Lipid Lowering Agents Flashcards
Modifiable Risk Factors of Coronary Artery Disease
- Cigarette Smoking
- Sedentary Lifestyle
- High Stress levels
- Hypertension
- Obesity
- Diabetes
Non-Modifiable Risk Factors of CAD
- Family History (onset under age of 55)
- Age
- Sex at birth (males >pre-menopausal women)
What are low-density lipoproteins?
*Tightly packed cholesterol, triglycerides, and lipids
* Carried by proteins with the purpose to be broken down for energy or stored for future energy
What are High-Density Lipoproteins?
- Loosely packed lipids
- Used for energy and to pick up leftovers of the LDL breakdown process (fats and cholesterol) to be excreted from the body
What is cholesterol?
*Necessary for normal function –> steroid hormones and cell membrane formation and maintenance
* Obtained through diet and through fat metabolism
* Body can make cholesterol if we don’t eat enough through diet
What is the enzyme responsible for cholesterol synthesis?
HMG-CoA reductase
What is Coronary Artery Disease?
Plaque build up in the arteries
What is Hyperlipidemia?
Increased levels of lipids in the blood
What are causes of lipidemia?
- Excess dietary intake
- Genetic alterations in fat metabolism
- Hypercholesterolemia
- Hypertriglyceridemia
- Alterations in HDL and LDL concetrations
What are the reasons for drug therapy in hyperlipidemia?
Genetic factors
Patients unwilling or unable to make lifestyle changes
Lipid Lowering Agents
in Children
- Genetic causes
- Dietary measures first
- Fibrates and Statins
Lipid Lowering Agents
in Adults
- Lifestyle changes first
- First choice: Statins
*Category X: Not to be used in pregnancy or women of child bearing age (without contraception)
First choice for pregnancy: Bile Acid Sequestrants
Lipid Lowering Agents
in Older Adults
- Lifestyle changes first
- Lower dose statins
- Higher risk of adverse effects => monitor renal and hepatic labs; monitor for muscle pain => rhabdomyolysis
Bile Acid Sequestrants
Mechanism of Action
Binds bile acids in the intestine; allows for excretion in feces instead of reabsorption
Bile Acid Sequestrants
Indications
- Hypercholesterolemia (high cholesterol or high LDLs)
- Pruritis associated with partial biliary obstruction
Bile Acid Sequestrants
Drug names
“Chole-“ or “Cole-“
Cholestyramine
Colestipol
Colesevelam
Bile Acid Sequestrants
Contraindications
Absolute: Allergy
Relative: complete biliary obstruction; abnormal intestinal function
Caution: pregnancy - because of Vitamin decrease
Bile Acid Sequestrants
Adverse Effects
- Direct GI irritation: Nausea, constipation
- Vitamin A, D, E, K deficiencies
- Increased Bleeding times due to Vit. K def.
Bile Acid Sequestrants
Drug Interactions
- Malabsorption of fat-soluble vitamins
- Affects absorption of other oral drugs
- Do not take at same time as other drugs or food
Bile Acid Sequestrants
Assessment
- History: Allergy, pregnancy, lactation, impaired intestinal function/obstruction
- Physical: Skin - looking for bruising with Vit. K def, GI system
- Labs: Cholesterol and lipid levels
Bile Acid Sequestrants
Nursing Conclusions
- Impaired comfort (adverse effects)
- Constipation
- Injury Risk (Vit. K def)
- Knowledge Deficit
Bile Acid Sequestrants
Interventions/Patient Teaching
- Powdered drugs must be mixed in liquid
- Tablets cannot be cut, chewed, or crushed
- Take before meals
- Administer other drugs 1 hour before or 4-6 hours after
- Arrange for a bowel program as appropriate
- Comfort and Safety measures
- Provide thorough PT
HMG-CoA Reductase Inhibitors
(Statins)
Mechanism of Action
- HMG-CoA Reductase is needed to synthesize cholesterol in the liver
- this drug blocks that enzyme, serum cholesterol and LDLs decrease since liver cannot produce it
- HDL levels increase
**Most effective for people who ALREADY have CAD
HMG-CoA Reductase Inhibitors (Statin)
Indications
- elevated cholesterol
- elevated triglycerides
- elevated LDLs
HMG-CoA Reductase Inhibitors
Drug Names
“-statin”
* Atorvastatin
* Lovastatin
* Pravastatin
* Rosuvastatin
* Simvastatin
HMG-CoA Reductase Inhibitors
Contraindications
Absolute: Allergy
Relative: Liver Disease (significant first pass effect)
Cautions:
* Renal impairment, (can be worsened if rhabdomyolysis occurs)
* impaired endocrine function
HMG-CoA Reductase Inhibitors (Statins)
Adverse Effects
GI system: Nausea, constipation, flatulence, abdominal pain
Liver: Elevated liver enzymes and acute liver failure
Muscle soreness, cramps, aches => Rhabdomyolysis: breakdown of muscles which releases waste products that can injure the glomerulus and result in acute renal failure
