Antilipemic Drugs Flashcards
What are the primary forms of lipids in the blood?
Cholesterol and triglycerides
What is HMG-CoA and what does it do?
The rate-limiting enzyme in cholesterol synthesis
Catalyzes hepatic cholesterol synthesis
What is total cholesterol?
The measurement of LDL cholesterol, HDL cholesterol, and triglycerides ????
What are low-density lipoproteins (LDL)?
Bad or “lousy” cholesterol
What are high-density lipoproteins (HDL)?
Good or “healthy” cholesterol
What are triglycerides (TG)?
The principal lipid in the blood
Function as an energy source and is stored in adipose tissue ???
Why is high LDL a problem?
LDLs initiate and fuel the development of atherosclerosis
Directly linked to the development of CAD
How is cholesterol related to atherosclerosis and coronary heart disease?
Lipids and lipoproteins participate in the formation of atherosclerotic plaque, which lead to the development of CHD
High serum cholesterol levels cause monocytes to adhere to blood vessel walls
These monocytes change into macrophage cells
Macrophage cells take up cholesterol from lipoproteins and become filled with fat, which become known as foam cells
Foam cell is precursor lesion of atherosclerosis
What are the therapeutic lifestyle changes to lower cholesterol?
Diet:
-Decrease cholesterol and saturated fat
-Increase soluble fiber and plant stanols and sterols
Weight control
Exercise (30 - 60 minutes of activity on most days)
Smoking cessation
What are the antilipemic drugs?
HMG-CoA reductase inhibitors (statins)
Nicotinic acid
What is the recommended level for total cholesterol?
< 200 mg/dL
What is the recommended level for LDL?
< 100 mg/dL
What is the recommended level for HDL?
Men: ≥ 40 mg/dL
Women: ≥ 50 mg/dL
What is the recommended level for triglycerides?
< 150 mg/dL
What is the mechanism of action of statins?
Decrease the rate of cholesterol production in the liver by inhibiting HMG-CoA reductase
May also decrease inflammation
What are the drug effects of statins?
Decrease LDL cholesterol by 25 - 63%
What are some statins?
Atorvastatin (Lipitor) Rosuvastatin (Crestor) Simvastatin (Zocor) Pravastatin (Pravachol) Lovastatin (Mevacor)
What are the adverse effects of statins?
Hepatotoxicity
Myopathy
Rhabdomylosis (rare)
What is rhabdomylosis?
Widespread breakdown of muscles
What are the contraindications of statins?
Avoid resuvastatin (Crestor) or prescribe in smaller doses for patient of Asian descent Avoid grapefruit juice Pregnancy category X
What are the signs and symptoms of hepatotoxicity?
Anorexia Nausea Vomiting Jaundice RUQ abdominal pain Dark urine and clay-colored stool Elevated liver function tests (LFT)
What are the nursing implications of statins?
Initial effects 2 weeks, maximal effects 4 - 6 weeks, reversal of effects upon withdrawal
Monitor liver function tests (LFT) and creatine kinase (CK) levels
Assess for C/O weakness, muscle aches
What should you educate the patient about 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
What is the mechanism of action of niacin?
B vitamin known as niacin (B3)
Higher doses are needed than available in OTC vitamins
“Exact mechanism of action of niacin is unknown
Believed to be related to its ability to inhibit lipolysis in adipose tissue, decrease esterification of triglycerides in the liver, and increase the activity of lipoprotein lipase”
What are the drug effects of niacin?
Decreases triglycerides
Decreases LDL to lesser extent
Raises HDL cholesterol
What are some examples of niacin?
Niacin (Niacor, Niaspan)
What are the adverse effects of niacin?
Intense facial flushing and pruritus
GI distress (self-limiting)
Hepatotoxicity
What are the nursing implications and patient education for niacin?
Instruct patient to take 325 mg of ASA 30 minutes prior to dose to decrease flushing
What is hepatotoxicity?
Liver injury as evidenced by elevations in serum transaminases levels
What is myopathy?
Injury to muscle tissue (adverse effect of statin)
What are the symptoms of myopathy?
Muscle aches
Tenderness
Weakness
What is cholelithiasis?
The presence of gallstones in the gallbladder
What is cholecystitis?
The inflammation of the gallbladder
What is pruritus?
Severe itching of skin
What is fecal impaction / obstruction?
Large lump of dry, hard stool that stays stuck in rectum
What is flushing?
Involuntary, temporary reddening of the skin
