Week 11 Lipid Lowering Flashcards
What are used to treat hyperlipidemia
lipid lowering drugs
Bile acids are released where?
they are released by the gallbladder
Therapeutic Action: CHOLESTYRAMINE
- Bind with bile salts in the intestine to form an insoluble complex that is excreted in the feces
- results w/ the liver using excess cholesterol to make more bile acid, which lowers serum cholesterol level
Indications: CHOLESTYRAMINE
- reduce serum cholesterol in pts w/ primary hypercholesterolemia as an adjunct to lifestyle changes
- Treat pruritus w/ partial biliary obstruction
pharmacokinetics: CHOLESTYRAMINE
- not absorbed systemically
- action is limited to their effect while they are present in the intestine
- excreted directly in the feces
- NO METABOLISM
contraindications: CHOLESTYRAMINE
- Allergy
- complete biliary obstruction
- abnormal intestinal function
adverse effects: CHOLESTYRAMINE
- GI irritation; n/v/constipation
- increased bleeding times r/t decreased absorption of Vit K
- vit A & D deficiencies
- muscle & joint pain
Drug-drug interaction: CHOLESTYRAMINE
- interact with thiazide diuretics, digoxin, warfarin, thyroid hormones, and corticosteroids
nursing considerations: CHOLESTYRAMINE
- GI assessment before & after given medication
- consider giving w/ meals
- do not give powered agents dry> always mix w/ water
- Labs; cholesterol
- do not crush or chew, swallow whole
- bowel program if needs, assess bowel patterns
- pt edu/ support
Therapeutic action: ATORVASTATIN
Blocks HMG-CoA reductase from completing the synthesis of cholesterol
indication: ATORVASTATIN
- treatment of increased cholesterol, triglyceride, LDL levels that are unresponsive to dietary restrictions
- prevention of CAD in adults
Pharmacokinetics: ATORVASTATIN
- Absorbed in GI tract
- metabolized in liver
- excreted in feces & urine
- most effective when taken at night
contraindications: ATORVASTATIN
Allergy
- pts w/ acute liver disease or hx of alcoholic liver disease
- pregnancy or lactation (cat X med)
Adverse effects: ATORVASTATIN
GI affects; n/v, cramps, constipation, gas
- CNS effects; dizzy, headache, blurry vision, fatigue
- possibility of rhabdomylosis
Drug-drug interactions: ATORVASTATIN
DO NOT TAKE w/ digoxin, oral contraceptives, niacin, warfarin, or grapefruit juice
Nursing consideration: ATORVASTATIN
- Liver function labs> contraindicated w/ liver failure
- take med at HS
- ask if pt could be pregnant or if they are taking oral contraceptives
- atttempt lifestyle changes first
- check cholesterol levels
- assess bowel elimination patterns
HMG-CoA Reductase Inhibitor prototype drug
Atorvastatin
Bile Salt Aequestraint prototype drug
Cholestyramine
Another name for vitamin B
Niacin
Therapeutic action: Vit B
- Inhibits the release of free fatty acids from adipose tissues
- increases the rate of triglycerid removal from plasma
- reduces LDL and triglyceride levels, increases HDL levels
Pharmacokinetics: Vit B
- initial effect 5-7 days, max effect 3-5wks
Adverse effects: Vit B
Associated w/ intense cutaneous flushing, nausea, and abdominal pain
Drug-drug interaction: Vit B
- Often combined w/ bile acid sequestrants for increased effects> give 4-6hrs after to ensure absorption
nursing considerations: Vit B
- Give at HS
- make sure to space other meds out!
Adverse effects: Omega 3 Fatty Acids
- n/d, abdominal pain
- May prolong bleeding time
Contradictions: Omega 3 Acid Ethyl Ester
not recommended in pregnancy/ lactation
Contradictions: Omega 3 Carboxylic Acid
caution in pts with allergy to fish or shellfish
Therapeutic Action: Omega-3-Acid ethyl esters
inhibits liver enzyme system to decrease the synthesis of triglycerides
Nursing Considerations for Omega 3 Fatty Acids
- check s/s of bleeding
- combine w/ appropriate diet and exercise
- swallow whole
Children considerations
- Familial hypercholesterolemia may be seen in children
- Lipids play an important role in developing the nervous system, so treatment is usually limited to tight dietary restrictions
- Atorvastatin can be used in postmenarchal girls and boys 10-17 y.o.; monitor closely
Adult considerations
- Lifestyle changes should be tried before initiating any antihyperlipidemic drugs
- HMG-CoA reductase inhibitors (statins) are the first drug of choice
- Bile acid sequestrants are the drug of choice for women of childbearing age
Older adult considerations
- Lifestyle changes should be tried before initiating any antihyperlipidemic drugs
- Lower doses of HMG-CoA reductase inhibitors (statins) should be used in elderly patients
