Antilipemic Drugs Flashcards
Atorvastatin (Lipitor)
Chemical Classification
HMG-CoA reductase inhibitor (statin)
Atorvastatin (Lipitor)
Functional Classification
Antilipidemic
Atorvastatin (Lipitor)
Mechanism of Action
Inhibits HMG-CoA reductase enzyme, which reduces cholesterol synthesis; high doses lead to plaque regression
Atorvastatin (Lipitor)
Uses
As adjunct for primary hypercholesterolemia (types Ia, Ib), dysbetalipoproteinemia, elevated triglyceride levels, prevention of CV disease by reduction of heart risk in those with mildly elevated cholesterol
Atorvastatin (Lipitor)
Contraindications
Pregnancy (X), breastfeeding, hypersensitivity, active hepatic disease
Atorvastatin (Lipitor)
Side Effects
CNS: headache, asthenia EENT: lens opacities GI: Abdominal Cramps, Constipation, Diarrhea, Flatus, Heartburn, dyspepsia, LIVER DYSFUNCTION, PANCREATITIS, nausea, increased serum transaminase GU: impotence INTEG: rash, pruritus, alopecia; photosensitivity (rare) MISC: hypersensitivity MS: arthralgia, myalgia, RHABDOMYOLYSIS RESP: pharyngitis, sinusitis
Atorvastatin (Lipitor)
Nursing Considerations
ASSESS:
- HYPERCHOlESTEROLEMIA: diet, obtain diet history including fat, cholesterol in diet; cholesterol triglyceride levels periodically during treatment; check lipid panel 6-12wk after changing dose
- Hepatic studies q1-2mo, at initiation, 6,12wk after initiation or change in dose, periodically thereafter; AST, ALT, LFTs may be increased
- Renal studies in patients with compromised renal system: BUN, I&O ratio, creatinine
- Bowel status: constipation, stool softeners may be needed; if severe, add fiber, water to diet
- RHABDOMYOLYSIS: FOR MUSCLE PAIN, TENDERNESS, OBTAIN CPK BASELINE; IF MARKEDLY INCREASED, PRODUCT MAY NEED TO BE DISCONTINUED
Cholestyramine (Questran)
Functional Classification
Antilipemic
Cholestyramine (Questran)
Chemical Classification
Bile Acid Sequestrant
Cholestyramine (Questran)
Mechanism of Action
Absorbs, combines with bile acids to form insoluble complex that is excreted through feces; loss of bile acids lowers LDL, cholesterol levels
Cholestyramine (Questran)
Uses
Primary hypercholesterolemia (esp. type IIa/IIb hyperlipoproteinemia), pruritus associated with biliary obstruction
Cholestyramine (Questran)
Contraindications
Hypersensitivity; biliary obstruction; hyperlipidemia III, IV, V
Cholestyramine (Questran)
Side Effects
CNS: headache, dizziness, drowsiness, vertigo, tinnitus, anxiety
GI: Constipation, Abdominal Pain, Nausea, fecal impaction, hemorrhoids, flatulence, vomiting, steatorrhea, peptic ulcer
HEMA: BLEEDING, increased PT
INTEG: rash, irritation of perianal area, tongue, skin
META: decreased vit A, D, K, red cell folate content; HYPERCHLOREMIC ACIDOSIS
MS: muscle, joint pain
Cholestyramine (Questran)
Nursing Considerations
ASSESS:
- Cardiac glycoside level if both products administered
- For signs of vit A, D, K deficiency
- HYPERCHOLESTEROLEMIA: fasting LDL, HDL, total cholesterol, triglyceride levels, electrolytes if receiving extended therapy; diet history
- PRURITUS: for signs of itching
- Bowel pattern daily; increase bulk, water in diet for constipation; diarrhea may also occur
Niacin
Functional Classification
Vit B3, antihyperlipidemic
Niacin
Chemical Classification
Water-soluble vitamin
Niacin
Mechanism of Action
Needed for conversion of fats, protein, carbohydrates by oxidation reduction; acts directly on vascular smooth muscle, this causing vasodilation; reduces total cholesterol, LDL, VLDL, triglycerides; increases HDL
Niacin
Uses
Pellagra, hyperlipidemias (types 4,5), peripheral vascular disease that presents a risk for pancreatitis
Niacin
Contraindications
Breastfeeding, hypersensitivity, peptic ulcer, hepatic disease, hemorrhage, severe hypotension
Niacin
Side Effects
CNS: paresthesias, headache, dizziness, anxiety
CV: postural hypotension, vasovagal attacks, dysrhythmias, vasodilation
EENT: blurred vision, ptosis
GI: nausea, vomiting, anorexia, JAUNDICE, HEPATOTOXICITY, diarrhea, peptic ulcer, dyspepsia, HEPATITIS
GU: hyperuricemia, GLYCOSURIA, HYPOALBUMINEMIA
INTEG: flushing, dry skin, rash, pruritus, itching, tingling
Niacin
Nursing Considerations
ASSESS:
- Cardiac status: rate, rhythm, quality; postural hypotension, dysrhythmias
- Nutritional status: liver, yeast, legumes, organ meat, lean poultry; fat in diet
- HEPATOTOXICITY: clay-colored stools, itching, dark urine, jaundice; hepatic studies: AST, ALT, bilirubin, uric acid, alk phos; blood glucose before and during treatment
- CNS symptoms: headache, paresthesias, blurred vision
- NIACIN DEFICIENCY: nausea, vomiting, anemia, poor memory, confusion, dermatitis
- HYPERLIPIDEMIA: for lipid, triglyceride, cholesterol level; obtain diet history
Simvastatin (Zocor)
Functional Classification
Antilipemic
Simvastatin (Zocor)
Chemical Classification
HMG-CoA reductase inhibitor
Simvastatin (Zocor)
Mechanism of Action
Inhibits HMG-CoA reductase enzyme, which reduces cholesterol synthesis
Simvastatin (Zocor)
Uses
As an adjunct for primary hypercholesterolemia (types IIa, IIb), isolated hypertriglyceridemia (Frederickson type IV) and type III hyperlipoproteinemia, CAD, heterozygous familial hypercholesterolemia
Simvastatin (Zocor)
Contraindications
Pregnancy (X), breastfeeding, hypersensitivity, active hepatic disease
Simvastatin (Zocor)
Side Effects
CNS: headache
GI: nausea, constipation, diarrhea, dyspepsia, flatus, abdominal pain, LIVER DYSFUNCTION, PANCREATITIS
INTEG: rash, pruritus
MS: muscle cramps, myalgia, MYOSITIS, RHABDOMYOLYSIS, myopathy
RESP: upper respiratory tract infection
Simvastatin (Zocor)
Nursing Considerations
ASSESS:
- Diet history: fat consumption; baseline and lipid profile: LDL, HDL, TG, cholesterol
- Hepatic studies at baseline, after 4-6wk, periodically thereafter; AST, ALT, LFTs may increase
- RHABDOMYOLYSIS: muscle tenderness, increased CPK levels (10x above upper normal limit); therapy should be discontinued
- Renal studies in patients with compromised renal systems: BUN, I&O ratio, creatinine
