ANTILIPEMICS

Question 1

cholesterol synthesis in the liver

Answer 1

Cholesterol synthesized by the liver, as well as any dietary cholesterol in the liver that exceeds hepatic needs, is transported in the serum within LDLs. … Ultimately, cholesterol is excreted in the bile as free cholesterol or as bile salts following conversion to bile acids in the liver

Question 2

role of HMG-CoA reductase

Answer 2

A critical step in hepatic cholesterol synthesis is catalyzed by an enzyme names hydroxymethylglutaryl coenzyme A reductase (HMG-CoA reductase).

Question 3

total cholesterol

Answer 3

a measure of the total amount of cholesterol in your blood, including low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol

Question 4

low-density lipoproteins (LDL)

Answer 4

Bad or “lousy” cholesterol. LDL is directly linked to the development of coronary artery disease. the main source of cholesterol buildup and blockage in the arteries.

Question 5

high-density lipoproteins (HDL)

Answer 5

Good or “healthy” cholesterol. HDL helps remove cholesterol from your arteries.

Question 6

triglycerides

Answer 6

another form of fat in your blood that can raise your risk for heart disease.Triglycerides store fat that your body can use for energy.

Question 7

how cholesterol is related to atherosclerosis

Answer 7

LDL can damage your arteries that carry blood from your heart to the rest of your body.

Question 8

how cholesterol is related to coronary heart disease

Answer 8

Being overweight or obese can raise your risk of CHD This is mainly because overweight and obesity are linked to other CHD risk factors, cholesterol and triglyceride levels

Question 9

therapeutic lifestyle changes to ↓ cholesterol (be specific).

Answer 9

Diet,Decrease cholesterol,Decrease saturated fat,
Increase soluble fiber,Increase plant stanols and sterols
Weight control,Exercise
30-60 minutes of activity on most days
Smoking cessation

Question 10

therapeutic goals of drug therapy for hyperlipidemia according to ATP III

Answer 10

Total cholesterol-Goal is < 200 mg/dL
LDL-Goal is LDL < 100 mg/dL
HDL-Goal ≥ 40 mg/dL in men/Goal ≥ 50 mg/dL in women (AHA)
Triglycerides-Goal <150 mg/dL

Question 11

mechanism of action -Statins – atorvastatin (Lipitor), simvastatin (Zocor)

Answer 11

Decrease the rate of cholesterol production in the liver by inhibiting hydroxymethylglutaryl coenzyme A reductase (HMG-CoA reductase). May also decrease inflammation as well

Question 12

drug effects Statins

Answer 12

Decrease LDL cholesterol by 25-63%

Question 13

contraindications statins

Answer 13

Avoid rosuvastatin (Crestor) in patient of Asian descent or prescribe in smaller doses.Grapefruit juice (CYP 450 inhibitor). Pregnancy category X

Question 14

adverse effects statins

Answer 14

Hepatotoxicity (0.5-2%)
Myopathy (5-10%)
Rhabdomylosis (rare)

Question 15

nursing responsibilities including labs statins

Answer 15

Initial effects 2 weeks, maximal effects 4 to 6 weeks, reversal of effects upon withdrawal.
Monitor LFT & CK levels
Assess for C/O weakness, muscle aches

Question 16

patient education statins

Answer 16

Most effective when taken at bedtime
Immediately report muscle pain/weakness or indications of liver dysfunction immediately
Keep all follow up appointments
Avoid alcohol

Question 17

mechanism of action-Nicotinic Acid – niacin (Niacor, Niaspan)

Answer 17

B vitamin known as niacin (B3). Higher doses are needed than available in OTC vitamins. niacin directly and noncompetitively inhibits diacylglycerol acyltransferase–2 (DGAT2), resulting in decreased triglyceride (TG) synthesis

Question 18

drug effects Nicotinic Acid

Answer 18

Decreases triglycerides mainly (20-50%). Decreases LDL to lesser extent (5-25%). Raises HDL cholesterol (15-35%).

Question 19

contraindications nicotinic acid

Answer 19

Nicotinic acid may exacerbate hepatic dysfunction and large doses may exacerbate peptic ulcer, overt diabetes mellitus, gout or hyperuricaemia. Large doses of Nicotinic acid should not be used by persons with heart or gallbladder disease, arterial bleeding or glaucoma.

Question 20

adverse effects nicotinic acid

Answer 20

Intense facial flushing and pruritus
GI distress (self-limiting)
Hepatotoxicity

Question 21

nursing responsibilities including labs (e.g. LFT, CK, etc.), and patient education nicotinic acid

Answer 21

Instruct patient to take 325 mg of ASA 30 minutes prior to dose to decrease flushing

Question 22

Hepatotoxicity

Answer 22

Liver injury, as evidenced by elevations in serum transaminases levels, develops in 0.5-2% of patients treated 1 year or longer.

Question 23

myopathy

Answer 23

Characteristic symptoms are muscle aches, tenderness, or weakness.

Question 24

rhabdomylosis

Answer 24

widespread breakdown of muscles.

Defined as muscle disintegration or dissolution

Question 25

flushing

Answer 25

intense redness of face, neck, and ears