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Pharmacology > Lipid Lowering Agents > Flashcards

Lipid Lowering Agents Flashcards

1
Q

Modifiable Risk Factors of Coronary Artery Disease

A
  • Cigarette Smoking
  • Sedentary Lifestyle
  • High Stress levels
  • Hypertension
  • Obesity
  • Diabetes
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2
Q

Non-Modifiable Risk Factors of CAD

A
  • Family History (onset under age of 55)
  • Age
  • Sex at birth (males >pre-menopausal women)
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3
Q

What are low-density lipoproteins?

A

*Tightly packed cholesterol, triglycerides, and lipids
* Carried by proteins with the purpose to be broken down for energy or stored for future energy

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4
Q

What are High-Density Lipoproteins?

A
  • 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
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5
Q

What is cholesterol?

A

*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

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6
Q

What is the enzyme responsible for cholesterol synthesis?

A

HMG-CoA reductase

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7
Q

What is Coronary Artery Disease?

A

Plaque build up in the arteries

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8
Q

What is Hyperlipidemia?

A

Increased levels of lipids in the blood

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9
Q

What are causes of lipidemia?

A
  • Excess dietary intake
  • Genetic alterations in fat metabolism
  • Hypercholesterolemia
  • Hypertriglyceridemia
  • Alterations in HDL and LDL concetrations
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10
Q

What are the reasons for drug therapy in hyperlipidemia?

A

Genetic factors

Patients unwilling or unable to make lifestyle changes

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11
Q

Lipid Lowering Agents
in Children

A
  • Genetic causes
  • Dietary measures first
  • Fibrates and Statins
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12
Q

Lipid Lowering Agents
in Adults

A
  • 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

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13
Q

Lipid Lowering Agents
in Older Adults

A
  • Lifestyle changes first
  • Lower dose statins
  • Higher risk of adverse effects => monitor renal and hepatic labs; monitor for muscle pain => rhabdomyolysis
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14
Q

Bile Acid Sequestrants
Mechanism of Action

A

Binds bile acids in the intestine; allows for excretion in feces instead of reabsorption

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15
Q

Bile Acid Sequestrants
Indications

A
  • Hypercholesterolemia (high cholesterol or high LDLs)
  • Pruritis associated with partial biliary obstruction
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16
Q

Bile Acid Sequestrants
Drug names

A

“Chole-“ or “Cole-“
Cholestyramine
Colestipol
Colesevelam

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17
Q

Bile Acid Sequestrants
Contraindications

A

Absolute: Allergy

Relative: complete biliary obstruction; abnormal intestinal function

Caution: pregnancy - because of Vitamin decrease

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18
Q

Bile Acid Sequestrants
Adverse Effects

A
  • Direct GI irritation: Nausea, constipation
  • Vitamin A, D, E, K deficiencies
  • Increased Bleeding times due to Vit. K def.
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19
Q

Bile Acid Sequestrants
Drug Interactions

A
  • Malabsorption of fat-soluble vitamins
  • Affects absorption of other oral drugs
  • Do not take at same time as other drugs or food
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20
Q

Bile Acid Sequestrants
Assessment

A
  • History: Allergy, pregnancy, lactation, impaired intestinal function/obstruction
  • Physical: Skin - looking for bruising with Vit. K def, GI system
  • Labs: Cholesterol and lipid levels
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21
Q

Bile Acid Sequestrants
Nursing Conclusions

A
  • Impaired comfort (adverse effects)
  • Constipation
  • Injury Risk (Vit. K def)
  • Knowledge Deficit
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22
Q

Bile Acid Sequestrants
Interventions/Patient Teaching

A
  • 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
23
Q

HMG-CoA Reductase Inhibitors
(Statins)
Mechanism of Action

A
  • 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
24
Q

HMG-CoA Reductase Inhibitors (Statin)
Indications

A
  • elevated cholesterol
  • elevated triglycerides
  • elevated LDLs
25
Q

HMG-CoA Reductase Inhibitors
Drug Names

A

“-statin”
* Atorvastatin
* Lovastatin
* Pravastatin
* Rosuvastatin
* Simvastatin

26
Q

HMG-CoA Reductase Inhibitors
Contraindications

A

Absolute: Allergy
Relative: Liver Disease (significant first pass effect)
Cautions:
* Renal impairment, (can be worsened if rhabdomyolysis occurs)
* impaired endocrine function

