Antilipemic Flashcards
Cholesterol synthesis
A critical step in hepatic cholesterol synthesis is catalyzed by an enzyme names hydroxymethylglutaryl coenzyme A reductase (HMG-CoA reductase).
Total cholesterol
Low-density lipoproteins (LDL)+High-density lipoproteins (HDL)+Triglycerides (TG)
-Goal is < 200 mg/dL
Triglycerides (TG)
Goal <150 mg/dL
compounds that consist of fatty acids and a type of alcohol known as glycerol. Triglycerides make up most animal and vegetable fats and are the principal lipids in the blood.
High-density lipoproteins (HDL)
- Goal ≥ 40 mg/dL in men
- Goal ≥ 50 mg/dL in women (AHA)
good or healthy cholesterol
Low-density lipoproteins (LDL)
Goal is LDL < 100 mg/dL
Bad or lousy cholesterol
What are the recommended therapeutic life style changes to decrease cholesterol?
- Diet
- Decrease cholesterol
- Decrease saturated fat
- Increase soluble fiber
- Increase plant stanols and sterols
- Weight control
- Exercise
- 30-60 minutes of activity on most days
- Smoking cessation
MOA for Statins
Decrease the rate of cholesterol production in the liver by inhibiting hydroxymethylglutaryl coenzyme A reductase (HMG-CoA reductase). May also decrease inflammation as well.
Drug effect for statins
Decrease LDL cholesterol by 25-63%
Examples of statins
atorvastatin (Lipitor), simvastatin (Zocor)
Adverse effects of statins
- Hepatotoxicity (0.5-2%)
- Myopathy (5-10%)
- Rhabdomylosis (rare)
Contraindications of statins
- Avoid rosuvastatin (Crestor) in patient of Asian descent or prescribe in smaller doses
- Grapefruit juice (CYP 450 inhibitor)
- Pregnancy category X
Nursing Implications of statins
- Initial effects 2 weeks, maximal effects 4 to 6 weeks, reversal of effects upon withdrawal.
- Monitor LFT & CK levels
- Assess for C/O weakness, muscle aches
Patient ED for statins
- Most effective when taken at bedtime
- Immediately report muscle pain/weakness or indications of liver dysfunction immediately
- Keep all follow up appointments
- Avoid alcohol
MOA for nicotinic acid
B vitamin known as niacin (B3). Higher doses are needed than available in OTC vitamins.
Drug effects for niacin
-Decreases triglycerides mainly (20-50%). Decreases LDL to lesser extent (5-25%). Raises HDL cholesterol (15-35%)
Adverse effect for niacin
- Intense facial flushing and pruritus
- GI distress (self-limiting)
- Hepatotoxicity
hepatotoxicity
S/S of hepatotoxicity Anorexia, nausea, or vomiting Yellowing of skin and sclera RUQ abdominal pain Dark urine and clay-colored stool Elevated LFTs
myopathy
Statins can injure muscle tissue. Mild injury occurs in 5-10% of patients.
Characteristic symptoms are muscle aches, tenderness, or weakness.
Measure of CK levels can faciltiat diagnosis. Levels should be determined at baseline, and again if symptoms of myopathy appear. If the CK level is more than 10 times the ULN, the statin should be discontinued. If the level is less than 10 times the ULN, the statin can be continued, provided myoopathy symptoms and the CK level are followed weekly.
rhabdomylosis
is widespread breakdown of muscles. Occurs in less than 0.15 case per 1 million.
Defined as muscle disintegration or dissolution. Release of muscle components leads to marked elevations of blood CK (greater than 10 times ULN). High levels of CK lead to renal impairment because CK can plug up the glomeruli and prevent normal filtration
cholelithiasis
gallstones
cholecystitis
is inflammation of the gallbladder that occurs most commonly because of an obstruction of the cystic duct by gallstones arising from the gallbladder (cholelithiasis).
