Chapter 29- Antilipemic Drugs

Question 1

Antilipemic/ Mech of Action

Answer 1

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.

Question 2

Apolipoprotein

Answer 2

The protein component of a lipoprotein

Question 3

Cholesterol

Answer 3

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

Question 4

Chylomicrons

Answer 4

Minute droplets of lipoproteins; the forms in which dietary fats are absorbed from the small intestine

Question 5

Exogenous lipids

Answer 5

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

Question 6

Foam cells

Answer 6

The characteristic initial lesion of atherosclerosis, aka fatty streak

Question 7

HMG-CoA reductase inhibitors

Answer 7

A class of cholesterol lowering drugs that act by inhibiting the rate-limiting step in cholesterol synthesis; aka statins

Question 8

Hypercholesterolemia

Answer 8

A condition in which greater than normal amounts of cholesterol are present in the blood

Question 9

Lipoprotein

Answer 9

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.

Question 10

Statins

Answer 10

A class of cholesterol-lowering drugs more formally known as HMG-CoA reductase inhibitors

Question 11

Triglycerides and Cholesterol

Answer 11

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.

Question 12

Coronary Heart Disease and Positive Risk Factors

Negative (Beneficial) Risk factor

Answer 12

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

Question 13

Treatment guideline

Answer 13

Adjunct to diet therapy.

Diet and excerise

Question 14

Statin Indications

Answer 14

First line drug therapy.

Question 15

Statin Contraindications

Answer 15

Pregnancy, Liver Disease, elevated liver enzymes

Question 16

Statin adverse effects

Answer 16

Mild GI disturbances, Rash, headache, myopathy (muscle pain), and #1 rhadomyolysis

Question 17

Statin Interactions

Answer 17

Oral anticoagulants, erythromycin, gemfibrozil (Lopid), insulin, grapefruit juice

Question 18

Bile Acid Sequestrants/ Mech of Action

Answer 18

Ex) cholestyramine (Novo-Cholamine), colestipol hydrochloride (Colestoid)

Prevents resorption of bile acids from small intestine which are necessary for absorption of cholesterol.

Question 19

Bile Acid Sequestrants Indications/ Contraindications

Answer 19

Relief of pruritus (severe itching). Adjunct to statins

Billiary or bowel obstruction

Question 20

Bile Acid S Adverse Effects

Answer 20

Constipation, Heartburn, N, belching, bloating- tend to disappear overtime

Question 21

Bile Acid S Interactions

Answer 21

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)

Question 22

Nicotinic Acid (Niacin, Niacamide, Niaspan)/ Mech of Action

Answer 22

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

Question 23

Nicotinic Acid Indications

Answer 23

Lowers triglycerides and LDL levels. Increases HDL levels

Question 24

Nicotinic Acid Contraindications

Answer 24

Liver Disease, Hypertension, Peptic Ulcer, any active hemorrhagic process

Question 25

Nicotinic Acid Adverse Effects

Answer 25

Flushing due to histamine release Pruritus GI Distress

Question 26

Nicotinic Acid Interactions

Answer 26

Increased risk of myopathy when taken concomitantly with a statin

Question 27

Fibric Acid Derivatives/ Mech of Action

Answer 27

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%

Question 28

Fibric Acid Contraindications

Answer 28

Severe liver or kidney disease, Cirrhosis, Gallbladder disease.

Question 29

Fibric Acid Adverse effects

Answer 29

Diarrhea, blurred vision, headache, increased risk of gallstones, prolonged prothrombin time, increased enzyme levels

Question 30

Fibric Acid Interactions

Answer 30

Enhance action of oral anticoagulants Increased risk for Myalgia May raise blood level of ezetimibe

Question 31

Cholesterol Absorption Inhibitor

Answer 31

Ex) ezetimibe (Ezetrol) Inhibits absorption of cholesterol Increases HDL levels Works well when taken with a statin drug

Question 32

Nursing Implications

Answer 32

"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.