drugs for lipid disorders

Question 1

3 types of lipids

Answer 1

Triglycerides
-neutral fat
- account for 90% of total lipids in body

Phospholipids
- building plasma membranes
- not effective against high cholesterol

Steroids
- necessary for production of ( Vit. D, bile acids, cortisol, estrogen, progesterone and testosterone)
- 75% of cholesterol needed

Question 2

Lipoproteins

Answer 2

consists of cholesterol, triglycerides, and phospholipids with protein carrier

3 types:
1) high density lipoprotein (HDL) *** want to keep high “good cholesterol”
- in liver and small intestine that assist in moving cholesterol away from body back to liver

2) low density lipoprotein ( LDL)***want to keep low 
         - carries highest amount of cholesterol from liver to the rest of the body and contributes to plaque deposits and CAD 

3) very los density lipoprotein (VLDL) 
         - carries triglycerides in blood

Question 3

dietary recommendations

Answer 3

• Consume a diet rich in fruits and vegetables.
• whole-grain, high-fiber foods.
• fish, especially oily fish (omega 3), at least
  twice a week.
• Decrease added sugars substances
• Choose and prepare foods with little or no salt.
• Consume alcohol in moderation –Men two drinks/day; Women one drink/day

Question 4

atorvastatin

Answer 4

Therapeutic Class:
Antihyperlipidemic

Pharmacologic Class:
HMG-CoA reductase inhibitor, statin

Actions and Uses:
reduces the risk of MI and stroke. It also prevents cardiovascular disease with those who have diabetes, smoke, hypertension, or have family history of heart disease
Liver makes less cholesterol which responds in making more LDL receptors in liver cells.Blood level. To enhance therapeutic effects, patients should be placed on an approved exercise program and diet low in saturated fat and cholesterol

Risks/ alert:
- Preg x
- take with food to decrease GI discomfort

Pharmacokinetics:
onset- 2 weeks
peak- 1-2hrs
duration- dk

Adverse effects:
GI complaints(stomach cramping, diarrhea,
and constipation) Some not all experience hepatotoxicity. Myopathy ( muscle ache), liver inflammation.
The most SERIOUS adverse effect is rhabdomyolysis.

contraindications:
serious liver disease, persistent elevations of serum transaminases

interactions:
drug to drug–> Azole antifungals, HIV protease inhibitors, and telaprevir due to an increased risk for myopathy and rhabdomyolysis. Atorvastatin may increase levels of digoxin and oral contraceptives containing norethindrone and ethinyl estradiol. Erythromycin may increase atorvastatin levels 40%.
Risk of rhabdomyolysis increases with concurrent administration of atorvastatin with macrolide antibiotics, cyclosporine, and niacin. Ethanol should be avoided during
therapy because of its effects on liver function.

Lab test–> increase serum transaminase, creatine kinase levels, renal function, LFT, cholesterol panel

Herbal/food–> grapefruit juice bc it inhibits metabolism statin. Red yeast rice = increase the effects of atorvastatin. Patients may benefit from CoQ10 supplements since atorvastatin decreases it

Pt teaching: alcohol, monitor liver function, food choices

Question 5

cholestyramine

Answer 5

Therapeutic Class:
Antihyperlipidemic

Pharmacologic Class:
Bile acid sequestrant

Actions and Uses:
Cholestyramine is a powder that is mixed with fluid before being taken once or twice daily. It is not absorbed or metabolized once it enters the intestine; It may take 30 days or longer to produce its maximum effect. Questran binds with bile acids (containing cholesterol) in an insoluble complex that is excreted in the feces. Cholesterol levels decline due to fecal loss.

Risk/alerts:
* Mix thoroughly with 60 to 180 m L of water, noncarbonated beverages, highly liquid soups, or pulpy fruits (applesauce, crushed pineapple). Have the patient drink it immediately to avoid potential irritation or obstruction in the GI tract.
* Give other drugs more than 2 hours before or 4 hours after the patient takes cholestyramine.
* Pregnancy category C.

Pharmacokinetics:
onset- 24-48hrs
peak- 1-3 wks
duration- 2-4wks

AE:
may experience constipation, bloating gas, and nausea. GI upsetness and warfarin interaction

Contraindications:
pts with total biliary obstruction

interactions:
drug-drug–> digoxin, tetracyclines, thyroid hormone, statin and thiazide diuretics should NOT be taken at the same time. With anticoagulatns = decrease potassium

Labs–> AST, phosphorus, chloride, and alkaline phosphatase (ALP) levels may increase.
Serum calcium, sodium, and potassium levels may decrease.

Herbal–> interfere with absorption

Pt teaching:
take alone

Question 6

Niacin (nicotinic acid)

Answer 6

helps improve all categories associated with hyperlipidemia-Niacin or vitamin B3 (decrease VLDL levels)

• Side effects –-> itching, nasal inflammation, dilated blood vessels, flushing, hot flashes, headache, GI discomfort-nausea, excess gas, diarrhea;
• Adverse effects -–> hepatotoxicity, gout, hyperglycemia, stomach ulcer
• Contraindicated –-> hypertension, peptic ulcer disease, active bleeding

Pt teaching: go slow and low and take with meals
avoid breastfeeding, watch blood sugar

Question 7

fibric acid agents (fibrates)—– gemfribrozil

Answer 7

break down lipids for elimination
Intended responses:
–Decrease triglycerides
–Mildly increase HDL cholesterol

primary use: hypertriglyceridemia

Side effects (usually mild) – stomach upset, diarrhea

Adverse effects: GI distress; gallstones, watch for bleeding with patients on anticoagulants, increased creatinine levels in patients with kidney disease

Interaction alerts:
– Can increase effectiveness of warfarin
– Gemfibrozil (Lopid) interacts with statins, causing higher blood levels of statins

Question 8

Gemfibrozil

Answer 8

Therapeutic Class:
Antihyperlipidemic

Pharmacologic Class:
Fibric acid drug (fibrate)

Actions and Uses
treatment of hypertriglyceridemia and hypercholesterolemia. 50% reduction in VLDL with an
increase in HDL. It is less effective than the statins at lowering LDL. NOT a drug of first choice for reducing LDL levels. Gemfibrozil is taken orally at 600 to 1200 m g/day.)

Risk/alert:
preg. B
take with meals

Pharmacokinetics:
onset- 1-2hrs
peak- 1-2hrs
duration- 2-4 months

AE:
increase gallstones and may occasionally affect liver function. The most common are GI related: dyspepsia, diarrhea, nausea, and cramping.

Contraindications:
patients with hepatic impairment, severe CKD, preexisting gallbladder disease

Interactions
Drug–Drug:
oral anticoagulants may potentiate anticoagulant effects. Statins should be avoided because this
increases the risk of myopathy and rhabdomyolysis.
Gemfibrozil may increase the effects of certain antidiabetic drugs, statins, and insulin.

Lab Tests:
increase liver enzyme values, and creatine
phosphokinase (CPK and serum glucose levels. May
decrease hemoglobin, hematocrit, and white
blood cellcounts.

Herbal/Food:
Fatty foods may decrease the efficacy, No grapefruit juice ( Take 1/2 hr before meals)

Question 9

ezetimibe

Answer 9

Inhibits absorption of cholesterol in small intestine, resulting in small reduction in LDL

AE: angioedema , fatigue, GI upset, joint pain

pt teaching:
useful when pt can’t tolerate statin