Ch 24 Antilipemic Agents

Question 0

Prior to starting anti lipemic drugs what should be obtained?

Answer 0

Prior to starting anti lipemic meds obtain baseline levels of total cholesterol, LDL & HDL cholesterol levels as well as triglycerides(TGs)

They should be monitored periodically throughout therapy

Question 1

What are anti lipemic agents?

Answer 1

They work in many ways to help lower LDL cholesterol levels
They raise HDL levels
And possibly decreases VLDL levels

Question 2

What are classifications of anti lipemic drugs

Answer 2

HMG CoA reductase inhibitors ( STATINS)
cholesterol absorption inhibitors 
Bile- acid sequestrants
Nicontinic acid
Fibrates

Question 3

What is the prototype drug of the class HMG CoA inhibitors ( STATINS)

Answer 3

Atorvastatin ( Lipitor)

Question 4

What are other medications of the class of drugs called HMG CoA inhibitors

Answer 4

Simvastatin ( Zocor)
Lovastatin ( Mevacor)
Pravastatin ( Pravachol)
Rosuvastatin ( Crestor)
Fluvastatin ( lescol, lescol XL)

Question 5

What are combination meds of the class HMG CoA inhibitors ( STATINS)

Answer 5

simvastatin and ezetimibe ( Vytorin)
Simvastatin and niacin ( Simcor)
Love station and niacin ( advicor)

Question 6

What is the purpose ( pharmalogical action) of the HMG CoA inhibitors

Answer 6

It decreases manufacture of LDL cholesterol
Decreases manufacture of VLDL
increases manufacture of HDL
Promotes vasodilation, decreases plaque site inflammation and decreased risk of thromboembolism.

Question 7

What is the therapeutic use of HMG CoA inhibitors

Answer 7

Primary hypercholesterolemia
Prevention of coronary events
Protection against MI and stroke for clients who have diabetes
Increasing levels of HDL in clients who have primary hypercholesterolemia

Question 8

What are adverse effects of HMG CoA inhibitors

Answer 8

Hepatoxicity, as evidenced by increase in aspartate transaminase ( AST)
Myopathy
Peripheral neuropathy

Question 9

What are contraindications and precautions of HMG CoA inhibitors

Answer 9

Pregnancy category X
contraindicated in ppl who have hepatitis induced by viral infection or alcohol.
Rosuvastatin should be avoided for Asian clients or prescribed in smaller doses.
Use cautiously in ppl with renal failure and older ppl

Question 10

What are medication food interactions of HMG CoA inhibitors

Answer 10

Fibrates ( gemifibrozil, fenofibrate) and ezetimibe ( Zetia) increase the risk of myopathy.
Medications that supress CYP3A4 such as erythromycin and ketoconazole can increase levels of statins when taken concurrently.

Question 11

How should statins be administered

Answer 11

By oral route

Question 12

How should lovastatin be administered

Answer 12

With the evening meal,

Evening is best because most cholesterol is synthesized during the night

Question 13

Cholesterol absorption inhibitors prototype drug

Answer 13

Ezetimibe ( Zetia)

Question 14

What is the expected pharmalogical action of ezetimibe ( Zetia)

Answer 14

It inhibits absorption of cholesterol secreted in the bile and from food

Question 15

What are the therapeutic uses of ezetimibe (Zetia)

Answer 15

Clients who have modified diets can use this medication as an adjunct to help lower LDL
Can be used alone or in combination with a statin med.

Question 16

What are adverse effects of the anti lipemic drug ezetimibe ( Zetia)

Answer 16

Hepatitis

Myopathy…obtain baseline CK level and monitor levels

Question 17

What are contraindications and precautions of cholesterol absorption inhibitors ezetimibe ( Zetia)

Answer 17

Pregnancy category X
Contraindicated in clients who have active moderate to severe liver disorders, especially those taking a statin concurrently.
Use cautiously in older ppl and those with mild liver disorders

Question 18

What are medication food interactions of ezetimibe ( Zetia)

Answer 18

Bile- acid sequestrants, such as cholestyramine interfere with absorption.(advise ppl to take ezetimibe 1 hr before or 4 hr after taking bile sequestrants)
Statins such as atorvastatin can increase the risk of liver dysfunction and or myopathy.
Concurrent use with Fibrates such as gemifibrozil, increases the risk of cholelithiasis and myopathy
Levels of ezetimibe can be increased with concurrent use of cyclosporine.

Question 19

What are bile acid sequestrants

Answer 19

Meds that decrease LDL cholesterol

It is used as an adjunct with a HMG CoA reductase inhibitor, such as atorvastatin and with dietary measures to lower cholesterol levels.

