drug therapy for dyslipidemia

Question 1

blood lipids/ blood fats/ blood fatty acids are derived from_______ and found in _____

Answer 1

diet and found in body cells, perform essential functions

Question 2

blood lipids/ blood fats/ blood fatty acids are synthesized at

Answer 2

the cellular level by liver and intestine

Question 3

each lipoprotein contains

Answer 3

cholesterol, phospholipid, and triglyceride bound to a protein

Question 4

what is metabolic syndrome

Answer 4

a cluster of conditions that occur together, increasing the risk of heart disease, stroke and type 2 diabetes

Question 5

s/sx of metabolic syndrome

Answer 5

increase waist circumference, increase triglyceride levels (result from excessive dietary proteins and carbohydrates), increase LDL (bad), decrease HDL (healthy), increase BP, increase fasting glucose (r/t insulin resistance), hypertension

Question 6

for good cholesterol what do you want to see

Answer 6

low LDL levels and high HDL levels

Question 7

metabolic syndrome doubles what

Answer 7

risk for cardiovascular disease

Question 8

dyslipidemia aka hyperlipidemia is

Answer 8

increase level of lipids in the blood

Question 9

a major risk of dyslipidemia is

Answer 9

CAD

Question 10

dyslipidemia/ hyperlipidemia is associated with

Answer 10

atherosclerosis, MI and ischemia, CVA, peripheral arterial occlusive disease

Question 11

primary type of dyslipidemia

Answer 11

genetic, familiar

Question 12

secondary type of dyslipidemia

Answer 12

dietary habits; DM, alcoholism, hypothyroidism, obesity, obstructive liver disease

Question 13

high cholesterol symptoms

Answer 13

loose stools, depression, stomach distention, poor appetite, weight gain (central), heart pain, fatigue, aching pain, bumps around eye

Question 14

total serum cholesterol less than

Answer 14

200 is optimal

Question 15

LDL cholesterol less than

Answer 15

100 is optimal

Question 16

HDL cholesterol higher than

Answer 16

60 is optimal

Question 17

major risk factors that modify LDL goals

Answer 17

smoking, hypertension (or on antihypertensive medication), low HDL cholesterol, family history of CHD, age

Question 18

treatment guidelines for dyslipidemia

Answer 18

stop meds that increase blood lipids, start low fat diet, use mediterrean diet, increase dietary intake of soluble fiber, dietary supplements and cholesterol lowering methods, start weight reduction diet, emphasize regular aerobic exercise, stop smoking, postmenopausal hormone replacement therapy

Question 19

general characteristics of antidyslipidemias

Answer 19

decrease blood lipids, prevent/ delay atherosclerotic plaque, promote regression of existing atherosclerotic plaque, reduce morbidity and mortality from cardiovascular disease

Question 20

mechanism of action of antidyslipidemics

Answer 20

alter production (absorption of lipids and lipoproteins) and metabolism (removal of lipids and lipoproteins)

Question 21

drugs for dyslipidemia

Answer 21

hydroxymethylglutaryl-coenzyme A reductase inhibitor (HMG-CoA reeductase inhibitors or statins), bile acid seqestrants, fibrates, cholesterol absorption inhibitors, PCSK9 inhibitors

Question 22

hydroxymethylglutaryl-coenzyme A reductase inhibitor (HMG-CoA reeductase inhibitors or statins) does what

Answer 22

decrease cholesterol production = decrease total cholesterol, LDL, VLDL, and triglycerides without reducing HDL (may increase)

Question 23

an example of hydroxymethylglutaryl-coenzyme A reductase inhibitor (HMG-CoA reeductase inhibitors or statins)

Answer 23

atorvastatin (lipitor)

Question 24

pharmacokinetics of hydroxymethylglutaryl-coenzyme A reductase inhibitor (HMG-CoA reeductase inhibitors or statins)

Answer 24

extensive first pass effect in liver/ food decreases rate/ absorption rate, 80-85% excreted in the stool, the rest is excreted in urine

Question 25

side effects of hydroxymethylglutaryl-coenzyme A reductase inhibitor (HMG-CoA reeductase inhibitors or statins)

Answer 25

myalgia, nausea, constipation, diarrhea

Question 26

drug interventions for hydroxymethylglutaryl-coenzyme A reductase inhibitor (HMG-CoA reeductase inhibitors or statins)

Answer 26

Mg+ antacids, "azalea" antifungals, some antibiotics, cholestyramine

Question 27

nursing concerns for hydroxymethylglutaryl-coenzyme A reductase inhibitor (HMG-CoA reeductase inhibitors or statins)