HMG-CoA Reductase Inhibitors (Statins)
Drug Interactions
Drug: Antibiotics, antifungals, immunosuppressants => may increase drug levels of the statin => increased adverse effects
Food: Grapefruit Juice => increased risk of toxicity (affects excretion)
Supplement: St. John’s Wort => decreases statin effectiveness
HMG-CoA Reductase Inhibitors (Statins)
Assessment
History:
Allergy, pregnancy, lactation, liver disease, impaired endocrine function, renal impairment
Physical:
Abdomen - r/t GI effects
Labs:
Hepatic and Renal function tests
Lipid Levels
Possible pregnancy test
HMG-CoA Reductase Inhibitors (Statins)
Nursing Conclusions
- Injury risk r/t liver and renal effects
- Impaired comfort r/t myalgia, GI effects
- Knowledge Deficit r/t drug therapy
HMG-CoA Reductase Inhibitors (Statins)
Implementation/Interventions/Patient Teaching
- Take at Bedtime
- Monitor serum cholesterol, LDLs, LFTs
- Lifestyle modifications - diet and exercise
- Withhold in any serious medical condition
- Use of barrier contraception
- Comfort measures: small, frequent meals, take with a small meal
- Provide PT
- Takes 1-2 weeks to reach effective levels
Memory Technique
STAT
Sore Muscles
Toxic to Liver (ALT/AST)
Avoid Grapefruit Juice and St. John’s Wort
Take at night
Cholesterol Absorption Inhibitor
Mechanism of Action
- Works in small intestine
- Decreases absorption of cholesterol
Less cholesterol => liver - Liver is able to clear more cholesterol from the blood, less circulating cholesterol
- Decreases total cholesterol, LDL, and triglycerides
Cholesterol Absorption Inhibitor
Indication
Hypercholesterolemia
Cholesterol Absorption Inhibitor
Drug Names
ONE DRUG
ezetimibe
Cholesterol Absorption Inhibitor
Contraindications
Absolute: Allergy
Caution: Liver Disease
Cholesterol Absorption Inhibitor
Adverse Effects
GI: Abdominal pain and diarrhea
Cholesterol Absorption Inhibitor
Drug Interactions
Drug: Cyclosporine (Increased risk of ezetimibe toxicity)
Cholesterol Absorption Inhibitor
Assessment
History:
Allergy, pregnancy, lactation, liver disease
Physical:
Abdomen - BS & elimination patterns
Labs:
Cholesterol, lipids, ALT/AST
Cholesterol Absorption Inhibitor
Nursing Conclusions
Impaired Comfort
Knowledge Deficit
Cholesterol Absorption Inhibitor
Interventions/Patient Teaching
- Monitor labs before and during therapy
- Lifestyle Changes
- Comfort and Safety measures
- Provide PT
Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitors
Mechanism of Action
- Monoclonal antibodies that prevent PCSK9 enzymes from attaching to the LDL receptors on the liver cells
- This allows for LDLs to attach to those liver cells and be metabolized and then excreted from the body
- Decreases LDL levels and total cholesterol
Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitors
Indications
- hypercholesterolemia
- Used with a statin drug or alone if statins cannot be taken.
Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitors
Drug Names
“-ocumab”
- Alirocumab
- Evolocumab
**Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitors **
Contraindications
Absolute: Allergy
Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitors
Adverse Effects
- Risk of infection (respiratory infections)
- Injection Site Reactions
Not taken orally…. so NO first-pass effect
NO liver toxicity
**Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitors **
Drug Interactions
NONE/Unknown
Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitors
Assessment
History:
* Allergy, pregnancy, lactation
Physical:
* Skin at intended injection site
* Vital Signs and lung sounds
Labs:
* Cholesterol, lipids
Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitors
Nursing Conclusions
- Impaired comfort
- Infection risk
- Impaired skin integrity
- Knowledge deficit
Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitors
Interventions/Patient Teaching
- Monitor labs periodically
- Encourage lifestyle changes
- Provide comfort and safety measures r/t injection site and infection risk
- Provide thorough PT
What are the indications and drug names for fibrates?
- Hypercholesterolemia
- Lowers triglycerides and LDL
- Increases HDL
Drug Names: - fenofibrate
- gemfibrozil
- fenofibric acid
What are the indications and side effect for Vitamin B3?
AKA: Niacin
* Hypercholesterolemia
* Lowers triglycerides and LDL
* Increases HDL
Could cause skin flushing - usually goes away after a few minutes
What are the indications and drug names for Omega 3 Fatty Acids (prescription strength)?
- Hypertriglyceridemia
- Lowers triglycerides
Drug names: - Omega-3-acid ethyl esters
- Omega-3-carboxylic acids
