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NRSG 220 > Chapter 29: Hyperlipidemics (9) > Flashcards

Chapter 29: Hyperlipidemics (9) Flashcards

1
Q

Lipids are classified as

A

Triglycerides, phospholipids, sterols

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2
Q

Triglycerides

A

Neutral fats
most common (90% of lipids in body)
major storage form of fat in body

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3
Q

Phospholipids

A

Essential to building plasma membranes
lecithins are in egg yolks and soybeans

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4
Q

Sterols

A

Best know sterol is cholesterol
- cholesterol promotes atherosclerosis

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5
Q

Lipoproteins are

A

Predictors of cardiovascular disease

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6
Q

High density lipoprotein (HDL)

A

Contains most apoprotein

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7
Q

Low density lipoprotein (LDL)

A

Contains most cholesterol

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8
Q

Very low density lipoprotein (VLDL)

A

Primary carrier of triglycerides in blood

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9
Q

Hyperlipidemia

A

High levels of lipids in blood

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10
Q

Hypercholesterolemia

A

Elevated blood cholesterol

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11
Q

Dyslipidemia

A

Abnormal levels of lipoproteins

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12
Q

Hypertriglyceridemia

A

Increase in triglyceride levels

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13
Q

How do patients often present with lipid disorders

A

Often asymptomatic until progression to chest pain or HTN

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14
Q

Long term consequences of being unaware of hyperlipidemia?

A

CV disease

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15
Q

Blood lipid profiles

A

important diagnostic tools in guiding the therapy of dyslipidemias

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16
Q

LDL : HDL Ratio

A

Goal to MAXIMIZE HDL, and MINIMIZE LDL

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17
Q

What should the LDL: HDL ratio be in men and women

A

Men: Ratio should be less than 5
Women: Ratio should be less than 4.5

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18
Q

Lipoprotein

A

subclass of LDL strongly associated with plaque formation and heart disease

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19
Q

Apoloipoprotein B (ApoB)

A

A protein that is involved in the metabolism of lipids
main protein constituent of lipoproteins such as VLDL and LDL

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20
Q

Cholesterol (total) goal

A

< 5.2 mmol/L

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21
Q

HDL recommend range

A

> 0.91mmol/L

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22
Q

LDL recommended range

A

<3.4mmol/L

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23
Q

Triglycerides recommended range

A

0.45-1.71 mmol/L - <2.20 mmol/l

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24
Q

ApoB range

A

40-125 mg/dL

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25
Q

What ApoB range is considered desirable in low or intermediate risk individuals

A

100mg/dL

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26
Q

What ApoB range is considered desirable in high risk individuals?

A

80mg/dL

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27
Q

What are some nonpharmacologic management things

A

monitor blood lipids regularly
maintain optimal weight
exercise 30mins 3-5 days/wk minimum

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28
Q

What are dietary modifications

A

Reduce intake of saturated fats and cholesterol
increase intake of soluble fibre
eliminate tobacco
increase intake of plant sterols
minimize alcohol (especially beer)

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29
Q

Statins are

A

the most effective drugs for reducing blood lipid levels, recommended first line therapy

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30
Q

what is HMG-CoA reductase

A

primary regulatory enzyme for cholesterol biosynthesis
inhibited by statins

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31
Q

Statins can reduce LDL by

A

20-40%

32
Q

Statins can also lower

A

triglyceride and VLDL levels

33
Q

Statins can raise

A

HDL levels

34
Q

Primary prevention

A

administering statins to patients with no Hx of CV disease

35
Q

Secondary prevention

A

slowing progression and reducing mortality in patients with Hx

36
Q

How many statins are there currently?

A

Seven
- all have similar actions and ADEs
- all given orally and tolerated well by most

37
Q

What are 3 important pieces to remember with statins?

A
  1. Watch liver
  2. No grapefruit juice (>1L)
  3. Stop if myopathies occur
38
Q

Rhabdomyolysis

A

Rapid breakdown of muscle fibers
rare but serious ADE of statins

39
Q

Statin pregnancy category

A

X = DEATH

40
Q

Statin prototype drug

A

Atorvastatin

41
Q

Atorvastatin therapeutic

A

Antihyperlipidemic

42
Q

Atorvastatin Pharmacologic

A

HMG-CoA reductase inhibitor

43
Q

Atorvastatin uses

A

Hypercholesterolemia
family hypercholesterolemia

44
Q

Atorvastatin MOA

A

Inhibits HMG-CoA reductase
liver makes less cholesterol and responds by making more LDL receptors to remove cholesterol from blood

