Chapter 29- Antilipemic Drugs Flashcards
Antilipemic/ Mech of Action
A drug that reduces lipid levels.
HMG-CoA reductase inhibitors ( statins) ex) lovastatin (Mevacor), pravastatin (Pravase)
Inhibit HMG-CoA reductase, which is used by the liver to produce cholesterol. Lower the rate of cholesterol production.
Apolipoprotein
The protein component of a lipoprotein
Cholesterol
A fat-soluble crystalline steroid alcohol that is found in animal fats and oils and egg yolk and widely distributed in the body, especially in bile, blood, brain tissue, liver, kidneys, adrenal glands, and myelin sheaths of nerve fibres
Chylomicrons
Minute droplets of lipoproteins; the forms in which dietary fats are absorbed from the small intestine
Exogenous lipids
Lipids originating outside the body or organ ( ex. dietary fats) or produced as the result of external causes, such as disease caused by a bacterial or viral drug foreign to the body
Foam cells
The characteristic initial lesion of atherosclerosis, aka fatty streak
HMG-CoA reductase inhibitors
A class of cholesterol lowering drugs that act by inhibiting the rate-limiting step in cholesterol synthesis; aka statins
Hypercholesterolemia
A condition in which greater than normal amounts of cholesterol are present in the blood
Lipoprotein
Combination of triglyceride or cholesterol with apolipoprotein.
Very low density lipoprotein (VLDL) produced by the liver.
Low density lipoprotein (LDL) bad cholesterol
High density lipoprotein (HDL) good cholesterol. Recycling of cholesterol.
Statins
A class of cholesterol-lowering drugs more formally known as HMG-CoA reductase inhibitors
Triglycerides and Cholesterol
A compound consisting of a fatty acid (oleic, palmitic, or stearic) and a type of alcohol known as glycerol.
Two primary forms of lipids in the blood.
Coronary Heart Disease and Positive Risk Factors
Negative (Beneficial) Risk factor
Risk of coronary heart disease in patients with high cholesterol levels.
Age - Male 45yrs or older. Female- 55yrs or older, or premature menopause not on estrogen.
Family history of premature CHD
Current smoking
Hypertension
LDL/HGL levels high
Diabetes mellitus
Negative= High HDL
Treatment guideline
Adjunct to diet therapy.
Diet and excerise
Statin Indications
First line drug therapy.
Statin Contraindications
Pregnancy, Liver Disease, elevated liver enzymes
Statin adverse effects
Mild GI disturbances, Rash, headache, myopathy (muscle pain), and #1 rhadomyolysis
Statin Interactions
Oral anticoagulants, erythromycin, gemfibrozil (Lopid), insulin, grapefruit juice
Bile Acid Sequestrants/ Mech of Action
Ex) cholestyramine (Novo-Cholamine), colestipol hydrochloride (Colestoid)
Prevents resorption of bile acids from small intestine which are necessary for absorption of cholesterol.
Bile Acid Sequestrants Indications/ Contraindications
Relief of pruritus (severe itching). Adjunct to statins
Billiary or bowel obstruction
Bile Acid S Adverse Effects
Constipation, Heartburn, N, belching, bloating- tend to disappear overtime
Bile Acid S Interactions
All concurrently administered drugs should be taken at least 1 hour before or 4-6 hours after the administration of ion-exchange resins.
Decrease the absorption of fat soluble vitamins (A, D, E , K)
Nicotinic Acid (Niacin, Niacamide, Niaspan)/ Mech of Action
Vitamin B’s. Require much higher doses. Effective and inexpensive. Used in combination with other lipid lowering drugs.
Breaks down lipids. Reduces the metabolism or catabolism of cholesterol and triglycerides
Nicotinic Acid Indications
Lowers triglycerides and LDL levels. Increases HDL levels
Nicotinic Acid Contraindications
Liver Disease, Hypertension, Peptic Ulcer, any active hemorrhagic process
Nicotinic Acid Adverse Effects
Flushing due to histamine release
Pruritus
GI Distress
Nicotinic Acid Interactions
Increased risk of myopathy when taken concomitantly with a statin
Fibric Acid Derivatives/ Mech of Action
Not used often. AKA Fibrates. ex) gemfibrozil (Lopid).
Activates lipase which breaks down cholesterol. Inhibits synthesis of triglycerides
Decrease triglyceride levels. Increase HDL by as much as 25%
Fibric Acid Contraindications
Severe liver or kidney disease, Cirrhosis, Gallbladder disease.
Fibric Acid Adverse effects
Diarrhea, blurred vision, headache, increased risk of gallstones, prolonged prothrombin time, increased enzyme levels
Fibric Acid Interactions
Enhance action of oral anticoagulants
Increased risk for Myalgia
May raise blood level of ezetimibe
Cholesterol Absorption Inhibitor
Ex) ezetimibe (Ezetrol)
Inhibits absorption of cholesterol
Increases HDL levels
Works well when taken with a statin drug
Nursing Implications
“What do you normally take?” Assess dietary patterns, excretes level, assess for contraindications
PTs on long-term therapy may need supplemental Vitamins A, D, K.
PTs to take with meals to avoid GI upset
Powder forms must be taken with a liquid NEVER dry
Other meds should be taken 1hr before or 4-6 hours after.
Take at supper- cholesterol made during the night
Small doses of Aspirin or NSAIDs can be taken 30mins before niacin to minimize flushing.
May take several weeks for therapeutic effects
Report persisten GI upset, constipation, abnormal bleeding.
