drug therapy for dyslipidemia Flashcards
where are blood lipids derived from
diet
where are blood lipids synthesized
at the cellular level by liver and intestine
name 3 lipids
-cholesterol
-phosoplipids
-triglycerides
where are lipids found and what do they do
found in body cells and they perform essential functions
how are lipids transported
-transported in plasma by lipoproteins
-each lipoprotein contains cholesterol, phospholipid, and triglyceride bound to protein
look at this thing
what is metabolic syndrome
a cluster of conditions that occur together, increasing the risk of heart disease, stroke, and type 2 diabetes
doubles the risk of cardiovascular disease
what conditions indicate metabolic syndrome
- increased weight circumference/abdominal obesity
- increased triglceride levels (result from excessive dietary proteins and carbs)
- increasesd LDL and decreased HDL
- increased BP, HTN
- increased fasting glucose (r/t insulin resistance)
what is the goal with metabolic syndrome
prevention or early detection
what is dyslipidemia (aka hyperlipidemia)
increased level of lipids in the blood
what are some risk factors associated with having dyslipidemia
-major risk factor for CAD
-associated wit atherosclerosis
-many pathophysiologic effects
-MI and ischemia
-CVA
-peripheral arterial occlusive disease
what is the tx goal with dyslipidemia
reduce morbidity and mortality
there are two types of dyslipidemia, what are they?
-primary
-secondary
describe primary dyslipidemia
-genetic, familial
-mutation in LDL receptor
describe secondary dyslipidemia
-lifestyle associated
-dietary habits, other diseases
-DM, alcoholism, hyperhtyroidism
-obesity, obstructive liver disease
what are symptoms of high cholesterol
-loose stools
-depression
-stomach distention
-poor appetite
-weight gain
-heart pain
-fatigue
-bumps
-aching pain
according to the NCEP treatment guidelines, where should someones total serum cholesterol be?
<200
according to the NCEP treatment guidelines, where should someones LDL be
<100
according to the NCEP treatment guidelines, where should someones HDL be
greater than 60
when determining lipoprotein levels, complete lipoprotein profile should be collected after…
12 hour fast
look at this thing
what are the NCEP treatment guidelines
- assess for and treat conditions known to increase blood lipids
- stop meds that increase blood lipids if possible
- start low fat diet, or maditerranean diet
- increase dietary intake of soluble fiber
- dietary supplements and cholesterol lowering methods
- start weight reduction diet (if pt is overweight or obese)
- emphasize regular aerobis exercise
- smoking cessation
- postmenopausal hormone replacement therapy
name some general characteristics of antidyslipidemics
-decrease blood lipids
-prevent/delay atherosclerotic plaque development
-promote regression of existing atherosclerotic plaque
-reduce morbidity and mortality from cardiovascular disease
describe the mechanism of action of antidyslipidemics
alter production (absorption of lipids and lipoproteins) and metabolism (removal of lipids and lipoproteins)
when is pharmacotherapy for dyslipidemia initiated?
when 6 months of dietary/lifestyle changes fail to decrease dyslipidemia to acceptable levels
what do HMG-CoA reductase inhibitors or “statins” do?
decrease cholesterol production = decrease LDL, VLDL, and triglycerides w/o reducing HDL (may increase)
what are some examples of HMG-CoA reductase inhibitors
atorvastatin, provastatin, rosuvastatin, simvastatin
describe the pharmacokinetics of statins
-extensive first pass effect
-food decreases absorption rate
-80-85% excreted in stool, rest in urine
what are some side effects of statins
-myalgias
-nausea
-constipation or diarrhea
what are some drugs that interact with statins
-Mg+ anatacids
-“azole” antifungals
-some antibiotics
-cholestyramine
what are some nursing implications r/t statins
-evening or HS administration (2100) bc cholesterol synthesis occurs at this time of day
-avoid grapfruit and pomegranate juice, red yeast rice, vitamin B3 (increase effects)
-monitor liver function tests and assess for signs of rhabdomyolysis (severe msucle cramps, cola coloerd urine, extreme fatigue) ; stop and call physician
-educate on importance of adherance, diet and exercise along with medication for increase success to reach therapy goal
should a pregnant person take statins?
