LAB - 7.5 - Lipid-lowering Agents Flashcards
these are called lipids
Cholesterol and other fatty acids
Lipids are not soluble in liquid, so they are carried in the plasma by linking ___
lipoproteins (albumins and globulins).
Lipids are not soluble in liquid, so they are carried in the plasma by linking lipoproteins like
(albumins and globulins).
Lipoproteins are described by
how thick and dense they are (“high density lipids” and “low-density lipids”)
The body needs a certain amount of cholesterol and triglycerides, which are both normal and vital parts of blood plasma.
NA
Four Major Types of Lipoprotiens
Chylomicrons
Very low-density lipoproteins (VLDLs)
Low-density lipoproteins (LDLs)
High-density lipoproteins (HDLs)
are the largest and lightest of the lipoproteins. They are formed from the absorption of dietary fat in the intestine and are mostly triglycerides. They are normally present in plasma for only 1 to 8 hours after the last meal.
Chylomicrons
Chylomicrons are formed from ___ and are mostly ___.
the absorption of dietary fat in the intestine
triglycerides
are made up of large amounts of triglycerides that were made in the liver
Very low-density lipoproteins (VLDLs)
Very low-density lipoproteins (VLDLs) are made up of large amounts of triglycerides that were made in the ___
liver
These are the result of when VLDLs break down and link with cholesterol and protein, very little triglyceride is left.
Low-density lipoproteins (LDLs).
High serum levels of this indicate cholesterol levels that are higher than the body needs.
LDLs
Patients with high LDL levels are at high risk for developing ___.
atherosclerosis
these are small, dense lipoproteins and contain very small parts of triglycerides.
High-density lipoproteins (HDLs)
They are the “vacuum cleaners” of the tissues, clearing out excess cholesterol.
High-density lipoproteins (HDLs)
these are seen as triglyceride-rich lipoproteins
Chylomicrons and VLDLs
these are cholesterol-rich lipoproteins
LDLs and HDLs
this moves cholesterol from the liver to the peripheral tissues
LDLs
LDLs move cholesterol from the ___ to the ___
liver
peripheral tissues
this removes cholesterol from the periphery and transport it to the liver
HDLs
HDLs remove cholesterol from the ___ and transport it to the ___
periphery
liver
this is used to describe an increase in levels of lipoproteins in the blood.
Hyperlipidemia
It leads to atherosclerosis and patients with damage to the lining of their vascular walls have a gradual build up of fatty deposits within the lining of the vessel walls of the arterial system.
Hyperlipidemia
This will lead to the onset of angina that results from ischemic heart disease, cerebrovascular disease, peripheral ischemia, and renovascular hypertension
Hyperlipidemia
Types of Antihyperlipidemic Drugs:
Bile Acid Sequestrants
HMG – CoA ( hydroxymethylglutartyl – CoEnzyme A)Reductase Inhibitors
Fibric acid derivatives
Niacin
Examples of Bile Acid Sequestrant
Cholestyramine (Questran)
Colestipol (Colestid)
Bile Acid Sequestrants can result in decrease LDL plasma levels of at least ___ and serum cholesterol levels.
20%
Cholestyramine (Questran) and Colestipol (Colestid) are no longer considered first-line drugs for dyslipidemia.
NA
Side Effects of Bile Acid Sequestrants:
Bloating
Constipation
Abdominal pain
Nausea
Vomiting
Diarrhea
Steatorrhea or excessive fat in the stool
Nursing Implementation for Bile Acid Sequestrants:
Do not administer powdered agents in dry form; these drugs must be mixed in fluids to be effective. Mix with fruit juices, soups, liquids, cereals, or pulpy fruits. Do not mix cholestyramine, with carbonated beverages. Stir, and encourage the patient to swallow all of the dose.
If the patient is taking tablets, ensure that tablets are not cut, chewed, or crushed because they are designed to be broken down in the GI tract
Administer other oral medications 1 hour or 4 hours after taking bile acid sequestrants to avoid interference of other drugs.
Arrange for a bowel program as appropriate to effectively deal with constipation if it occurs.
Inform client to follow a high-bulk diet and drink lots of fluids.
