Antilipemic Agents

Question 1

Antilipemic Agents

Answer 1

-various medications that maintain or decrease blood lipid concentrations

Question 2

Antilipemic Agent: classifications

Answer 2

1) fibrates
2) HMG CoA reductase inhibitors (statins)
3) cholesterol absorption inhibitors
4) bile-acid sequestrants
5) nicotinic acid

Question 3

Fibrates

Answer 3

1) prototype = gemfibrozil (Lopid)

2) other medications = (TriCor, Lofibra); clofibrate (Atromid-S)

Question 4

Fibrates:

1) expected action
2) therapeutic uses

Answer 4

1) -decrease in triglyceride levels
- increase in HDL levels
2) -reduction of plasma triglycerides (VLDL)
- increase levels of HDL

Question 5

Fibrates: adverse effects

Answer 5

1) GI distress
2) gallbladder disease
3) myopathy (muslce tenderness, pain)
4) hepatotoxicity

Question 6

Fibrates:

nursing interventions/client education

Answer 6

1) mild and self-limiting
2) observe for right upper pain, fat intolerance, bloating–notify provider
3) obtain baseline creatinine kinase (CK) levels
4) monitor for muscle pain and tenderness
5) stop if CK levels elevated
6) obtain baseline liver function tests. monitor periodically
7) observe for liver dysfunction
8) stop medication if liver function tests abnormal

Question 7

Fibrates:

medication/food interactions

Answer 7

1) w/ concurrent use, warfarin (Coumadin)
2) statins increase risk of myopathy
3) bile acid sequestrants interfere w/ absorption

Question 8

Fibrates:

nursing administration

Answer 8

1) obtain baseline PT and INR
2) report signs of bleeding
3) adminster gemfibrozil 1 hr before or 4 hr after taking bile sequestrants
4) administer by oral route
5) take medications 30 min prior to breakfast or dinner

Question 9

HMG CoA Reductase Inhibitors (Statins)

Answer 9

1) prototype = atorvastatin (Lipitor)
2) other medications =
- simvastatin (Zocor)
- lovastatin (Mevacor)
- Pravastatin sodium (Pravachol)
- Rosuvastatin (Crestor)
- Fluvastatin (Lescol, Lescol XL)

Question 10

HMG CoA Reductase Inhibitors (Statins):

expected action and therapeutic uses

Answer 10

1) -decrease LDL cholesterol
- decrease (VLDL)
- increase (HDL)
2) -hypercholesterolemia
- prevention of coronary events
- protection against MI, stroke for clients who have diabetes mellitus

Question 11

HMG CoA Reductase Inhibitors (Statins): adverse effects

Answer 11

1) hepatotoxicity

2) increase in serum transaminase

Question 12

HMG CoA Reductase Inhibitors (Statins): nursing interventions/client educations

Answer 12

1) obtain baseline liver function
2) monitor liver function test after 12 wks and then every 6 months
3) monitor for symptoms of liver dysfunction: anorexia, vomiting, nausea, jaundice
4) avoid alcohol
5) medications may be discontinued if tests are abnormal

Question 13

HMG CoA Reductase Inhibitors (Statins): adverse effects

Answer 13

1) myopathy (evidenced by muscle aches, pain, tenderness)
2) may progress to myositis or rhabdomyolysis
3) peripheral neuropathy (evidenced by weakness, numbness, tingling, pain in hands and feet)

Question 14

HMG CoA Reductase Inhibitors (Statins): nursing interventions/client education

Answer 14

1) obtain baseline CK level
2) monitor CK levels periodically
3) advise to report symptoms
4) medication may be discontinued if levels are elevated
5) advise clients to observe for manifestations, and notify provider if occur

Question 15

HMG CoA Reductase Inhibitors (Statins): medication/food interactions

Answer 15

1) fibrates (gemfibrozil, fenofibrate) and ezetimibe (Zetia) increase risk of myopathy
2) grapefruit juice suppresses CYP3A4 and can increase levels of statins

Question 16

HMG CoA Reductase Inhibitors (Statins): nursing administration

Answer 16

1) administer statins by oral route
2) administer lovastatin w/ evening meal
3) other statins can be taken w/o food intake, but evening dosing is best
4) advise clients to obtain baseline cholesterol levels, HDL, LDL, and triglycerides. monitor periodically while taking med.

