Lipid Regulating Flashcards
What is the medical name for high cholesterol?
Hypercholesterolaemia
What is a commonly associated risk of Hypercholesterolaemia?
Atherosclerosis
What does a lipid profile test?
Total cholesterol
LDL level
HDL level
Triglycerides
What conditions can triglyceride levels be used to predict?
coronary problems
What is healthy range on a lipid profile for general population?
Total Cholesterol - <5.5mmol/L
LDL level - <2.0 mmol/L
HDL - >1.0mmol/L
Triglycerides - <2.0mmol/L
What is HMG-CoA?
3-hydroxy-3-methylglutaryl coenzyme A
How does HMG-CoA reductase inhibitors work
HMG-CoA Reductase inhibitors prevent 3-hydroxy-3-methylglutaryl coenzyme-A from becoming mevalonate which is a precursor to cholesterol
What suffix is a HMG-CoA reductase inhibitor?
Statins
What are 3 common HMG-CoA Reductase inhibitors?
Simvastatin, Atorvastatin and Fluvastatin
What are some general uses of Statins ?
Hypercholesterolaemia, Mixed hyperlipidaemia, Prevention of cardiovascular disease in people with two or more risk factors
What are some General Adverse reactions of Statins
Constipation, abdo pain, nausea, diarrhoea, rash, pruritus, back pain, myalgia, arthralgia, elevated liver enzymes and creatine kinase, (rare) myopathy and Rhabdomyolysis
General Nursing Points for Statins
lipid levels should be tested 4 weeks after commencing statin, liver function test should be completed prior to, 6 weeks and 12 weeks after commencing statin, creatine kinase levels to be monitored in pt with Hx of hypothyroidism hereditary muscle disorders previous muscle toxicity alcohol abuse or >70 as there is > risk of myopathy or rhabdomyolysis, therapeutic response expected in 2 weeks with max effect at 4 weeks, Statins with short half-life (simvastatin, fluvastatin and pravastatin) should be taken nocte as peak cholesterol synthesis is between midnight and 2am, Statins should be withheld in pt with increased risk of rhabdomyolysis such as trauma, severe infection, hypotension, major surgery and uncontrolled epilepsy.
General Pt Teaching for Statins
Pt to seek medical attention if following symptoms begin; muscle pain, cramps, tenderness and or weakness (not related to exercise), Malaise, dark urine or fever, non-productive cough, difficulty breathing, fatigue and weight loss, itching, yellowing of skin or eyes, loss of appetite.
Advise Pt to take 1 hour prior to or 4-6 hours post cholestyramine
Pt should be advised against drinking high levels of alcohol as they are at increased risk of liver damage.
What form does Atorvastatin come in, what doses and initial starting dose
Tablets
10mg,20mg,40mg,80mg
initial starting dose of 10mg PO daily
What are some interactions of Atorvastatin
-serum levels of atorvastatin may increase if taken with; HIV protase inhibitors, clarithromycin (antibiotic), itraconazole (antifungal), diltiazem (treat gout), boceprevir (treat hepatitis) and grape fruit juice
-Increased risk of myopathy if given with colchicine (treat gout)
-may affect the efficacy of contraceptives containing norethiseterone and ethinylestradiol
- Serum levels of atorvastatin may decrease if given with antacids
- Caution if given with digoxin, Serum levels of Digoxin to be monitored
What are some adverse effects of Atorvastatin
Nasopharyngitis, Muscle spasm and Joint swelling, (Rare) Haemorrhagic Stroke
Nursing Points for Atorvastatin
Ensure Pt Hx has been taken regarding previous TIA’s within last 6 months, as Atorvastatin increases risk of haemorrhagic stroke
Pt teaching of Atorvastatin
avoid grape fruit juice
instruct pt to take 2 hours apart from antacids
What form does Simvastatin come in, what doses and what initial starting dose for lipid lowering, HeFH and coronary heart disease
Tablets
5mg,10mg,20mg,40mg,80mg
initial starting dose for;
lipid lowering - 10mg-20mg Daily Nocte (max daily dose 80mg)
HeFH - initialy 10mg Nocte (max 40mg daily)
Coronary Heart disease - 40mg - 80mg Daily Nocte
What is another use for Simvastatin along with general statin uses
Heterozygous Familial Hypercholesterolaemia
Adverse reactions of Simvastatin
Transient hypotension, (Rare) peripheral neuropathy, paraesthesia (pins and needles sensation)
What are some drug interactions with Simvastatin
- Contraindicated with gemfibrozil (fibrate), ciclosporin (immunosuppressant for RA and psoriasis), danazol (endometriosis), clarithromycin and erythromycin (antibiotics), HIV protase inhibitors and Azole antifungals
- Caution if used with warfarin, INR to be closely monitored
- Not recommended with grapefruit juice
- caution if given with digoxin, monitor serum digoxin levels
- Increased risk of rhabdomyolysis if given with amiodarone (antiarrhythmic) and following calcium channel blockers verapamil, diltiazem, amlodipine (or niacin)
- Caution if given with colchicine (gout) in pt with renal insufficiency
Pt teaching for simvastatin
avoid grapefruit juice
report numbness or tingling in hands and feet
nursing points for Simvastatin
Risk of myopathy increases with increased dose (80mg dose should only be given to pt with high risk of cardiovascular complications and benefits outweigh risk) or people who have not achieved treatment goals
