Chapter 16 Flashcards
Name the different types of drug therapies for Cholesterol Managment
HMG-CoA reductase inhibitors Bile-acid sequestrants Cholesterol absorption inhibitors Fibrates Nicotine acids
How do HMG-CoA reductase inhibitors work
they control the rate of cholesterol produced by the liver which decreases total cholesterol, decreases LDL and decreases triglycerides
What is the suffix of HMG-CoA reductase inhibitors
statin
atorvastatin
simvastatin
What are the side effects of statin drugs
muscle aches, GI upset, liver problems
usually they go away
What are the adverse effects of statins
Decreased liver fx, need a liver test q 3-6months, Rhabdomyolysis which can lead to kidney failure
what do you check before giving statin drugs
kidney and liver function, check for muscle problems and alcohol consumption
What do you check after giving statin drugs
liver function and assess for muscle breakdown
What do you teach your patient about statin drugs
Can take them at bedtime if it upsets their stomach, or they can be taken twice per day
Lifespan considerations for statin drugs
not for children under 8, not for pregnancy (X), not for patients with myopathy or liver disease
What is the suffix of Bile Acid Sequestrants
cole
cholestyramine
colesevelam
colestipol
What are side effects of Bile Acid
GI upset
What are adverse effects of Bile Acid (cole)
decrease in body’s ability to absorb oral drugs, inhibit fat soluble vitamins (A,D,E, and K) they may need a vitamin supplement, can increase or decrease the effects of warfarin
What do you check before you give Bile Acid (cole)
Give at least 2 hours before or 4-6 hours after taking other oral drugs, watch for problems with constipation
What do you check after you take Bile Acid (cole)
assess for constipation, and other GI problems, if patient is taking warfarin, monitor for s/s of bleeding (clammy, easily bruising, paleness, dizziness, increased HR, decreased BP, SOB, or confusion)
What do you teach your patients taking Bile Acid (cole)
Take at least 2 hours before taking other oral medications or 4-6 hours after, tablet forms should be taken with 12-16oz of water (to prevent bowel obstruction), take WITH meals so that it can bind with the cholesterol, and take 2 hours before/after antacids
What Bile Acid is safe for pregnant women
Colestipol
What is the suffix for Cholesterol Absorption Inhibitors
EZE
esetimible
When are Cholesterol Absorption Inhibitors used
when low fat/low cholesterol diets didn’t work, or when statins side effects were too bad, they can also be paired with statin
What are the side effects of Cholesterol Absorption Inhibitors (eze)
GI discomfort, diarrhea, rash, fatigue, back pain, joint pain, and sinusitis
What are the adverse effects of Cholesterol Absorption Inhibitors (EZE)
Angioedema, liver problems
What does Cholesterol Absorption Inhibitors do
Lower LDL and total cholesterol
What do you check before you give Cholesterol Absorption Inhibitors (eze)
liver disease or muscle disorders
What do you teach the patient taking Cholesterol Absorption Inhibiting (eze)
report muscle pain, tenderness or weakness, take drug once a day at the same time, which will help you remember to take the medication and it can help time intestinal problems
Lifespan considerations for Cholesterol Absorption Inhibitors
Not safe for children under 10, not for pregnant or breast feeding patients
Bile Acid binds with cholesterol where?
In the intestine, which prevents fat absorption, so you poop it out
What is the suffix for Fibrates
fib
fenofibrate
gemfibrozil
How do fibrates (fib) work
They bind to the cell wall receptors and break down lipids for elimination
What do Fibrates do to cholesterol
decrease trigs and liver production of trigs
increase (mildly) HDL, use of trigs by fat tissues, cholesterol excretion in bile
What are some side effects of Fibrates
GI upset, dyspepsia, muscle problems, rash, pruritis
What are the adverse effects of Fibrates
gallstones, rhabdomyolysis, liver damage
What does Fibrates interact with
grapefruit juice, alcohol, increases warfarin which increases bleeding
What do you check before you give Fibrates
kidney, liver or gallbladder disease
What do you check after giving Fibrates
monitor kidney, liver or gallbladder, bleeding
What do you teach patients taking Fibrate
follow up lab tests, take 30 minutes before morning and evening meals, avoid alcohol, no grapefruit juice, report s/s of bleeding, Older adults will get INR tested weekly
What is the Nicotinic Acid Agent
Niacin (Vitamin B)
What are the intended responses for Niacin
decrease trig, total and LDL, increase HDL by dilating blood vessels
What are the side effects of Niacin
flushing, itching, GI upset, headache, tachy, dizziness, nasal inflammation, hot flashes, SOB, sweating and swelling
What are the adverse affects of Niacin
Liver failure, Gout, Hyperglycemia
What are the contraindications for Niacin
Not for patients with hypertension, peptic ulcer disease, or active bleeding
What do you check before you give Niacin
baseline vitals, blood sugar, BP and HR, history of liver disease, diabetes, alcohol intake and gout
What do you teach about Niacin
Take with meals, tell your dentist, take NSAID or aspirin 30 minutes prior to taking Niacin to reduce flushing and hot flashes
Cholesterol is good for your body (T/F)
True
Which lipid is considered the “good” lipid
HDL
The use of lipid lowering drugs lessens the importance of implementing dietary changes in preventing coronary artery disease (t/f)
False
The side effects of statins disapear as the body adjusts to the medication (T/F/)
True
What are the normal levels of: Total Cholesterol, Trigs, LDL, and HDL
Total: 200 or less
Trigs: 40-160, 35-135
LDL: 60-180
HDL greater than 45, 55
When should drug therapy be used for cholesterol?
Drugs should only be used if TLC’s (Therapeutic lifestyle changes) fail.
