Antilipemic

Question 1

Cholesterol synthesis

Answer 1

A critical step in hepatic cholesterol synthesis is catalyzed by an enzyme names hydroxymethylglutaryl coenzyme A reductase (HMG-CoA reductase).

Question 2

Total cholesterol

Answer 2

Low-density lipoproteins (LDL)+High-density lipoproteins (HDL)+Triglycerides (TG)
-Goal is < 200 mg/dL

Question 3

Triglycerides (TG)

Goal <150 mg/dL

Answer 3

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.

Question 4

High-density lipoproteins (HDL)

• Goal ≥ 40 mg/dL in men
• Goal ≥ 50 mg/dL in women (AHA)

Answer 4

good or healthy cholesterol

Question 5

Low-density lipoproteins (LDL)

Goal is LDL < 100 mg/dL

Answer 5

Bad or lousy cholesterol

Question 6

What are the recommended therapeutic life style changes to decrease cholesterol?

Answer 6

• 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

Question 7

MOA for Statins

Answer 7

Decrease the rate of cholesterol production in the liver by inhibiting hydroxymethylglutaryl coenzyme A reductase (HMG-CoA reductase). May also decrease inflammation as well.

Question 8

Drug effect for statins

Answer 8

Decrease LDL cholesterol by 25-63%

Question 9

Examples of statins

Answer 9

atorvastatin (Lipitor), simvastatin (Zocor)

Question 10

Adverse effects of statins

Answer 10

• Hepatotoxicity (0.5-2%)
• Myopathy (5-10%)
• Rhabdomylosis (rare)

Question 11

Contraindications of statins

Answer 11

• Avoid rosuvastatin (Crestor) in patient of Asian descent or prescribe in smaller doses
• Grapefruit juice (CYP 450 inhibitor)
• Pregnancy category X

Question 12

Nursing Implications of statins

Answer 12

• 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

Question 13

Patient ED for statins

Answer 13

• Most effective when taken at bedtime
• Immediately report muscle pain/weakness or indications of liver dysfunction immediately
• Keep all follow up appointments
• Avoid alcohol

Question 14

MOA for nicotinic acid

Answer 14

B vitamin known as niacin (B3). Higher doses are needed than available in OTC vitamins.

Question 15

Drug effects for niacin

Answer 15

-Decreases triglycerides mainly (20-50%). Decreases LDL to lesser extent (5-25%). Raises HDL cholesterol (15-35%)

Question 16

Adverse effect for niacin

Answer 16

• Intense facial flushing and pruritus
• GI distress (self-limiting)
• Hepatotoxicity

Question 17

hepatotoxicity

Answer 17

S/S of hepatotoxicity
Anorexia, nausea, or vomiting
Yellowing of skin and sclera
RUQ abdominal pain
Dark urine and clay-colored stool
Elevated LFTs

Question 18

myopathy

Answer 18

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.

Question 19

rhabdomylosis

Answer 19

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

Question 20

cholelithiasis

Answer 20

gallstones

Question 21

cholecystitis

Answer 21

is inflammation of the gallbladder that occurs most commonly because of an obstruction of the cystic duct by gallstones arising from the gallbladder (cholelithiasis).