Ch 41

Question 1

lipoproteins

Answer 1

Lipids are composed of cholesterol, triglycerides, and phospholipids bound in the inner shell of protein, carrying lipids in the bloodstream.
4 types: HDL, LDL, VLDL, chylomicrons

Question 2

hyperlipidemia

Answer 2

aka hyperlipoproteinemia

Excess of one or more lipids in blood

Question 3

HDL

Answer 3

good.
remove cholesterol from blood and deliver to liver for excretion in bile.
smallest, most dense (more protein and less fat).
goal >60

Question 4

LDL

Answer 4

bad.
50-60% of cholesterol in blood.
if elevated > greater risk for atherosclerotic plaque and heart disease.
goal <100

Question 5

VLDL

Answer 5

carries mostly triglycerides, less cholesterol

Question 6

chylomicron

Answer 6

large particles transporting fatty acids and cholesterol to liver, composed mostly of triglycerides.

Question 7

non pharm methods for reducing cholesterol

Answer 7

use first before drugs.
-reduce sat fats/cholesterol in diet (total fat <30% of intake, cholesterol <300mg/d)
-teach pt to read food labels, make better choices.
-exercise
-smoking will inc ldl, decrease hdl
*dietary changes alone may not be enough: reduce levels 10-30%.
despite exercise and diet cholesterol is high –> antihyperlipidemics (tell pt even if on med must eat healthy)

Question 8

antihyperlipidemic types

Answer 8

drugs lowering lipid levels

1. bile acid sequestrants
2. fibrates
3. nicotinic acid
4. cholesterol absorption inhibitor
5. statins

Question 9

bile acid sequestrants

Answer 9

antihyperlipidemic
drug of choice: cholestyramine(Questran).
-reduces LDL by binding with bile acids in intestine
-effective aganst hyperlipidemia II
-can be adjunct with statins

Question 10

fibrates

Answer 10

antihyperlipidemic
drug of choice: gemfibrozil (Lopid)
-fibric acid derivative
-more effective reducing triglyceride and VLDL than LDL
-highly protein bound: don’t take with anticoags (compete for protein sites)
-inc bleeding with warfarin

Question 11

nicotinic acid

Answer 11

antihyperlipidemic.
drug of choice: niacin (nicotinic acid/Niaspan)
-reduces VLDL and LDL
-very eff at lowering cholesterol
-numerous SE, requires large doses: only 20% of pts tolerate the drug

Question 12

cholesterol absorption inhibitor

Answer 12

antihyperlipidemic
drug of choice: ezetimibe (Zetia)
-acts on cells in small intestine to stop cholesterol absorption
-decrease cholesterol from dietary absorption, reduce serum cholesterol, LDL, triglycerides, apoB levels
-cause only small inc in HDL
-must be combined with statin for optimal effect

Question 13

statins

Answer 13

HMG-CoA reductase inhibitor antihyperlipidemic

• Inhibit enzyme HMG CoA reductase in cholesterol biosynthesis > decreases the concentration of cholesterol, decreases LDL, and slightly increases HDL
• LDL reduction seen as early as 2 weeks after starting
• can be combined with other drugs to decrease BP and blood clotting to enhance antihyperlipidemics effect
• If cease taking medications, cholesterol and LDL levels will return to pre-treatment levels: lifelong commitment.
• Abrupt cessation may cause threefold rebound effect causing MI

Question 14

values cholesterol/triglyc/ldl/hdl

Answer 14

cholesterol: 150-200
triglyceride: 40-150
ldl: <100
hdl: >60

Question 15

rosuvastatin (Crestor)

Answer 15

statin
decreases cholesterol/serum lipid (esp LDL and triglycerides) by inhibiting HMG-CoA reductase (the enzyme necessary for hepatic production of cholesterol).
assess baseline VS and serum chem (cholesterol, triglycerides, CPK, AST/ALT: elevated liver enzyme is adv)
-serial labs q 6-8 wks for first 6 mos.
-follow regimen as ordered!
-report muscle pain immediate: may be rhabdo, an adv rxn
-don’t stop! risk for cardiac problem.
-maintain low fat diet with exercise

Question 16

PAD/PVD

Answer 16

PAD: peripheral arterial disease
PVD: peripheral vascular disease
-similarities: numbness and coolness of extremities, intermittent claudication (pain in limb when walking/exercise but subsides at rest), leg ulcers
-cause: arteriosclerosis and hyperlipidemia

Question 17

Peripheral vasodilators

Answer 17

increase blood flow to extremities for disorders of venous and arterial vessels (PVD/PAD)
-most effective for disorders of vasospasms (Raynaud’s) than arterial occlusions

Question 18

cilostazol (Pletal)

Answer 18

peripheral vasodilator drug of choice.
tx PVD by acting directly to inhibit platelet aggregation and causing vasodilation(esp in femoral vasculature)
-assess for inadequate blood flow in extremities (pallor, coolness, pain, pulses)
-may take 1.5-3mos for effect
-stop smoking: smoking increases vasospasm
-OTC ASA or similar meds must be doctor approved because risk for bleeding
-grapefruit/green tea will increase drug levels
-ginger/ginko biloba may also prolong bleeding

Question 19

pentoxifylline (Trental)

Answer 19

peripheral vasodilator.
tx PVD, intermittent claudication, improves cerebral fx for those with cerebrovascular insufficiency, decreases stroke incidence for those with recurring TIAs.
PD:
1. Hemorrheologic agent, improving microcirculation and tissue perfusion by decreasing blood viscosity
2. Improves flexibility of erythrocytes > improved tissue oxygenation
3. Inhibits aggregation of platelets, and RBC’s > increasing flow through peripheral vessels due to decreased blood viscosity
-assess for inadequate blood flow
-pt must stop smoking: its a CI
-take with food for GI
adv: flushing, faint, sedation, GI disturbance