Ch 24 Antilipemic Agents Flashcards
Prior to starting anti lipemic drugs what should be obtained?
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
What are classifications of anti lipemic drugs
HMG CoA reductase inhibitors ( STATINS) cholesterol absorption inhibitors Bile- acid sequestrants Nicontinic acid Fibrates
What is the prototype drug of the class HMG CoA inhibitors ( STATINS)
Atorvastatin ( Lipitor)
What are other medications of the class of drugs called HMG CoA inhibitors
Simvastatin ( Zocor) Lovastatin ( Mevacor) Pravastatin ( Pravachol) Rosuvastatin ( Crestor) Fluvastatin ( lescol, lescol XL)
What are combination meds of the class HMG CoA inhibitors ( STATINS)
simvastatin and ezetimibe ( Vytorin)
Simvastatin and niacin ( Simcor)
Love station and niacin ( advicor)
What is the purpose ( pharmalogical action) of the HMG CoA inhibitors
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.
What is the therapeutic use of HMG CoA inhibitors
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
What are adverse effects of HMG CoA inhibitors
Hepatoxicity, as evidenced by increase in aspartate transaminase ( AST)
Myopathy
Peripheral neuropathy
What are contraindications and precautions of HMG CoA inhibitors
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
What are medication food interactions of HMG CoA inhibitors
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.
How should statins be administered
By oral route
How should lovastatin be administered
With the evening meal,
Evening is best because most cholesterol is synthesized during the night
Cholesterol absorption inhibitors prototype drug
Ezetimibe ( Zetia)
What is the expected pharmalogical action of ezetimibe ( Zetia)
It inhibits absorption of cholesterol secreted in the bile and from food
What are the therapeutic uses of ezetimibe (Zetia)
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.
What are adverse effects of the anti lipemic drug ezetimibe ( Zetia)
Hepatitis
Myopathy…obtain baseline CK level and monitor levels
What are contraindications and precautions of cholesterol absorption inhibitors ezetimibe ( Zetia)
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
What are medication food interactions of ezetimibe ( Zetia)
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.
What are bile acid sequestrants
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.
What is the prototype drug of bile acid sequestrants
colesevelam HCL ( Welchol) colestipol ( Colestid)
What are adverse effects of bile acid sequestrants
Constipation increase intake of high fiber foods
What are contraindications and precautions of bile acid sequestrants
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.
How is colesevelam taken
Orally in tablet form
It should be taken wit food and 8 oz of water
How should colestipol be administered
As an oral tablet that should not be crushed or chewed
Give 30 min before meals
It is also given in powder formulation.
What is nicotinic acid, niacin ( niacin, niaspan)
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.
What are complications of nicotinic acid and niacin
GI distress Facial flushing and feeling of warmth, tingling in hands and feet Hyperglycemia Hepatotoxicity Hyperuricemia
What should be administered if a persons URIC acid level is elevated
Allopurinol
Nicotinic acid and niacin are contraindicated in who
Ppl with liver disease and gout
What are prototype drugs of Fibrates
Gemifibrozil ( Lopid)
Fenofibrate ( Tricor, Lofibra)
What is the expected action of Fibrates
It reduces plasma triglycerides
Increases levels of HDL
What are adverse effects of Fibrates
Gemifibrozil ( Lopid,)
fenofibrate ( Tricor, Lofibra)
GI distress
Gallstones
Myopathy
Hepatoxicity
What are indications of gallbladder disease
RUQ pain
Fat intolerance
Bloating
When administering Fibrates and the client c/o myopathy, what should the nurse do
Obtain baseline creatine kinase ( CK) level, monitor periodically
Stop med if CK levels are elevated
What drugs are contraindicated with Fibrates
Concurrent use with warfarin increases the risk of bleeding
Statins increase the risk of myopathy
How should Fibrates be administered
Orally
Advise clients to take med 30 min prior to breakfast and dinner
What is a recommended teaching for a person taking simvastatin
Take in the evening because cholesterol is synthesized at night doing this increases the meds effectiveness.
What is a adverse reaction effect of gemifibrozil
Jaundice as this is a sign of hepatoxicity
Jaundice, anorexia, and upper abdominal discomfort may be findings in liver impairment
What are teaching of a person taking digoxin and Colesevalam
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.
Ezetimibe is contraindicated in who
In ppl with a active moderate to severe liver disorder, especially if the client is taking a statin such as simvastatin
When administering niacin, what adverse effects should be Monitored for?
Hyperglycemia
Flushing of the skin
Jaundice
What are direct renin inhibitors and the prototype drug of this class
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)
What are adverse effects of direct renin inhibitors
Aliskiren ( Tekturna)
Allergic reaction: angioedema, rash
Hyperkalemia
Diarrhea
What are medication interactions of direct renin inhibitors
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.
What type of meals interact with direct renin inhibitors
High fat meals interfere with absorption
Instruct to take at the same time daily away from High fat foods
What are anti lipemic agents?
They work in many ways to help lower LDL cholesterol levels
They raise HDL levels
And possibly decreases VLDL levels