27
Q

HMG-CoA Reductase Inhibitors (Statins)
Adverse Effects

A

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

28
Q

HMG-CoA Reductase Inhibitors (Statins)
Drug Interactions

A

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

29
Q

HMG-CoA Reductase Inhibitors (Statins)
Assessment

A

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

30
Q

HMG-CoA Reductase Inhibitors (Statins)
Nursing Conclusions

A
  • Injury risk r/t liver and renal effects
  • Impaired comfort r/t myalgia, GI effects
  • Knowledge Deficit r/t drug therapy
31
Q

HMG-CoA Reductase Inhibitors (Statins)
Implementation/Interventions/Patient Teaching

A
  • 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
32
Q

Memory Technique
STAT

A

Sore Muscles
Toxic to Liver (ALT/AST)
Avoid Grapefruit Juice and St. John’s Wort
Take at night

33
Q

Cholesterol Absorption Inhibitor
Mechanism of Action

A
  • 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
34
Q

Cholesterol Absorption Inhibitor
Indication

A

Hypercholesterolemia

35
Q

Cholesterol Absorption Inhibitor
Drug Names

A

ONE DRUG
ezetimibe

36
Q

Cholesterol Absorption Inhibitor
Contraindications

A

Absolute: Allergy

Caution: Liver Disease

37
Q

Cholesterol Absorption Inhibitor
Adverse Effects

A

GI: Abdominal pain and diarrhea

38
Q

Cholesterol Absorption Inhibitor
Drug Interactions

A

Drug: Cyclosporine (Increased risk of ezetimibe toxicity)

39
Q

Cholesterol Absorption Inhibitor
Assessment

A

History:
Allergy, pregnancy, lactation, liver disease
Physical:
Abdomen - BS & elimination patterns
Labs:
Cholesterol, lipids, ALT/AST

40
Q

Cholesterol Absorption Inhibitor
Nursing Conclusions

A

Impaired Comfort

Knowledge Deficit

41
Q

Cholesterol Absorption Inhibitor
Interventions/Patient Teaching

A
  • Monitor labs before and during therapy
  • Lifestyle Changes
  • Comfort and Safety measures
  • Provide PT
42
Q

Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitors
Mechanism of Action

A
  • 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
43
Q

Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitors
Indications

A
  • hypercholesterolemia
  • Used with a statin drug or alone if statins cannot be taken.
44
Q

Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitors
Drug Names

A

“-ocumab”

  • Alirocumab
  • Evolocumab
45
Q

**Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitors **
Contraindications

A

Absolute: Allergy

46
Q

Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitors
Adverse Effects

A
  • Risk of infection (respiratory infections)
  • Injection Site Reactions

Not taken orally…. so NO first-pass effect
NO liver toxicity

47
Q

**Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitors **
Drug Interactions

A

NONE/Unknown

48
Q

Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitors
Assessment

A

History:
* Allergy, pregnancy, lactation

Physical:
* Skin at intended injection site
* Vital Signs and lung sounds

Labs:
* Cholesterol, lipids

49
Q

Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitors
Nursing Conclusions

A
  • Impaired comfort
  • Infection risk
  • Impaired skin integrity
  • Knowledge deficit
50
Q

Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitors
Interventions/Patient Teaching

A
  • Monitor labs periodically
  • Encourage lifestyle changes
  • Provide comfort and safety measures r/t injection site and infection risk
  • Provide thorough PT
51
Q

What are the indications and drug names for fibrates?

A
  • Hypercholesterolemia
  • Lowers triglycerides and LDL
  • Increases HDL
    Drug Names:
  • fenofibrate
  • gemfibrozil
  • fenofibric acid
51
Q

What are the indications and side effect for Vitamin B3?

A

AKA: Niacin
* Hypercholesterolemia
* Lowers triglycerides and LDL
* Increases HDL

Could cause skin flushing - usually goes away after a few minutes

52
Q

What are the indications and drug names for Omega 3 Fatty Acids (prescription strength)?

A
  • Hypertriglyceridemia
  • Lowers triglycerides
    Drug names:
  • Omega-3-acid ethyl esters
  • Omega-3-carboxylic acids

Pharmacology (10 decks)

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