Hyperlipidemia Drugs Flashcards
Lipoproteins
VLDL (produced by the liver, transports endogenous lipids to the cells)
LDL
HDL (responsible for “recycling” or cholesterol; good cholesterol)
Antilipemic Drugs
Used to lower lipid levels
Used as an adjunct to diet therapy
Drug choice based on the specific lipid profile of the patient (PHENOTYPING)
All reasonable nondrug means of controlling cholesterol should be tried for AT LEAST 6 MONTHS before drug therapy
HMG-CoA Reductase Inhibitors (Statins)
Most potent LDL reducers
Very patient-specific
Inhibit HMG-CoA reductase, which is used by the liver to produce cholesterol, thereby lowering the rate of cholesterol production
Indications for HMG-CoA Reductase Inhibitors (Statins)
First-line drug therapy for hypercholesterolemia
Adverse Effects of HMG-CoA Reductase Inhibitors (Statins)
Mild GI disturbances
Rash
Headache
MYOPATHY (muscle pain) leading to rhabdomyolysis
ELEVATIONS IN LIVER ENZYMES OR LIVER DISEASE
Rhabdomyloysis
Breakdown of muscle protein
Urinary elimination of the muscle protein myoglobin
INSTRUCT PATIENTS TO IMMEDIATELY REPORT ANY SIGNS OF TOXICITY INCLUDING MUSCLE SORENESS OR CHANGES IN URINE COLOR
Atorvastatin (Lipitor)
One of the most commonly used drugs in this class of cholesterol-lowering drugs
Lowers total LDL and triglycerides while raising HDL
Dosed once daily, USUALLY WITH THE EVENING MEAL OR AT BEDTIME
Bile Acid Sequestrants
Prevent resorption of bile acids from small intestine
Bile acids are necessary for absorption of cholesterol
Relief of pruritus associated with partial biliary obstruction
Constipation is the most common adverse effect
Considerations for Bile Acid Sequestrants
ALL OTHER DRUGS MUST BE TAKEN AT LEAST 1 HOUR BEFORE OR 4-6 HOURS AFTER THE ADMINISTRATION OF BILE ACID SEQUESTRANTS
HIGH DOSES OF BILE ACID SEQUESTRANTS DECREASE THE ABSORPTION OF FAT-SOLUBLE VITAMINS
Treatment of overdose includes restoring gut motility
Overdose can cause obstruction because the bile acid sequestrants are not absorbed
Niacin (Nicotinic Acid)
Lipid-lowering properties require much higher doses than when used as a vitamin
Effective in lowering triglyceride, total serum cholesterol, and LDL levels and increasing HDL
ADVERSE EFECTS INCLUDE FLUSHING, PRURITUS, AND GI DISTRESS
Fibric Acid Derivitaves
Gemfibrozil (Lopid)
Believed to work by activating lipase, which breaks down cholesterol
Decrease triglycerides and increase HDL
Nursing Implications
Obtain liver baseline function studies
Explain these drugs may take weeks to show effectiveness
Counsel patient concerning diet and nutrition on an ongoing basis
Fibric Acid Derivitaves Adverse Effects
ABDOMINAL DISCOMFORT
BLURRED VISION/HEADACHE
INCREASED RISK OF GALLSTONES
PROLONGED PROTHROMBIN TIME
INCREASED LIVER ENZYME LEVELS