Advise client to immediately report yellowing of the skin or eyes to evaluate possible adverse effects
Do not mix cholestyramine, with ___
carbonated beverages
Administer other oral medications ___ hours after taking bile acid sequestrants to avoid interference of other drugs.
1 hour or 4
If the patient is taking tablets, ensure that tablets are not ___
cut, chewed, or crushed because they are designed to be broken down in the GI tract
examples of HMG-CoA Reductase Inhibitors
Simvastatin ( Zocor)
Atorvastatin (Lipitor)
Rosuvastatin (Crestor)
this HMG-CoA Reductase Inhibitors is indicated for lowering cholesterol and preventing MI in patients with known hypercholesterolemia and CAD
Simvastatin ( Zocor)
these drugs block an enzyme needed by the body to make cholesterol and lowers the amount of cholesterol in the blood
HMG-CoA Reductase Inhibitors
HMG-CoA reductase inhibitor drugs are called
statins
HMG-CoA Reductase Inhibitors is associated with severe liver complications but can be used to lower cholesterol levels in children 10 to 17 years of age
Atorvastatin (Lipitor)
Atorvastatin (Lipitor) can be used to lower cholesterol levels in children ___ of age
10 to 17 years of age
this is the newest statin and lowers LDL and raise HDL slightly better than the other statins
Rosuvastatin (Crestor)
Statins should be administered at what time?
in the evening because cholesterol biosynthesis in the body is higher at night
Minor side effects for statins
include headache, fatigue, muscle or joint pain
Serious adverse effects for statins are severe myopathy (abnormal condition of the skeletal muscle characterized by muscle weakness) and rhabdomyolysis (contents of the muscle cells spill into the systemic circulation causing potentially fatal acute renal failure)
are severe myopathy (abnormal condition of the skeletal muscle characterized by muscle weakness) and rhabdomyolysis (contents of the muscle cells spill into the systemic circulation causing potentially fatal acute renal failure)
abnormal condition of the skeletal muscle characterized by muscle weakness
severe myopathy
contents of the muscle cells spill into the systemic circulation causing potentially fatal acute renal failure
rhabdomyolysis
Liver dysfunction may occur with the use of statin drugs, monitor liver function tests before and during the first few months of therapy
NA
Statin drugs should not be used in clients with
active liver disease or unexplained elevations in liver function tests
Nursing Implementation for statins
Administer the drug at bedtime because the highest rates of cholesterol synthesis occur between midnight and 5 AM, and the drug should be taken when it will be most effective; but atorvastatin can be given at any time during the day
Monitor serum cholesterol and LDL levels before and periodically during therapy to evaluate the effectiveness of the drug.
Monitor liver function tests before and periodically during therapy to monitor for liver damage; consult with the prescriber to discontinue the drug if the aspartate aminotransferase (AST) or alanine aminotransferase (ALT) level increases to three times normal.
Ensure that the patient has attempted a cholesterol lowering diet and exercise program for at least 3 to 6 months before beginning therapy to ensure the need for drug therapy.
Withhold lovastatin, atorvastatin, or fluvastatin in any acute, serious medical condition (e.g., infection, hypotension, major surgery or trauma, metabolic endocrine disorders, seizures) that might suggest myopathy or serve as a risk factor for the development of renal failure.
Suggest the use of barrier contraceptives for women of childbearing age because there is a risk of severe fetal abnormalities if these drugs are taken during pregnancy.
Arrange for periodic ophthalmic examinations to monitor for cataract development.
Provide comfort measures to help the patient tolerate drug effects. These include small, frequent meals to minimize nausea and vomiting; access to bathroom facilities to ensure adequate bowel evacuation; give food if GI upset is severe to decrease direct irritating effects; environmental controls, such as temperature and lighting controls, to help deal with headaches; and safety precautions, such as activity restrictions, to protect the patient if vision changes and muscle effects occur.
