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Pharmacology Exam 1 > Lipid Lowering Agents > Flashcards

Lipid Lowering Agents Flashcards

1
Q

What is the suffix for Protein convertase Subtilisin/ Kexin type 9 (PcKS9) Inhibitor

A

“-Ocumab”

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2
Q

Why do we give Kexin type 9 Inhibitors

A

Hypercholesterolemia

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3
Q

How is Alirocumab Administered? And how often?

A

Via SUBQ injection every 2-3 weeks

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4
Q

How does Proprotein Convertase Subtilisin work on the body?

A

Lab made protein prevent PCSK9 enzymes from attaching to the LDL receptors on liver cells. This allows for the liver to metabolize more LDL’s which decreases circulating LDL levels

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5
Q

What are the adverse reactions of Evolocumab

A

Risk of infections
injection site reaction

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6
Q

What should a nurse assess before administering Alirocumab?

A

Skin assessment for injection site. Baseline labs and cholesterol and lipid levels

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7
Q

What implementations should a nurse do when administering Evolocumab

A

Comfort measures for the injection site. Safety measures to decrease infection risk i.e hand hygiene.

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8
Q

What is the Drug- Drug interaction with Alirocumab

A

No know reaction

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9
Q

There is a liver risk associated with Proprotein convertase subtilisin ? Kexin type 9 (PCSK9) inhibitors.
True or False

A

False

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10
Q

True or False
a patient that takes Alirocumab has a risk for flu like infection of the upper respiratory tract?

A

True

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11
Q

True or False
Evolocumab is often given in conjunction with a statin?

A

True

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12
Q

What is the suffix of Bile Acid Sequestrants?

A

“Chole” or “Cole”

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13
Q

Why is Bile Acid Sequestrants given to patients?

A

To treat Hypercholesterolemia
High LDL’s
High Cholesterol

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14
Q

How does Bile Acid Sequestrants work on the body?

A

binds to bile acid in the intestines, blocks reabsorption of the bile acid and excreted in feces. Liver will produce more bile acid and less LDL’s will circulate in blood.

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15
Q

What is Pruritus?

A

A condition that causes itching of skin and is associated with bile salts in the blood.

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16
Q

How does Cholestyramine help with Pruritus?

A

Reduces bile salt in blood.

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17
Q

Can Colestipol be taken by a pregnant person?

A

Yes, Bile Acid Sequestrants are considered the only “safe” lipid lowering agent for pregnancy.

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18
Q

What are some adverse reactions to Cholestyramine?

A

Nausea, constipation. Vitamin A.D.E & K deficiencies

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19
Q

How come Bile Acid Sequestrants may affect increased bleeding in a patient?

A

Due not low absorption of vitamin K which is important for blood clotting. Vitamin K is a fat soluble vitamin so need lipid to be absorbed in the body.

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20
Q

What should the nurse assess before prescribing Cholestyramine?

A

Patient should be assessed for impaired intestinal obstruction. If there is no bile in the intestines the drug cannot work.

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21
Q

What labs should be ordered before prescribing Bile Acid Sequestrants?

A

Cholesterol and Lipid levels in order to recheck for effectiveness of drug later on.

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22
Q

What is the nursing diagnosis for someone who is about to be prescribed Colesevelam?

A

Impaired comfort due to constipation, Injury risk related to potential bleeding is vitamin K deficiency occur.

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23
Q

What implementations should you expect to take with a patient taking Bile Acid Sequestrants?

A

Give drug before meal (AC) Give other oral medications one hour prior to or 6 hrs after administering Bile Acid Sequestrants.
Its in powder form so must be mixed with liquid. Pill form cannot be crushed.
Constipation bowel program.

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24
Q

What would be a contraindication to Cholestyramine?

A

Complete biliary obstruction because drug would be ineffective if there is no bile in the intestine

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25
Q

What is the caution r/t pregnancy with Bile Acid Sequestrants?

A

Medication could interfere with lipid soluble vitamin absorption which could affect the fetus.
Low vitamin K levels could cause more bleeding.

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26
Q

What is the suffix for HMG-COA Reductase inhibitors?

A

“Statin”

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27
Q

Why give statins?

A

To treat elevated cholesterol, LDL and Triglyceride levels

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28
Q

Can you give statin to a pregnant woman?

A

No, it is Category X

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29
Q

What is the most significant contraindication of Statins?

A

Liver disease due to the first pass effect which is tough on the liver.

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30
Q

What are some cautions with statins?