Answer 27

evening administration r/t cholesterol synthesis occurs at this time of day; avoid grapefruit & pomegranate juice, red yeast rice, vitamin B; monitor Liver function test, rnhabdomylosis(severe muscle Ramos, cola colored urine, fatigue), educate on importance of diet and exercise

Question 28

what are bile acid sequestrants

Answer 28

Binds bile acids in the intestinal lumen = bile acids excreted via stool= prevents recirculation to liver = stimulates increase bile acid synthesis from cholesterol in liver = increases cholesterol to liver = lowers serum LDL

Question 29

example of bile acid sequestrants

Answer 29

cholestyramine

Question 30

pharmacokinetic of bile acid sequestrants

Answer 30

not absorbed with oral administration. excreted unchanged in stool/ decrease LDL within a week of use and max levels will maximize in one month

Question 31

side effects of bile acid sequestrants

Answer 31

GI fullness, flatulence, constipation/ diarrhea r/t no systemic absorption

Question 32

nursing concerns of bile acid sequestrants

Answer 32

decrease absorption of many drugs (dig, folic acid, propranolol, thiazide diuretics, thyroid hormone, warfarin)

Question 33

what are fibrates

Answer 33

increase oxidation of fatty acids in liver and muscle tissue = decrease hepatic production of triglycerides, VLDL, and increase HDL

Question 34

example medications of fibrates

Answer 34

fenofibrate, gemfibrozil

Question 35

pharmacokinetics of fibrates

Answer 35

oral administration/ highly protein bound, peak 6-8 hrs, liver metabolism, urinary excretion

Question 36

side effects of fibrates

Answer 36

GI discomfort, diarrhea, RF gallstones (not for pts with preexisting/ PMH of gallbladder disease)

Question 37

nursing concerns for fibrates

Answer 37

Nursing: Can enhance effects of warfarin (increasing RF bleeding), increase RF myopathies or rhabdomyolysis with statins, decrease effects of bile sequestrant RX; gemfibrozil must be taken on an empty stomach (30 minutes before a meal)

Question 38

cholesterol absorption inhibitor

Answer 38

Inhibit absorption of cholesterol in the small intestines & decreases delivery of intestinal cholesterol to the liver = reduced hepatic cholesterol stores , increasing cholesterol clearance from the blood

Question 39

example medication of cholesterol absorption inhibitor

Answer 39

ezetimibe

Question 40

pharmacokinetics of cholesterol absorption inhibitor

Answer 40

protein bound, metabolized in small intestines and liver/excreted in stool. Peak effect I n4-12 hours

Question 41

side effects of cholesterol absorption inhibitor

Answer 41

HA, diarrhea, nausea

Question 42

nursing concerns for cholesterol absorption inhibitor

Answer 42

Educate on diet and lifestyle changes with this medication, can be used as monotherapy or in conjunction with a statin; Pregnancy category C: not recommended for use

Question 43

PCSK9 inhibitors

Answer 43

Antibody that inactivates protein in liver that regulates the lifespan of cholesterol, promoting modulation of the receptors = prolonging receptor activity = promoting clearance of cholesterol = can have a 60-70% reduction in LDL -Used in patients with familial hypercholesterolemia with max statin dose, lifestyle changes with continued elevated LDL

Question 44

example medication of PCSK9 inhibitor

Answer 44

alirocumab

Question 45

pharmacokinetics of PCSK9 inhibitor

Answer 45

SubQ every 2-4 weeks/doses vary, 3-7 day max serum concentrations

Question 46

side effects of PCSK9 inhibitor

Answer 46

Appears well tolerated/ can see injection site reactions, itching, nasopharyngitis, muscle pain

Question 47

miscellaneous dyslipidemics are

Answer 47

niacin and omega 3 fatty acids

Question 48

what does niacin (vitamin B) do

Answer 48

boost levels of “healthy” HDL cholesterol and lower triglycerides modestly lowers “lousy” LDL cholesterol  

Question 49

side effects of niacin

Answer 49

facial flushing, stomach upset (take with food), diarrhea, can raise blood sugar

Question 50

contraindications of niacin

Answer 50

Liver issues, stomach ulcers, changes to glucose levels, muscle damage, low blood pressure, heart rhythm changes, and other issues

Question 51

examples of omega 3 fatty acids

Answer 51

omega 3 acid ethyl esters & omega 3 carboxylic acids

Question 52

combination drug therapy for dyslipidemia is

Answer 52

Advicor(extended release niacin & lovastatin) & simmer(simvastatin and niacin)