CH29: Hyperlipidemics Flashcards
Statins - what are they used for?
- for reducing blood lipid levels / for dyslipidemias
- first-line therapy
- can reduce LDL levels by 20-40%
- raise HDL levels
- primary prevention (no hx of cvs disease)
- secondary prevention (slow progression and reduce mortality)
Prototype drug for statins?
atorvastatin (Lipitor)
therapeutic: antihyperlipidemic
pharmacologic: HMG-CoA reductase inhibitor
atorvastatin - what are the uses and what is the mechanism of action?
therapeutic uses:
- hypercholesterolemia
- family hypercholesterolemia
mechanism of action:
- inhibits HMG-CoA reductase (primary regulatory enzyme in cholesterol biosynthesis)
- liver makes less cholesterol and responds by making more LDL receptors to remove cholesterol from blood
atorvastatin - what are the s/s of hepatotoxicity?
- RUQ tenderness
- changes in stool
- jaundice
- bleeding/ bruising
- abdominal distention
Bile acid sequestrants - what are they used for?
- often combined w/ statins to reduce LDL cholesterol levels
- GI SEs
bile breaks down fat –> bile acid sequestrants binds with bile acids so fat doesn’t get broken down/reabsorbed
atorvastatin (Lipitor) - what are the nursing considerations?
- obtain baseline lipid values
- monitor LDL cholesterol values
- assess lipid lab tests within 2-4 weeks of initiation of therapy/ change in dose
- assess for signs of rhabdomyolysis or myopathies (generalized muscle pain/aches all over)
- observe for digoxin toxicity
- watch for hepatotoxicity
- pregnancy - category X
- no grapefruit juice
- no alcohol (liver)
What is the prototype drug for bile acid sequestrants?
cholestyramine (Questran)
therapeutic: antihyperlipidemic
pharmacologic: bile acid sequestrant
cholestyramine (Questran): what are the therapeutic uses & what’s the mechanism of action?
therapeutic use:
- hypercholesterolemia (elevated LDL)
mechanism of action:
- binds to bile acids
- forms insoluble compounds containing cholesterol that is excreted in feces
- lowers LDL levels by increasing LDL receptors on hepatocytes
cholestyramine - what are some nursing considerations?
- completely dissolve powder before administration
- increase fluid intake
- assess for early signs of hypoprothrombinemia (watch bld)
- monitor lab tests for therapeutic effectiveness
- consult prescriber to see if supplemental vit A & D, and folic acid are required in LT care
- A & D = fat-soluble vitamins, so can decr absorption, and cholestyramine binds to folic acid –> can lead to deficiencies
What is fibric acid used for?
- to lower triglyceride levels
- have little effect on LDL cholesterol
- most often used for elevated triglycerides and other “L”s are within good range
what is the prototype drug for fibric acid?
gemfibrozil (Lopid)
therapeutic: antihyperlipidemic
pharmacologic: fibric acid agent (fibrate)
gemfibrozil: what is the therapeutic use & mechanism of action?
therapeutic effect/use:
- hypertriglyceridemia and VLDL (very low-density lipoprotein)
- second-line therapy after statins
mechanism of action:
- exact mechanism unknown
- inhibits breakdown of stored fat
gemfibrozil (Lopid) - what are the adverse effects?
- GI: abdominal cramping, diarrhea, nausea, dyspepsia (indigestion)
- headache
- dizziness
- peripheral neuropathy
- diminished libido
fibric acid
gemfibrozil (Lopid) - what are the serious adverse effects?
- cholelithiasis (gallstones)
- anemia
- eosinophilia (high #)
- bleeding
gemfibrozil (Lopid) - what are the contraindications/ precautions with this medication?
- gallbladder disease
- serious liver impairment
- renal impairment
gemfibrozil (Lopid) - any drug interactions?
- increased risk of myositis (inflammation) and rhabdomyolysis w/ some statins
- incr risk of bleeding with anticoagulants: easily bruised, tarry/dark stool, vomit coffee grounds, check hematocrit/labs, hematuria, pain, stroke s/s
- enhanced hypoglycemia effects w/ antidiabetic agents
gemfibrozil - What are some considerations?
- monitor lab tests
- consult prescriber if inadequate response after 3 months
- educate pt that drug will cause bloating and gas
- watch for bleeding