A

Renal impairment which will worsen if Rhabdomyolysis occur.
Impaired endocrine functions since Statins affect the formation of steroid hormones.

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31
Q

Which group would the possible Statin endocrine disruption affect the most?

A

Pre-teen and teens as it would affect the sex hormone’s.

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32
Q

What are some adverse reactions that may be seen in a patients GI system taking Pravastatin?

A

Flatulence and abdominal pain due to slowed digestion.

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33
Q

What are some adverse reactions that may be seen in a patients Liver due to taking Lovastatin?

A

Elevated liver enzymes & Acute liver failure due to being metabolized in the liver

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34
Q

What is Rhabdomyolysis?

A

a serious medical condition that occurs when muscle tissue breaks down and releases its contents into the bloodstream. This can lead to kidney damage, organ damage, and other serious complications.

35
Q

How does Rhabdomyolysis affect the liver?

A

Elevated liver enzymes

36
Q

Why may statins cause Rhabdomyolysis?

A

Statins can cause rhabdomyolysis by damaging skeletal muscles, which releases muscle components into the bloodstream.

37
Q

How may Rhabdomyolysis affect the kidneys?

A

Waste product from skeletal muscle breakdown may harm the glomerulus which may result in kidney failure.

38
Q

What are some known Drug-Drug interactions with Pravastatin?

A

Grapefruit Juice : Increases risk of toxicity due to altered metabolism of the drug.
St John’s Wort : Decreased Statin effect
Antibiotics, immunosuppressants : Can increase serum levels of statins which could increase Rhabdomyolysis.

39
Q

What should the nurse assess for in a patient that has been prescribed statins?

A

Impaired Endocrine function as this can worsen with statins.
Bowels sounds and elimination patterns related to adverse effects.
Renal and Hepatic functions.
Lipid levels
Possibly pregnancy test,

40
Q

What are some nursing implementations that are related to a patient who is taking statins?

A

Administer at bed time since the liver metabolizes lipids at nigh.
Monitor cholesterol, LDL and LPT levels before and during therapy.
Withhold medications if Rhabdomyolysis occur.
Barrier contraceptive

41
Q

What are some nursing diagnosis related to statins?

A

Impaired Liver and Renal Effects.
Impaired comfort due to myalgia (muscle pain)
Knowledge deficit.

42
Q

What is the first choice of drug when it comes to Lipid Lowering Agents

A

Statins, however NOT in pregnancy.

43
Q

What does Lipid lowering agents treat?

A

High Triglycerides
High Cholesterol
Hyperlipidema
Prevent Coronary Artery disease.

44
Q

What does S.T.A.T stand for

A

S- sore muscles
T- Toxic Liver
A- Avoid Grapefruit & St. Johns W
T- Take at night

45
Q

What are the modifiable risk factors for CAD (Coronary Artery disease)?

A

Cigarette Smoking
Sedentary Lifestyle
High Stress Levels
Hypertension
Obesity

46
Q

What are some Non-Modifiable risk factors of CAD (Coronary Artery Disease) ?

A

Genetics - onset before 55 y/o
Incidence - Increase with age
Males - More often than pre- menopausal women
Males and Post-menopausal women same risk

47
Q

What are LDL’s

A

Low-denisty Lipoproteins. Tighlty pacled cholesterol, triglycerides and lipids. Carried by protein to be broken down for energy or stored

48
Q

What are HDL’s

A

High - Density lipoproteins. Loosely packed lipids. Used for energy and to pick up leftovers from the LDL breakdown process (fat & Cholesterold)

49
Q

What is Cholesterol?

A

Essential for normal functioning, Steroid hormones (Sex & Adrenal cortical hormones) and cell membrane formation and functioning.

50
Q

What is the enzyme responsible for cholesterol synthesis?

A

HMG-COA reductase

51
Q

How is Cholesterol obtained.

A

through diet, but body may also synthesized if enough is not consumed. (liver and cells)

52
Q

What is the suffix of Cholesterol Absorption inhibitors?

A

Ezetimibe

53
Q

How does Ezetimibe work?

A

Works in the small intestine to decrease absorption of dietary cholesterol. less cholesterol circulated to the liver, so liver clears more LDL’s and Triglycerides.

54
Q

Why do we give patients Cholesterol Absorption Inhibitors?

A

Hypercholesterolemia

55
Q

What are some adverse reactions of Ezetimibe?

A

Abdominal pain and diarrhea, however no flatulence which is common in other lipid reducing agents.