Question 20

What is the prototype drug of bile acid sequestrants

Answer 20

colesevelam HCL ( Welchol)
colestipol ( Colestid)

Question 21

What are adverse effects of bile acid sequestrants

Answer 21

Constipation increase intake of high fiber foods

Question 22

What are contraindications and precautions of bile acid sequestrants

Answer 22

colesevelam is pregnancy category B
colestipol is pregnancy category C

Colesevelam is contraindicated in pancreatitis caused by high triglycerides and in bowel obstruction
Use cautiously in clients who have billary disorders, diabetes mellitus and in older ppl.

Question 23

How is colesevelam taken

Answer 23

Orally in tablet form

It should be taken wit food and 8 oz of water

Question 24

How should colestipol be administered

Answer 24

As an oral tablet that should not be crushed or chewed Give 30 min before meals It is also given in powder formulation.

Question 25

What is nicotinic acid, niacin ( niacin, niaspan)

Answer 25

Nicotinic acid and niacin decrease LDL and triglyceride levels. They are used for ppl at risk for pancreatitis and elevated triglyceride levels and LDL niacin raises HDL levels.

Question 26

What are complications of nicotinic acid and niacin

Answer 26

``` GI distress Facial flushing and feeling of warmth, tingling in hands and feet Hyperglycemia Hepatotoxicity Hyperuricemia ```

Question 27

What should be administered if a persons URIC acid level is elevated

Answer 27

Allopurinol

Question 28

Nicotinic acid and niacin are contraindicated in who

Answer 28

Ppl with liver disease and gout

Question 29

What are prototype drugs of Fibrates

Answer 29

Gemifibrozil ( Lopid) | Fenofibrate ( Tricor, Lofibra)

Question 30

What is the expected action of Fibrates

Answer 30

It reduces plasma triglycerides | Increases levels of HDL

Question 31

What are adverse effects of Fibrates Gemifibrozil ( Lopid,) fenofibrate ( Tricor, Lofibra)

Answer 31

GI distress Gallstones Myopathy Hepatoxicity

Question 32

What are indications of gallbladder disease

Answer 32

RUQ pain Fat intolerance Bloating

Question 33

When administering Fibrates and the client c/o myopathy, what should the nurse do

Answer 33

Obtain baseline creatine kinase ( CK) level, monitor periodically Stop med if CK levels are elevated

Question 34

What drugs are contraindicated with Fibrates

Answer 34

Concurrent use with warfarin increases the risk of bleeding | Statins increase the risk of myopathy

Question 35

How should Fibrates be administered

Answer 35

Orally | Advise clients to take med 30 min prior to breakfast and dinner

Question 36

What is a recommended teaching for a person taking simvastatin

Answer 36

Take in the evening because cholesterol is synthesized at night doing this increases the meds effectiveness.

Question 37

What is a adverse reaction effect of gemifibrozil

Answer 37

Jaundice as this is a sign of hepatoxicity | Jaundice, anorexia, and upper abdominal discomfort may be findings in liver impairment

Question 38

What are teaching of a person taking digoxin and Colesevalam

Answer 38

Take digoxin 4 hrs before Monitor total cholesterol, LDL, and triglycerides, as well as blood glucose and HbAIC levels for ppl with diabetes mellitus Take Colesevalam with at least 8 oz of water.

Question 39

Ezetimibe is contraindicated in who

Answer 39

In ppl with a active moderate to severe liver disorder, especially if the client is taking a statin such as simvastatin

Question 40

When administering niacin, what adverse effects should be Monitored for?

Answer 40

Hyperglycemia Flushing of the skin Jaundice

Question 41

What are direct renin inhibitors and the prototype drug of this class

Answer 41

Binds with renin to inhibit the production of angiotensin I, thus decreasing the production of angiotensin II and aldosterone By doing this, hypertension is relieved. This med can be used alone or with other aniptihypertensive meds Prototype drug; aliskiren ( Tekturna)

Question 42

What are adverse effects of direct renin inhibitors | Aliskiren ( Tekturna)

Answer 42

Allergic reaction: angioedema, rash Hyperkalemia Diarrhea

Question 43

What are medication interactions of direct renin inhibitors

Answer 43

Direct renin inhibitors decreases levels of furosemide It increases the effects of other antihypertensive meds Atorvastatin ( Lipitor) and ketoconazole ( nizoral) increase the levels of aliskiren./ monitor for hypotension if used concurrently.

Question 44

What type of meals interact with direct renin inhibitors

Answer 44

High fat meals interfere with absorption | Instruct to take at the same time daily away from High fat foods