无恶化现象 2）迄今无肌病及肌溶解报道 J Gerontol Med Sci 2001;13:1-9; Curr Ther Res 1996;57:118-127. Red yeast rice（红曲） for dislipidemia in a statin- intolerant patients: a randomize trial Design （设计）: Randomized, controlled trial Patients（患者）: 62 名他汀肌病停药者 Therapy （治疗）: Rid yeast rice 1800mg (Sylvan bioproducts, Kittanning, Pennsylvania) or placebo (n=31 respectively) Bid Follow-up（随访）: 24 weeks, primary outcome: LDL-C; secondary outcome: TC, HDL-C, TG, Liver enzyme, CK, weight, Results （结果）: LDL-C减少: 1.11mmol/L vs 0.28 mmol/L at 12 wks, 0.93 mmol/L vs 0.39 mmol/L at 24 wks Conclusion （结论）: Red yeast rice may be a treatment option for dislipidemic patients who cannot tolerate statin therapy Becher DJ, et al. Ann Intern Med 2009;150:830-839. Omega-3-fatty acids (?-3-脂肪酸): an