56
Q

What are some adverse drug-drug interactions of Ezetimibe?

A

Cyclosporine may increase risk of Ezetimibe toxicity and risk of Rhabdomyolysis.

57
Q

What are some cautions related to Ezetimibe?

A

Liver disease due to risk of elevated liver enzymes, especially when taken with statin.

58
Q

What Assessment should be done prior to giving a patient Cholesterol Absorption Inhibitors

A

Bowel sound and elimination pattern, Liver function test ( ALT and AFT most important)

59
Q

What nursing diagnosis can you make with a patient taking Ezetimibe?

A

Impaired comfort r/t GI effect. Knowledge deficit.

60
Q

What nursing implementation can you make with a patient taking Ezetimibe?

A

Monitor Labs, comfort measures related to GI effect, small meals , non - spicy meals.

61
Q

Why would you expect a child to take lipid lowering agents?

A

Usually genetic - Familial Hypercholesterolemia.
Lifestyle changes always tried and encouraged before administering medications as lipids are essential for developing of the nervous system.

62
Q

What lipid lowering comes in pediatric doses?

A

Statins and Fibrates.

63
Q

What considerations should be taken when administering lipid lowering agents to adults?

A

Lifestyle changes should be tested first.
Statin first choice but not in pregnancy
Bile Acid Sequestrant MAY be used in pregnancy if benefits outweighs risk.

64
Q

What considerations should be taken when administering lipid lowering agents to older adults?

A

Lifestyle changes first.
Start Low go Slow
Statin should be tried first
Keep an eye on renal labs
Assess for muscle pain and Rhabdomyolysis.

65
Q

What are some other lipid lowering agents?

A

Fibrates - Have fibrate in the name
Vitamin B3 : Niacin (may cause skin flushing for 15 min)
Omega 3 fatty acid: Prescription hypertriglyceridemia

66
Q

What are Triglycerides?

A

Triglycerides are a type of fat, or lipid, that circulate in your blood and are the most common type of fat in the body. They are important for good health, but high levels can increase your risk of heart disease and stroke

67
Q

What activity increases HDL levels?

A

Excercise

68
Q

What hormone increases HDL levelers

A

Estrogen

69
Q

What are some causes for high LDL levels in the blood?

A

Excess dietary intake
Genetic alternations in fat metabolism
Hypercholesterolemia
Hypertriglyceridemia
Alterations in HDL and LDL concentrations

70
Q

Why would you do a baseline skin exam before administering Cholestyramine?

A

Cholestyramine is a Bile Acid Sequestrant which can impact vitamin absorption of fat soluble lipids. Bruising on the skin could indicate a vitamin K deficiency due to decrease in blood clotting.

71
Q

What form does Cholestyramine come in?

A

Cholestyramine is a powder so it must be mixed with liquids

72
Q

Which are the fat soluble vitamins?

A

A,D,E,K

73
Q

Which Lipid reducing agent has a strong first pass effect and therefore is extra strong on the liver?

A

Statins

74
Q

Which Lipid reducing agent cant impact the endocrine system?

A

Statins

75
Q

How come antibiotics, antifungal and immunosuppressants should not be combined with statins?

A

Because they can increase the serum level of the statin which could lead to Rhabdomyolysis.

76
Q

what does St Johns Wort do to statins?

A

St Johns Wort decreases the effect of statin.

77
Q

What Lipid Reducing agent should be taken at night?

A

Statins because the liver processes lipid at night time.

78
Q

Which lipid lowering agent has an adverse effect of causing flatulence?

A

Statins

79
Q

Which lipid lowering agent has an adverse effect of causing diarrhea?

A

Ezetimibe

Cholesterol reducing agent

80
Q

When reviewing the patient’s history, what is the most significant contraindication for therapy with lipid-lowering agents?

A

The majority of lipid lowering agents are potentially hepatotoxic, so the most significant contraindication is liver disease

81
Q

How is Alirocumab administered?

A

Via injection every 2-3 weeks. This is why we want to be aware of any injection site reaction.

PCSK9 inhibitor

82
Q

Why is liver disease not a concern when it comes to PCSK9 inhibitors?

A

Because these drugs are administered via infection so there is no first pass effect.

83
Q

Which lipid lowering agent may cause a increase in respiratory illnesses such as colds and the flu?

A

PCSK9 inhibitors. Reason not know however there’s a theory that PCSK9 can have a protective effect on immunity and by inhibiting these enzymes, it may increase the risk of getting a cold.

Pharmacology Exam 1 (9 decks)

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