Question 17

Cholesterol Absorption Inhibitor

Answer 17

1) prototype = ezetimibe (Zetia)

Question 18

Cholesterol Absorption Inhibitor:

1) expected action and 2) therapeutic uses

Answer 18

1) absorption of cholesterol secreted in bile and from food
2) -adjunct to help lower LDL
- can also be used alone or in combination w/ statin

Question 19

Cholesterol Absorption Inhibitor: adverse effects

Answer 19

1) hepatitis

2) myopathy

Question 20

Cholesterol Absorption Inhibitor: medication/food interactions

Answer 20

1) bile acid sequestrants interfere w/ absorption
2) statins can increase risk of liver dysfunction/myopathy
3) fibrates concurrent use gallstones

Question 21

Cholesterol Absorption Inhibitor: nursing administration

Answer 21

1) advise client to report muscle aches and pain
2) advise clients to follow low-fat/low-cholesterol diet
3) advise clients to get involved in regular exercise regimen
4) clients can take med in fixed-dose combination w/ simvastatin as Vytorin

Question 22

Bile-Acid Sequestrants

Answer 22

1) prototype = colesevelam HCl (Welchol)
2) other medications =
- cholestyramine (Questran)
- colestipol (Colestid)

Question 23

Bile-Acid Sequestrants: 1) expected action and 2) therapeutic use

Answer 23

1) decrease LDL cholesterol

2) lower cholesterol levels

Question 24

Bile-Acid Sequestrants: adverse effects

Answer 24

1) GI distress
2) decreased absorption of fat-soluble vitamins
3) constipation (less w/ colesevelam HCl)

Question 25

Bile-Acid Sequestrants: nursing interventions/client education

Answer 25

1) administer vitamin supplements

2) advise clients to increase intake of high-fiber food and oral fluids, if not restricted

Question 26

Bile-Acid Sequestrants: nursing administration

Answer 26

1) colesevelam HCl
- taken orally in tablet form
- take w/ food and water
2) colestipol
- supplied as oral tablet
- do not crush or chew
- give 30 min before meal
3) cholestyramine and colestipol
- powder formulation
- advise clients to use adequate amount of fluid (4-8 oz) to dissolve medication (this prevents irritation or impaction of esophagus)

Question 27

Nicotinic Acid, Niacin (Niacor, Niaspan):

1) expected action and 2) therapeutic use

Answer 27

1) decrease LDL cholesterol and triglyceride levels

2) for clients at risk for pancreatitis and elevated triglyceride levels

Question 28

Nicotinic Acid, Niacin (Niacor, Niaspan): adverse effects

Answer 28

1) GI distress
2) facial flushing
3) hyperglycemia
4) hepatotoxicity
5) hyperuricemia

Question 29

Nicotinic Acid, Niacin (Niacor, Niaspan): nursing interventions/client education

Answer 29

1) usually self-limiting
2) advise client to take w/ food
3) advise client to take aspirin 30 min before each dose
4) monitor blood glucose levels
5) obtain baseline liver function tests. monitor periodically
5) advise clients to observe for liver dysfunction
6) encourage adequate fluid intake of 2-3 L of water each day from food and beverage sources

Question 30

Nicotinic Acid, Niacin (Niacor, Niaspan): nursing administration

Answer 30

1) administer by oral route, either pill or liquid form
2) pill may be standard or time-released
- administer standard from 3x a day with or after meals
- administer time-released formulation once in evening
3) dosage is much larger when taken as vitamin supplement