41. Hyperlipidemia Medications Flashcards
Causes of primary hyperlipidemia
genetic or familial
Causes of secondary hyperlipidemia
More common
- dietary habits
- DM
- alcoholism
- hypothyroidism
- obesity
- obstructive liver disease
4 types of lipoproteins
HDL, LDL, VLDL, and chylomicrons
3 types of lipids that form lipoproteins
- cholesterol
- phospholipids
- triglycerides
most common lipids (90%); 3 fatty acids attached to a glycerol backbone; major storage of fat in the body and only type of lipid that serves as an important energy source
triglycerides
type of lipid that forms when a phosphate group replaces a fatty acid in a triglyceride; essential to building plasma membranes; best known are lecithins (egg yolks and soybeans)
phospholipids
cholesterol is most widely known; vital component of plasma membranes and building block of essential biochemicals; synthesized by liver and diet from animal products (don’t need diet); only need minute amount (< 300mg/day)
steroids
What is contained in every lipoprotein?
cholesterol, phospholipid, and triglyceride bound to a protein
Desired range of lipids
- total cholesterol: 150-200
- triglycerides: 40-150
- LDL: <100
- HDL: >60
nonpharmacologic methods to reduce cholesterol
- low-fat diet
- Mediterranean diet or DASH diet
- increased intake of fiber
- exercise
- smoking cessation
general characteristics of antidyslipidemics
- decrease blood lipids
- prevent/delay atherosclerosis
- promote regression of existing plaques
- reduce morbidity and mortality from CAD
MOA of statins (Rosuvastatin)
inhibition of enzyme HMC-CoA reductase in cholesterol biosynthesis -> decreases LDL and slightly increases HDL
What happens if statins are withdrawn
- cholesterol and LDL levels return to pretreatment levels (usually lifetime commitment)
- abrupt withdrawal can lead to 3x rebound effect that may cause death from MI
uses for Rosuvastatin
- decrease LDL, hypercholesterolemia and hyperlipoproteinemia and atherosclerosis
- CAD risk reduction in DM
Side effect/adverse effects of Rosuvastatin
- rhabdomyolysis
- elevated liver enzymes
- myopathy
- hepatotoxicity
When is Rosuvastatin contraindicated
- acute hepatic disease
- pregnancy (category X)
Pt teaching for Rosuvastatin
- may take several weeks for lipid levels to decrease
- need for liver enzymes to be monitored
- take in evening w/ meal
- avoid grapefruit/grapefruit juice -> toxic levels
What should patients do before a lipid panel is done?
fast for 12 hours
What class of meds is Cholestyramine
Bile Acid Sequestrant
MOA of Cholestyramine
forms a resin that limits the reabsorption of bile acids in the intestines which causes bile acids to be excreted in feces
Uses of Cholestyramine
- lower LDL
- itching caused by liver disease
- diarrhea
Adverse effects of Cholestyramine
- GI effects such as ABD fullness
- flatulence
- constipation
- osteoporosis
- Vitamin A, D, and K deficiency
How is Cholestyramine administered?
power (mixed w/ food or liquids)
nursing implications for Cholestyramine
- avoid taking other meds w/ it (blocks absorption)
- wait 4-6 hours after administration to take any other meds
What class of meds is Gemfibrozil?
Fibrates
MOA of Gemfibrozil
decrease hepatic production of triglycerides and VLDL and increases HDL
Uses of Gemfibrozil
hyperlipoproteniemia and hypertriglyceridemia
Adverse effects of Gemfibrozil
- GI discomfort
- diarrhea
- gallstones
What class of meds is Ezetimibe?
cholesterol absorption inhibitor
MOA of Ezetimibe
blocks biliary and dietary cholesterol absorption in intestine
uses of Ezetimibe
hypercholesterolemia and hyperlipoproteinemia
Administration of Ezetimibe
needs to be taken at the same time each day
Adverse effects of Ezetimibe
- headache
- diarrhea
- arthralgia
- ABD and back pain
- rhabdomyolysis
Which vitamin is Niacin
vitamin B3
MOA of Niacin
reduces total LDL, VLDL, and triglyceride levels; increases HDL
Use of Niacin
- most effective in increasing HDL
- use w/ statins lowers LDL more than any other drug alone
Adverse effects of Niacin
pruritus and gastric irritation (hard to tolerate)
Patient education about Niacin
- Nicotinamide (sold OTC) does NOT have lipid lowering effects
- reduce flushing by taking ASA 325mg 30 min prior to niacin or Ibuprofen 200mg 60 min before niacin
- take w/ cold water
What class of meds is Alirocumab (Praulent)?
PSK9 Inhibitors (newest category indicated in drug resistant hypercholesterolemia and familia hypercholesterolemia)
MOA of Alirocumab
- block PSK9 (liver enzyme that binds to LDL receptors on liver causing higher plasma LDL)
- PSK9 is unregulated when on statins (complementary effect; additional 60% lower of LDL)
Administration of Alirocumab
subcutaneous injection every 14 or 28 days (monitor lipid panel)
Side effects of Alirocumab
- injection site reactions
- hypersensitivity rash
- no significant drug interactions
Pt education for Cholestyramine
- take before meals w/ plenty of fluids
- should mix powder thoroughly
- take other meds 1 hour before or 4 hours after administration
Pt education for Gemfibrozil
should be taken w/ a meal
What should patients taking statins report?
- unusual or unexplained muscle tenderness
- increasing muscle pain
- numbness/tingling to extremities
- changes in ADLs
What should patients taking bile acid resins report?
- severe nausea
- heart burn
- constipation or straining w/ passing stools
- any tarry stools or jaundice
What should patients taking niacin report?
- flank, joint, or ABD pain
- jaundice
What should patients taking fibrates report?
- unusual bleeding or bruising
- RUQ ABD pain
- muscle cramping
- changes in color of stool
What is a physical warning sign of a pt w/ high cholesterol?
cholesterol deposits around the eyes (xanthelasma) -> don’t disappear w/ treatment