nope, pregnancy category X
what do bile acid sequestrants do?
binds bile acids in intestinal lumen = bile acids excreted via stool = prevents recirculation to liver = stimulates increase bile acid synthesis from chlesterol in the liver = increases cholesterol to the liver = lowers serum LDL
give an example of a bile acid sequestrants
cholestyramine
describe the pharmacokinetics of bile acid sequestrants
-not absorbed with oral administration
-excreted unchanged in stool
-decrease LDL within a week of use and max levels will maximize in one month
what are some side effects of bile acid sequestrants
-GI fullness
-flatulence
-constipation
-diarrhea
r/t no systemic absorption
what are some side effects of bile acid sequestrants
-GI fullness
-flatulence
-constipation
-diarrhea
r/t no systemic absorption
what are some nursing implications r/t bile acid sequestrants
-decrease absorption of many drugs (digoxin, folic acid, propranolol, thiazide diuretics, warfarin)
-fibers can increase effect
-can prevent absorption of fat soluble vitamins (A,D,E,K)
-give other meds 1 hour before or 4-6 hours after
what do fibrates do?
increase oxidation of fatty acids in liver and muscle tissue = decrease hepatic production of triglycerides, VLDL and increase HDL
give two examples of fibrates
-fenofibrate
-gemfibrozil
descirbe the pharmacokinetics of fibrates
-oral administration
-highly protien bound
-peak 6-8 hours
-liver metabolism
-urinary excretion
what are some side effects of fibrates
-GI discomfort
-diarrhea
-risk for gallstones, not for pts with preexisting/PMH of gallbladder disease
what are some nursing implications r/t fibrates
-can enhance effects of warfarin
-increase risk for myopathies or rhabdomyolysis
-can decrease effects of bile sequestrants
-gamfibrozil must be taken on an empty stomach (30 mins before a meal)
what do cholesterol absorption inhibitors do
inhibit absorption of cholesterol in small intestines and decrease delivery of intestinal cholesterol to the liver = reduced hepatic cholesterol stores and increasing cholesteral clearance from blood
give and example of cholesterol absorption inhibitors
ezetimibe
describe the pharmacokinetics of cholesterol absorption inhibitors
-protein bound
-metabolized in small intestines and liver
-excreted in stool
what are some side effects of cholesterol absorption inhibitors
HA, diarrhea, nausea
what are some nursing implications r/t cholesterol absorption inhibitors
-educate on diet and lifestyle changes with this med
-can be uses as monotherapy or in conjunction with a statin
-pregnancy category C: not recommended for use
what do PCSK9 inhibitors do
antibody that inactivates protein in liver that regulates the lifespan of cholesterol, promoting modulation of the receptors = proloning receptor activity = promoting clearance of cholesterol =** can have a 60-70% reduction in LDL**
who are PCSK9 inhibitors used for
patients with familial hypercholesterolemia with max statin dose, lifelstyle changes with continued elevated LDL
give an example of PCSK9 inhibitors
alirocumab
describe the pharmacokinetics of PCSK9 inhibitors
sub Q every 2-4 weeks/doses vary
3-7 day max serum concentrations
what are some side effects of PCSK9 inhibitors
-appears well tolerates
-can see injection site reactions
-itching
-nasopharyngitis
-muscle pain
what are some nursing implications r/t PCSK9 inhibitors
-educate pt onsubq injection process
-schedule follow up 4-8 weeks
-encourage diet and exercise as appropriate to facilitate lipid lowering process
what does niacin (vitamin B3) do?
boost evels of HDL cholesterol and lowers triglycerides modestly lowers LDL cholesterol
what are some side effects of niacin
- facial flushing
- stomach upset (take with food)
- diarrhea
- can raise blood sugar
what are some contraindications of niacin
- liver issues
- stomach ulcers
- changes to glucose levels
- muscle damage
- low blood pressure
- heart rhythm changes
- other issues
what are two omega 3 fatty acids that are though to help lower serum lipids?
-omega 3 acid ethyl esters
-omega 3 carboxylic acids
name two combination rx therapies for dyslipidemia
-advicor
-simcor
what is advicor
extended release niacin and lovastatin
niacin dose is variable
what is simcor
simvastatin and niacin
niacin dose is variable
