Dyslipidemia

Question 1

How does someone get dyslipidema?

Answer 1

Dietary habits, genetics, medications

Elevated blood lipids

Atherosclerotic cardiovascular disease (ASCVD)

Stroke, coronary artery disease, myocardial infarction

Question 2

Undesirable value for total serum cholesterol

Answer 2

240 or above

Question 3

Undesirable amount for LDL cholesterol

Answer 3

160 or above

Question 4

Undesirable value for HDL cholesterol

Answer 4

Less than 40

Question 5

Undesirable value for triglycerides

Answer 5

200 or above

Question 6

Prototype for HMG-CoA Reductase Inhibitors aka “statins”

Answer 6

Atorvastatin

Question 7

MOA for atorvastatin

Answer 7

Inhibits enzyme primarily responsible for hepatic synthesis of cholesterol

Question 8

Uses for atorvastatin

Answer 8

Hypercholesterolemia

Reduced risk of CV events

Question 9

Nursing considerations for atorvastatin

Answer 9

Best class for lowering LDL cholesterol. It also lowers TG and increases HDL

Question 10

Adverse effects of atorvastatin

Answer 10

Pregnancy category X

CYP substrates (needs to be metabolized by the CYP enzymes)

Take at evening/bedtime because our bodies make most cholesterol at night.. except we don’t need to do that with atorvastatin because of its long half life

Myopathy

Hepatic dysfunction

Increase blood glucose

Question 11

What is myopathy?

Answer 11

It’s muscle pain/weakness associated with statin use

Can range from mild to severe

Can lower dose or try a different statin

Question 12

What could be the reason of severe pain while taking a statin

Answer 12

Rhabdomyolysis

Question 13

What is rhabdomyolysis

Answer 13

Severe, potentially life threatening side effect

It’s when muscle is broken down, releasing enzymes which can damage the kidneys

Watch for dark cola coloured urine

Question 14

What are drugs that can increase risk of statin side effects and toxicity?

Answer 14

Azole antifungals (fluconazole)

Macrolide antibiotics (erythromycin)

Fibric acid derivatives (fenofibrate)

Grapefruit juice

Question 15

What is the prototype for the bile acid sequestrants

Answer 15

Cholestyramine

Question 16

MOA for cholestyramine

Answer 16

Binds to bile acids, causing them to be excreted in the feces

Result: liver uses excess cholesterol to make new bile acids

Question 17

Uses for cholestyramine

Answer 17

Decreases LDL

Little to no effect on HDL and TG

Question 18

Nursing considerations for cholestyramine

Answer 18

Decreases efficacy of statins

Decreases efficacy of many orally taken drugs- vitamin supplements may be required (A,D,E,K)

Most side effect are GI related, such as constipation, NVD, etc

Question 19

Prototype for fibric acid derivative (fibrates)

Answer 19

Fenofibrate

Question 20

MOA for fenofibrate

Answer 20

Decrease hepatic production of TG, decrease VLDL cholesterol, increase HDL

Question 21

Uses for fenofibrate

Answer 21

Most effective at lowering serum TG (better than statins)

Question 22

Nursing considerations for fenofibrate

Answer 22

Main indication is for TG over 500 mg/dL

Increase risk of bleeding from anticoagulants

Contraindicated in patients with severe renal impairment or liver disease- fibrates can worsen both