Antilipemics

Question 1

HMG-CoA Reductase Inhibitors - Simvastatin

Answer 1

1st line drug

MOA - block the Hydroxymethylglutaryl coenzyme which is needed for cholesterol formation - so this lowers LDL

Indications - 1st line for cholesterol control (reduce by 30-40%) and used to increase HDL

AEs - TRANSIENT GI disturbances, rash, HA, increase liver enzymes, myopathy (muscle pain)

Interactions - anticoagulants (decrease Warfarin metabolism), antiinfectives decrease statin effectiveness, don’t use with gembirozil

NCs - educate patient on muscle pain AE; draw labels Q3 months, monitor lipid panel; monitor INR if on anticoagulant

Question 2

Bile Acid Sequestrants - Cholestyramine

Answer 2

2nd line drug

MOA - Prevents reabsorption of bile acids from small intestine - reduces LDL by 15%; does this by preventing bile acid reabsorption so prevents LDL in our food from being reabsorbed.

Contraindications - biliary and bowel obstruction; PKU

AEs - constipation, heartburn, N, belching, bloating - NOT transient

Interactions - fat soluble vitamins, and other meds taken a la vez

NC - take with meals so MOA will work best, increase dietary fiber, teach about AEs, increase fluid intake, don’t take with other medications

Question 3

Niacins - Niacin (Vit. B)

Answer 3

MOA - unknown (but maybe niacin has ability to inhibit breakdown of fat from fat cells so it helps keep fat in cells), causes moderate decrease in LDL and triglyceride levels and 20-30% increase in HDL

Use: elevated lipid levels, triglycerides, serum cholesterol, LDL

Contraindications - hypotension (related to histamine release), hypertension, liver disease, PEPTIC ULCER

AEs - Flushing, pruritus, GI distress

Interactions - HMG-CoA Reductase inhibitors - taken with these causes increase in myopathies

NCs - take NSAID or aspirin 30 mins before to reduce AE or flushing

Question 4

Fibric Acid Derivatives - Gemfibrozil

Answer 4

MOA - activates LIPOPROTein lipase, which causes breakdown (and decrease) of cholesterol and triclycerides

Use: elevated triclycerides

Contraindications - gall bladder, kidney, liver disease

AEs: abdominal discomfort, diarrhea, N, HA, increased risk for gall stones

Interactions - oral anticoagulants (increase bleeds), statins (increase myopathies….rhabdomylosis )

NCs - watch liver enzymes and INR,

**these also sometimes cause a decrease in H&H and WBC counts