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Acipimox <strong>–</strong> derivát kys. nikotínovej. K neţiaducim účinkom patria bolesti hlavy, koţná vazodilatácia,<br />
pocit tepla, flaš. Kontraindikáciou je peptický vred, precitlivenosť na liečivo. Podáva sa v dávkach<br />
500 <strong>–</strong> 750 mg/d (dmd 1250 mg); (Olbetam ® 250 mg v 1 tbl.).<br />
Probukol (Lurselle‹) <strong>–</strong> zvyšuje klírens častíc LDL z plazmy, nie však cestou LDL-receptorov, lebo je<br />
účinný aj u pacientov s homozygotnou familiárnou hypercholesterolémiou. Zniţuje hodnoty LDL-C,<br />
ale aj HDL-C. Má aj antioxidačný účinok, zmenšuje šľachové xantómy. K neţiaducim účinkom patrí<br />
predĺţenie intervalu Q<strong>–</strong>T, hnačky, plynatosť, bolesti brucha, nauzea, pruritus, nespavosť,<br />
hyperhidróza, angioneurotický edém. Je nevhodný u pacientov s arytmiami. Podáva sa v dávke 250<br />
mg 2-krát/d.<br />
Kombinácia antihyperlipoproteinemík umoţňuje zníţiť dávky jednotlivých liečiv, väčšia je však<br />
moţnosť neţiaducich účinkov. Kombinácia statínov a fibrátov môţe vyvolať vznik myopatií<br />
(odporúča sa sle<strong>do</strong>vať aktivitu kreatínkinázy v sére, max. prípustné sú jej 3-násobné hodnoty, inak<br />
treba th. prerušiť). Najčastejšie kombinácie sú: statíny + ţivice, fibráty a ţivice, statíny + probukol,<br />
statíny + niacín, ţivice + niacín. Pri ťaţkej heterozygotnej familiárnej h. moţno pouţiť aj<br />
trojkombináciu, napr. statín + ţivica + fibrát.<br />
Intermediárne a konečné ciele diéty pri hyperlipoproteinémii<br />
<strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong>-<strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><br />
% energetickej spotreby Intermediárne Riziková Konečné<br />
celkovej populácie ciele <strong>sk</strong>upina ciele<br />
<strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong>-<br />
Zloţité sacharidy > 40 > 45 45 <strong>–</strong> 55<br />
Proteíny (P) 12 <strong>–</strong> 13 12 <strong>–</strong> 13 12 <strong>–</strong>13<br />
Sacharidy (S) 10 10 10<br />
Tuky celkove 35 30 > 1,0<br />
Nasýtené karboxylové kys. 15 10 10<br />
Pomer P/S > 0,5 > 1,0 > 1,0<br />
Cholesterol mg/d < 300 < 300 < 300<br />
Vláknina g/d 30 > 30 > 30<br />
Soľ g/d 7 <strong>–</strong> 8 5 5<br />
<strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><br />
Ciele farmakoterapie dyslipoproteinémií<br />
<strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><br />
Celkové<br />
Cieľový<br />
riziko LDL-C non-HDL-C HDL-C TAG<br />
muţi ţeny muţi ţeny<br />
<strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><br />
> 20 % < 2,5 < 3,5 > 1,4 > 1,6 < 1,5<br />
10 <strong>–</strong> 20 % < 3,5 < 4,5 > 1,2 > 1,4 < 2,0<br />
< 10 % < 4,5 < 5,5 > 1,0 > 1,2 < 3,0<br />
<strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong>-<strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><strong>–</strong><br />
Výber vhodného farmaka:<br />
Izolovaná hypercholesterolémia: statíny al. ţivice, príp. ich kombinácia<br />
Kombinovaná hyperlipidémia: statíny, fibráty, kys., nikotínová, acipimox<br />
Hypertriacylglycerolémia:<br />
fibráty, kys. nikotínová<br />
Prim. prevencia u <strong>do</strong>spelých bez ICHS <strong>–</strong> stanoví sa TC (ţiaduca je hodnota < 5,2 mmol/l) a HDL-C v<br />
sére a pátra sa po rizikových faktoroch ICHS.
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