Dyslipidemia Flashcards
How does someone get dyslipidema?
Dietary habits, genetics, medications
Elevated blood lipids
Atherosclerotic cardiovascular disease (ASCVD)
Stroke, coronary artery disease, myocardial infarction
Undesirable value for total serum cholesterol
240 or above
Undesirable amount for LDL cholesterol
160 or above
Undesirable value for HDL cholesterol
Less than 40
Undesirable value for triglycerides
200 or above
Prototype for HMG-CoA Reductase Inhibitors aka “statins”
Atorvastatin
MOA for atorvastatin
Inhibits enzyme primarily responsible for hepatic synthesis of cholesterol
Uses for atorvastatin
Hypercholesterolemia
Reduced risk of CV events
Nursing considerations for atorvastatin
Best class for lowering LDL cholesterol. It also lowers TG and increases HDL
Adverse effects of atorvastatin
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
What is myopathy?
It’s muscle pain/weakness associated with statin use
Can range from mild to severe
Can lower dose or try a different statin
What could be the reason of severe pain while taking a statin
Rhabdomyolysis
What is rhabdomyolysis
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
What are drugs that can increase risk of statin side effects and toxicity?
Azole antifungals (fluconazole)
Macrolide antibiotics (erythromycin)
Fibric acid derivatives (fenofibrate)
Grapefruit juice
What is the prototype for the bile acid sequestrants
Cholestyramine
MOA for cholestyramine
Binds to bile acids, causing them to be excreted in the feces
Result: liver uses excess cholesterol to make new bile acids
Uses for cholestyramine
Decreases LDL
Little to no effect on HDL and TG
Nursing considerations for cholestyramine
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
Prototype for fibric acid derivative (fibrates)
Fenofibrate
MOA for fenofibrate
Decrease hepatic production of TG, decrease VLDL cholesterol, increase HDL
Uses for fenofibrate
Most effective at lowering serum TG (better than statins)
Nursing considerations for fenofibrate
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