45
Q

Atorvastatin ADEs

A

Headache
intestinal cramping
diarrhea
constipation

46
Q

Atorvastatin Serious ADE

A

Rhabdomyolysis

47
Q

Atorvastatin contraindications

A

Pregnancy (X)
Lactation
Caution with hepatic imairment

48
Q

Atorvastatin Drug Interactions

A

May increase digoxin levels
May increase OCP levels
Erythromycin increase
risk of rhabsomylosis increase with macrolide antibiotics, cyclosporine, and azole antifungals
grapefruit juice inhibits metabolism of statins

49
Q

Atorvastatin Considerations

A
  • obtain baseline lipid values
  • monitor LDL cholesterol levels
  • Assess lipid lab tests within 2 to 4 weeks of initiation of therapy or change in dose
  • assess foreigns of rhabdomyolysis or myopathies
  • observe for digoxin toxicity
  • watch for hepatotoxicity - changes In stool, jaundice, bleeding/bruising, abd distention
  • no grapefruit
  • NO ALCOHOL
50
Q

Bile acid sequestrants are

A

often combined with statins to reduce LDL cholesterol levels

51
Q

What are bile acid sequestrates capable of?

A

Producing 20% drop in LDL cholesterol
tend to cause more frequent ADEs in GI tract

52
Q

Bile acid sequestrate Prototype drug?

A

Cholestyramine

53
Q

Cholestyramine therapeutic

A

Antihyperlipidemic

54
Q

Cholestyramine pharmacologic

A

Bile acid sequestrate

55
Q

Cholestyramine uses

A

Hypercholesterolemia
- elevated LDL

56
Q

Cholestyramine MOA

A

Binds to bile acids
forms insoluble complex containing cholesterol that is excreted in feces
lowers LDL levels by increasing LDL receptors on hepatocytes

57
Q

Cholestyramine ADEs

A

constipation
bloating
belching
nausea

58
Q

Cholestyramine Serious ADEs

A

Obstruction of GI tract
hypercholermic acidosis
malabsorption syndrome

59
Q

Cholestyramine Contraindications

A

Complete biliary obstruction
serum triglycerides > 400mg/dL
hypertryglyceridemia
pregnancy
GI disorders

60
Q

Cholestyramine Drug Interactions

A

Dogixin, penicillin, ironsupplement, thyroid hormone, thiazides reduce effects
warfarin increases effects

61
Q

Cholestyramine Considerations

A
  • completely dissolve powder before administration
  • increase fluid intake
  • assess for early signs of hypothrombinemia
  • monitor lab tests for therapeutic effectiveness
  • consult prescriber to see if supplemental vitamins A and D and folic acid are required in LTC
62
Q

Niacin can

A

reduce triglycerides and LDL cholesterol levels, but ADEs limit its usefulness

63
Q

Niacin is a

A

B complex vitamin
decreases production of VLD
produces more ADEs than statins
additive effects with other drugs
instruct patients not to self medicate

64
Q

Fibric acid drugs

A

lower triglyceride levels but have little effect on LDL cholesterol

65
Q

Types of fibric acid drugs

A

Fenofibrate
fenofibric acid
gemfibrozil
have little effect on LDL cholesterol but preferred for treating severe hypertriglyceridemia

66
Q

Fabric acid prototype

A

Gemfibrozil

67
Q

Gemfibrozil therapeutic

A

antihyperlipidemic

68
Q

Gemfibrozil Pharmacologic

A

Fibric acid agent

69
Q

Gemfibrozil uses

A

hypertriglyceridemia and VLDL
second line therapy after statins

70
Q

Gemfibrozil MOA

A

specific MOA Unknown
inhibits breakdown of stored fat

71
Q

Gemfibrozil ADEs:

A

Abdominal cramping
D/N
dyspepsia
headache
dizziness
peripheral neuropathy
diminished libido

72
Q

Gemfibrozil serious ADEs

A

Cholelithiasis
anemia
eosinophilia
bleeding

73
Q

Gemfibrozil contraindications/precautions

A

gallbladder disease
serious liver impairment
renal impairment

74
Q

Gemfibrozil drug interactions

A

statins
increased risk of myositis and rhabdomyolysis

Anticoagulatns
increased risk of bleeding

Antidiabetic
enhanced hypoglycemic effects

75
Q

Gemfibrozil considerations

A

monitor lab tests
consult prescriber if inadequate response after 3 months
educate pt drug will cause bloating and gas
watch for bleeding

76
Q

Miscellaneous drug for dyslipidemias

A

Ezetimibe

NRSG 220 (8 decks)

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