For statins, Administer the drug at bedtime because the highest rates of cholesterol synthesis occur between___, and the drug should be taken when it will be most effective; but ___ can be given at any time during the day
midnight and 5 AM
atorvastatin
For statins, Monitor liver function tests before and periodically during therapy to monitor for liver damage; consult with the prescriber to discontinue the drug if the ___ or ___ level increases to three times normal.
aspartate aminotransferase (AST) or alanine aminotransferase (ALT)
For statins, Ensure that the patient has attempted a cholesterol lowering diet and exercise program for at least___ months before beginning therapy to ensure the need for drug therapy.
3 to 6
For statins, Withhold ___, ___, and ___ in any acute, serious medical condition (e.g., infection, hypotension, major surgery or trauma, metabolic endocrine disorders, seizures) that might suggest myopathy or serve as a risk factor for the development of renal failure.
lovastatin, atorvastatin, or fluvastatin
For statins, Suggest the use of ___ for women of childbearing age because there is a risk of severe fetal abnormalities if these drugs are taken during pregnancy.
barrier contraceptives
examples of Fibric acid derivatives
Ezetimibe (Ezetrol, Vytorin)
Fenofibrate (Lipanthyl)
Gemfibrozil (Lopid)
these lipid-lowering drugs act by the activation of peroxisome proliferator-activated receptor (PPAR-α) that increase lipoprotein lipase activity and reduces secretion of very low-density lipoprotein (VLDL) from the liver
Fibric acid derivatives
this Fibric acid derivative works by decreasing the absorption of dietary cholesterol, leading to a drop in serum cholesterol levels.
Ezetimibe (Ezetrol, Vytorin)
this Fibric acid derivative inhibits triglyceride synthesis in the liver, resulting in reduction of LDL levels
Fenofibrate (Lipanthyl)
this Fibric acid derivative inhibits peripheral breakdown of lipids, reduces production of triglycerides and LDLs and increases HDL concentration.
Gemfibrozil (Lopid)
Fenofibrate and Gemfibrozil are well tolerated but can cause ___ and ___
liver toxicity and cholelithiasis (gallstones)
another term for gallstones
cholelithiasis
One of the most effective antihyperlipidemics at lowering triglyceride levels and increasing HDL levels.
Niacin (Vitamin B3 )
Similar to bile acid sequestrants in its ability to lower LDL levels.
Niacin (Vitamin B3 )
These medicines work by blocking bile acid in your stomach from being absorbed in your blood. Your liver then needs the cholesterol from your blood to make more bile acid. This reduces your cholesterol level. This medicine also may help people with type 2 diabetes manage their blood sugar
Bile Acid Sequestrants
Adverse effect of Niacin (Vitamin B3 ):
flushing, which occurs shortly after the drug is taken and can be reduced by taking aspirin (30 minutes before) and increasing the niacin dosage very slowly over 3 to 4 weeks.
flushing, which occurs shortly after Niacin is taken, can be reduced by taking aspirin (___ minutes before) and increasing the niacin dosage very slowly over ___ weeks.
30
3 to 4
Client Teaching for Antihyperlipidemic Drugs
Teach client to take vitamins A, D, and K as supplements if antihyperlipidemic drugs are to be taken for long period of time.
Inform client that bile acid sequestrants are to be taken 3x a day before meals.
Instruct client that bile acid sequestrants come as a powder and should be added to a liquid either milk, juice or carbonated drinks or put into soups or cereals. Allowing the power to dissolve slowly without stirring.
Instruct patients to take any other medicine 1 hour before or 4 to 6 hours after taking antihyperlipidemics since these medicines are like glue and will delay the absorption of other drugs if taken at the same time.
Teach client to take vitamins ___, ___, and ___ as supplements if antihyperlipidemic drugs are to be taken for long period of time.
A, D, and K
Instruct client that bile acid sequestrants come as a powder and should be added to a liquid either milk, juice or carbonated drinks or put into soups or cereals. Allowing the power to dissolve slowly without stirring.
NA
Instruct patients to take any other medicine 1 hour before or 4 to 6 hours after taking antihyperlipidemics since these medicines are like glue and will delay the absorption of other drugs if taken at the same time.
NA
These bile acid sequestrants work to reduce serum cholesterol levels by forming an insoluble compounds with bile salts and increasing bile loss through the feces.
Cholestyramine (Questran)
Colestipol (Colestid)
