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Dislipidemias

QuestionAnswer
Estatinas (General) Mecanismo: Reducción de LDL-C y aumento de HDL-C. RAMs críticos: - Miopatía - Rabdomiólisis - Hepatotoxicidad Monitorización: - Perfil lipídico a 12 semanas - CK basal y ante síntomas musculares - Transaminasas a los 3 meses
Rosuvastatina Potencia: Alta Dosis: 5-40 mg/día Dosis ERC: - TFG <30: 10 mg/día Interacciones clave: - Gemfibrozilo: ↑ 2x niveles (evitar) - Warfarina: Monitorizar INR
Consideraciones Rosuvastatina RAMs frecuentes: -Proteinuria leve (no progresiva) - Cefalea, mialgias Ventajas en Chile: - Metabolismo independiente de CYP450 - Menor riesgo de interacciones
Atorvastatina Potencia: Alta Dosis: 10-80 mg/día Dosis ERC: Sin ajuste. Interacciones peligrosas: - Inhibidores CYP3A4: Claritromicina, itraconazol (↑ toxicidad) - Gemfibrozilo: Contraindicado
Consideraciones Atorvastatina RAMs distintivos: - Mayor riesgo de hiperglicemia vs. otras estatinas - Insomnio (5% pacientes) Contexto chileno: - Primera elección en síndrome coronario agudo
Fibratos (General) Mecanismo: Reducción de TG RAMs críticos: - Molestias GI - Miopatía (↑ riesgo con estatinas) - Colelitiasis (10-20%) - Elevación transaminasas
Fenofibrato Dosis: 100-200 mg/día Dosis ERC: - TFG <30: Contraindicado Interacciones: - Resinas (colestiramina): Disminuyen absorción (separar 2h) - Warfarina: ↑ efecto anticoagulante
Consideraciones Fenofibrato Monitorización: - TG a las 12 semanas - Función renal cada 6 meses Ventajas en Chile: -Menor riesgo de interacciones con estatinas - Perfil seguro en diabéticos
Ezetimibe Mecanismo: Inhibe absorción intestinal de colesterol Indicación: - Adyuvante a estatinas si no se alcanza meta LDL - Intolerancia a estatinas Dosis: 10 mg/día Dosis ERC: Sin ajuste
Consideraciones Ezetimibe RAMs: - Diarrea (5%) - Dolor articular (raro) Efectividad: - ↓ LDL-C adicional 15-20% con estatina
Diagnóstico Criterios dislipidemia: - LDL ≥160 mg/dL (hipercolesterolemia) - HDL <40-50 mg/dL (Hombre/Mujer) - TG ≥150 mg/dL (hipertrigliceridemia) Signos clínicos: -Xantomas - Xantelasmas - Arco corneal
Interacciones Críticas Combinaciones peligrosas: - Estatina + Gemfibrozilo: ↑ 80x riesgo rabdomiólisis - Simvastatina + Amiodarona: ↑ toxicidad muscular Fármacos que ↑ TG: - Tiazidas - Betabloqueadores - Tamoxifeno - Corticoides
Created by: EliasPoblete
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