Antilipemic, Antianginal, Coagulation Modifier drugs (Week 2)

Question 1

Define Antipemic

Answer 1

A drug that reduces lipid levels

Question 2

HMG-CoA Reductase inhibitors suffix

Answer 2

“statins”

Question 3

HMG-CoA Reductase inhibitors Theraputic Effect

Answer 3

Lower the Blood cholesterol level by decreasing the rate of cholesterol production.

Question 4

HMG-CoA Reductase inhibitors MOA

Answer 4

Inhibit the enzyme HMG-CoA Reductase, and decrease cholesterol production.

The liver requires HMG-CoA Reductase to produce cholesterol so ^^^

Question 5

HMG-CoA Reductase inhibitors Indications

Answer 5

First line drug therapy for hypercholesterolemia (most common and dangerous form of dyslipidemia)

Question 6

HMG-CoA Reductase inhibitors Contraindications

Answer 6

Drug allergy, pregnancy, liver disease or increase liver enzymes

Question 7

HMG-CoA Reductase inhibitors AE

Answer 7

Typically well Tolerated.
Common: Mild transient gastrointestinal disturbances and headache

Less common: myopathy (muscle pain) which can progress to rhabdomyolysis ( breakdown of muscle protein).

Question 8

HMG-CoA Reductase inhibitors Drug interactions

Answer 8

Should be cautioned for pts taking anticoagulants.

Limit drinking of grapefruit juice to 1 L

Question 9

Name 4 antilipemic drugs

Answer 9

HMG-CoA Reductase inhibitors
Bile Acid Sequestrants
Nicotinic Acid
Fibric Acid Derivatives.

Question 10

Bile Acid Sequestrants Theraputic Effects

Answer 10

Lower the plasma concentrations of LDL by 15-30% and increase HDL cholesterol by 3-8% and increase liver triglyceride production

Question 11

Bile Acid Sequestrants MOA

Answer 11

Bile Acid resins bind bile, preventing the reabsorption of bile acids from sm intestine.

Bile acids are necessary for the absorption of cholesterol from the sm intestine

Question 12

Bile Acid Sequestrants Indications

Answer 12

Primary or adjunct therapy in the management of hyperlipoproteinemia

Question 13

Bile Acid Sequestrants Contraindications

Answer 13

Drug allergy and bowel or biliary obstruction

Question 14

Bile Acid Sequestrants AE

Answer 14

Common: Constipation accompanied by heartburn, nausea, belching and bloating

Question 15

Bile Acid Sequestrants Interactions

Answer 15

High doses of Bile Acid Sequestrants will decrease the absorption rate of fat solubles (Vit A,D,E,K)

Question 16

Nicotinic Acid MOA

Answer 16

Is a vitamin B that inhibits lipolysis in adipose tissue, decrease esterfication of triglycerides in the liver and increase the activity of lipoprotein lipase.

Question 17

Nicotinic Acid Theraputic effects

Answer 17

Decrease LDL by 10-20%, decrease triglycerides from 30-70% and increase HDL by 20-35%.

Question 18

Nicotinic Acid Indications

Answer 18

> > Types IIa, IIb, II, IV, V hyperlipidemia

Question 19

Nicotinic Acid Contraindications

Answer 19

drug allergy, liver disease, htn, peptic ulcer, active hemorrhagic process

Question 20

Nicotinic Acid AE

Answer 20

Flushing, pruritus, and GI distress.

Take drug with meals to minimize undesired effects

Question 21

Fibric Acid Derivatives (FIBRATES) Theraputic Effects

Answer 21

Decrease LDL N Raise HDL

Question 22

Fibric Acid Derivatives (FIBRATES) MOA

Answer 22

• Activate lipoprotein lipase, enzyme responsible for breaking down cholesterol
• Suppress release of of free fatty acid from adipose tissue
• inhibit synthesis of triglycerides in liver and increase secretion of cholesterol into bile

Question 23

Fibric Acid Derivatives (FIBRATES) Indications

Answer 23

IIa,IIb, IV, and V type of hyperlipidemias

Question 24

Fibric Acid Derivatives (FIBRATES) Contraindications

Answer 24

Drug allergies, severe kidney/liver disease, cirrhosis or gallbladder disease

Question 25

Fibric Acid Derivatives (FIBRATES) AE

Answer 25

Common: abdominal discomfort, diarrhea nausea, headache, blurred vision, increase risk for gallstones and prolonged prothrombin time.

Question 26

Key Patient education tips for Antilipemic drugs

Answer 26

-Notify Health care provider if there is any persistant: GI upset, constipation, gas, bloating, heartburn, nausea, vomiting, abnormal or unusual bleeding -Encourage pts to drink 2000 ml of fluids/day -Encourage to exercise with supervision first d/t possible dizziness

Question 27

Name the 3 main Antianginal Drugs

Answer 27

Nitrates/Nitrites B-Blockers Calcium Channel Blockers

Question 28

Nitrates/Nitrites MOA

Answer 28

Dilate all blood vessels. Dominantly affect venous vascular beds. Dilation allows venous return and reduces preload of left ventricular end- diastolic volume

Question 29

Nitrates/Nitrites Indications

Answer 29

Stable, Unstable and Vasospastic (Prinzmetal's) angina.

Question 30

Nitrates/Nitrites Contraindications

Answer 30

Drug allergy, severe anemia, closed angle glaucoma, hypotension, or severe head injury

Question 31

Nitrates/Nitrites AE

Answer 31

Mostly well tolerated. Most common: headache, tachycardia, and postural hypotension, reflex tachycardia (if nitrate vasodilation happens too fast)

Question 32

Nitrates/Nitrites Interactions

Answer 32

Produce hypotensive effects if taken with alcohol, calcium channel blockers, phenothiazines and erectile dysfunction drugs

Question 33

B-Blockers MOA

Answer 33

Decreases the heart rate, Decrease BP and suppress the hormone renin from being released

Question 34

B-Blockers Indications

Answer 34

Angina, MI and HTN

Question 35

B-Blockers Contraindications

Answer 35

Systolic heart failure, and conduction disturbances Caution in the use of pts with bronchial asthma

Question 36

B-Blockers AE

Answer 36

CV: brady/tachy cardia, hypotension, 2nd or 3rd degree heart block, heart failure CNS: dizzy, fatigue, drowsy, mental depresssion, lethargy, unusual dreams

Question 37

Calcium Channel Blockers MOA

Answer 37

- Decrease muscle contractions and allows for muscle relaxation - Relaxation= dilation which allows increase blood flow to the heart, increasing o2 supply.

Question 38

Calcium Channel Blocker Indications

Answer 38

First line drug for angina, HTN, and supraventricular tachycardia.

Question 39

Calcium Channel Blocker Contraindications

Answer 39

drug allergy, acute MI, second or third atrioventricular block (unless pt has a pace maker) and hypotension

Question 40

Calcium Channel Blocker AE

Answer 40

CV: hypotension, palpitations, tachycardia or bradycardia, heart failure GI: constipation nausea

Question 41

Calcium Channel Blocker Drug Interactions

Answer 41

B-Blockers- additive effects and results bradycardia or atrioventricular block Digoxin- Interferes with elimination and results increased digoxin levels H2 blockers- decreases H2 and results increase of calcium channel blockers

Question 42

Patient Education For Nitroglycerin

Answer 42

- Instruct pt to have journal to keep track of when anginal episodes occur, intensity of pain, frequency and factors that relieve pain - Keep away from moisture, light, heat - Blurred vision, dry mouth or severe headaches may indicate drug overdose= IMMEDIATE MED ATTENTION - Take med before stressful sitations