Week 2 Hyperlipidemia

Question 1

Exogenous Cholesterol vs Endogenous Cholesterol

Answer 1

Exogenous

• 25%
• Dietary
• Not concern for overconsumption

Endogenous

• 75%
• Manufactured by liver cells (HMG-CoA reductase)
• Uses Saturated fat

Question 2

Should you do fasting blood glucose levels for serum labs?

Answer 2

Yes!

Question 3

Normal lab values for:

Cholesterol
HDL (women, men, optimal)
LDL
TG

Answer 3

Cholesterol — <100 mg/dL

HDL — optimal: >60 mg/dL
— women: >45 mg/dL
— men: >55 mg/dL

LDL — <100 mg/dL

TG — <150 mg/dL

Question 4

Ratio of LDL to HDL:

Women
Men

Answer 4

Women < 4.5

Men < 5.0

Question 5

Is familial hypercholesterolemia common?

What is it?

Answer 5

No

It is a defect in LDL receptors in liver cells so it doesn’t matter what they eat.

Liver cannot effectively remove LDL from blood stream

Question 6

Risk factors for Hyperlipidemia

Answer 6

Age
Family hx
Smoking
HTN
DM
Physical inactivity

Question 7

Atherosclerosis

Answer 7

Elevated LDL and cholesterol

Thickening/hardening of arterial walls (AKA arteriosclerosis)

Question 8

C-Reactive Protein

Answer 8

Inflammation marker

ELEVATED levels indicate ⬆️ risk of atherosclerosis

Question 9

Coronary Heart Disease/
Coronary Artery Disease/
Atherosclerotic Cardiovascular Disease

Answer 9

All mean the same thing

Insufficient delivery of O2 to the heart due to plaque build up

Question 10

Therapeutic lifestyle changes for Hyperlipidemia

Answer 10

Diet: heart healthy diet
—> ⬆️ salmon (omega 3 FAs)
—> DASH diet
—> ⬇️ red meats, whole milk products, fried foods

Weight control

Regular exercise

Stop smoking

Question 11

How do statins work in the body?

Answer 11

HMG-CoA ————> mevalonate ——> cholesterol LDL
HMG-CoA
Reductase

• Happening in the LIVER
• HMG-CoA inhibitor (statins) will prevent cholesterol & LDL
  production thus LOWERING LDL levels in the body and can
  ⬆️ HDL production minimally, & ⬇️ TG
• DOES NOT AFFECT FAMILIAL HYPERCHOLESTEROLEMIA

Question 12

HMG-CoA reductase inhibitors (STATINS)

Answer 12

atorvaSTATIN, simvaSTATIN, rosuvaSTATIN

MOA:

• Inhibits HMG-CoA reductase
• Less cholesterol produced by liver
• Liver makes more LDL receptors
• More LDL is removed from the blood

Indications:
- Hyperlipidemia

Adverse reactions:

• Avoid drugs that increase risk of rhabdo & myopathy
• Acute kidney disease
• Hepatotoxicity

Nursing considerations:

• NOT permanent drop, keep taking drug
• Takes 2 weeks to see effect
• W/ food for GI discomfort
• QHS (S and R)
• 🚫 Grapefruit juice
• 🚫 PREGNANT

Question 13

S.T.A.T.I.N

Answer 13

S - Sore muscles? ⬆️ creatine kinase -> rhabdo
T - Toxicity w/ grapefruit consumption
A - ALT/AST monitored
T - Therapeutic effects: ⬇️ LDL, ⬆️ HDL
I - Increase glucose in pt @ risk T2DM 
N - Not a cure!

Question 14

What color can urine be with rhabdomyolysis?

Answer 14

Brown

Question 15

Cholesterol Absorption Inhibitor

Answer 15

ezetiMIBE

MOA:

• Blocks absorption of cholesterol in jejunum
• Dietary
• Cholesterol secreted in bile

Indications:

• Hyperlipidemia
• Combo w/ statin (Vytorin) -> greater ⬇️ in LDL
• 2nd line therapy to STATINS

Adverse reactions:

• Rhabdo
• Myopathy
• Angioedema

Nursing considerations:

• Prior to therapy:
  
  • > Fasting lipid panel
  • > ALT (liver)
  • > CK (creatine kinase – rhabdo)
  • > Consider secondary causes

Question 16

Secondary causes of Hyperlipidemia

Answer 16

Diet: saturated or trans fats, weight gain, anorexia, very low
fat diet, excessive alcohol intake

Drugs: diuretics, beta blockers (not carvedilol), thiazides

Diseases: biliary obstruction, nephrotic syndrome, chronic
renal failure

Disorders: obesity, pregnancy, poorly controlled FM

Question 17

Other meds to treat HLD

Answer 17

Fish oil
Niacin
Fibrates
Bile acid sequestrants