Antihyperlipidemics

Question 1

statins

Answer 1

anything with -statin

atorvastatin, simvastatin, rosavastatin

Question 2

bile acid resins (sequestrans)

Answer 2

• cholestyramine

- colsevelam

Question 3

nicotinic acids (niacin, B3)

Answer 3

niacin

Question 4

omega-3 drug

Answer 4

fish oil

Question 5

statins route

Answer 5

PO

Question 6

statins MOA

Answer 6

inhibit cholesterol synthesis in the liver

Question 7

statins adverse effect

Answer 7

1. liver failure
   - elevated LFT, check base line and Q8 wks
2. myopathy and cramps
   - hold when pt has muscle aches
3. rhabdomyolysis
   - check baseline CK and Q8 wks

Question 8

statins contraindications

Answer 8

1. pregnancy

2. lactation

Question 9

statins nursing

Answer 9

1. taper, abruptly stopping causes rebound effect and acute MI
2. grapefruit juice reduce statins level
3. take at night (cholesterol biosynthesis is higher at night)
4. may cause cataract formation (annual eye exam)

Question 10

statins drug interactions

Answer 10

MANY (all we need to know)

Question 11

bile acid resins (sequestrans) - cholestyramine and colsevelam MOA

Answer 11

bind bile acid and increase excretion of cholesterol and LDL

• take 30 min before meal
• take with at least 8 oz of water to avoid impaction of esophagus

Question 12

bile acid resins (sequestrans) - cholestyramine and colsevelam side effects

Answer 12

1. constipation, SBO, flatulence, cramping
   - increase intake of high-fiber foods, fluid and activity
2. poor absorption of fat-soluble vitamins and many drugs
   - take 4 hours apart from other drugs and vitamins

Question 13

bile acid resins (sequestrans) - cholestyramine and colsevelam contraindication

Answer 13

abdominal pain = possible small bowel obstruction (SBO)

Question 14

niacin route

Answer 14

PO

• vitamin dose 25 mg/day (OTC)
• anticholesterol dose 2500 mg/day (Rx)

Question 15

niacin MOA

Answer 15

• inhibits breakdown of triglycerides to free fatty acids

- synthesis of LDL and breakdown of HDL

Question 16

niacin side effects

Answer 16

• flushing of face/neck, feeling warmth, paresthesia

- hyperglycemia - caution with DM, monitor BG closely for them

Question 17

niacin adverse effects

Answer 17

• hepatotoxicity

- hyperuricemia = gout, RF (monitor renal panel, increase fluid, may need allopurinol)

Question 18

niacin contraindications

Answer 18

• pregnancy
• liver disease
• gout

Question 19

omega-3 and fish oil MOA

Answer 19

inhibits triglyceride production in the liver

• omega-3 is Rx
• fish oil is OTC

Question 20

omega-3 and fish oil indication

Answer 20

• preventative/treat hyperlipidemia
• off label:
  
  • HTN
  • rheumatoid arthritis (RA)

Question 21

omega-3 and fish oil side effects

Answer 21

1. GI distress (its acidic)
   - nausea
   - gross aftertaste = take with food!
   - rash