Week 7- Lipids/ Angina Flashcards
HMG CoA Reductase Inhibitors
“Statins”
- Atorvastatin
- Pravastatin
Atorvastatin, Pravastatin
HMG CoA Reductase Inhibitor
Used to treat:
-LDL Levels (1st line therapy, most potent reducer), post MI, post stroke (lowers CRP)
MOA:
-inhibit HMG CoA Reductase in hepatocytes (rate-limiting step in production of cholesterol) –> increase in LDL receptors on liver –> more LDL rceptors= more LDL taken out of blood
(Summary: stops cholesterol production in liver)
Adverse effects:
- FDA warning: myopathy –> rhabdomyolysis
- Hepatoxicity (check baseline LFTs)
CI:
-avoid in pregnancy and lactation (category X)
Drug Drug:
-they go through CYP3A4 metabolism so grapefruit juice will increase statin concentration (risk for rhabdomyolysis)
(pravastatin is ok with grapefruit)
Nursing considerations:
- educate about muscle pain : do not take with grapefruit juice. measure creatine kinase (CK) levels
- report s/s of heptatoxicity (monitor LFT periodically)
- generally take at night (because body makes choleseterol at night)
Bile Acid Sequestrants
Cholestyramine + Colesevelam
Cholestyramine + Colesevelam
Bile Acid Sequestrants
Used to treat:
- high cholesterol (add on for LDL reduction)
- cholestyramine powder can be used off label to treat diarrhea (binds everything)
MOA:
-insoluble polymers that bind bile acids in the gut
Summary: drug binds up bile acid. our body senses low bile acid, so it tries to make bile acid. our body breaks down cholesterol to make more bile acid. End result= less cholesterol
Adverse effects:
- constipation (increase fiber and fluid intake)
- heartburn, nausea, belching, bloating (disappear over time)
- decreased absorption of fat soluble vitamins (ADEK) (because we are reducing bodies bile acids)
Drug Drug interactions:
- based on timing of admin: take 1 hour before or 4 hours after use
- Digoxin- 1 hour before you take cholestyramine
Niacin/ Nicotinic Acid/ Vitamin B3
Used to treat:
-Cholesterol: increases HDL, lowers LDL and TG
Adverse effects:
- elevated liver enzymes (extended release products)- monitor AST/ALT (hepatotoxic)
- pruitus
- Flushing (common) Red face - NSAIDs/ ASA can be taken 30 minutes prior, gradually taper up doses
- increases in uric acid levels (hyperuricemia)
- increase in blood glucose (hyperglycemia)
CI:
-peptic ulcer diease, hepatic, gout
Nursing considerations:
- if patient develops flushing can give NSAID/ASA prior to dose (taper dosing regimen up)
- keep in mind increased uric acid and gluocse
Fibrates
Gemofibrozil + Fenofibrate
Gemfibrozil + Fenofibrate
Fibrates
Used to treat:
-elevated TGs. can also help increase HDL
MOA:
-bind to PPARa, causing many changes in liver and muscle cells
end result= decreased TG (and minimal HDL improvement)
Adverse effects:
- headache, GI issues( (N/V)
- blurred vision
- Myopathy (rarely)- Rhamdomyolysis [don’t give with other cholestrol meds with this risk, can check CK levels)
- increased risk for gall stones
- Hepatotoxicity (elevated liver enzymes)
CI:
-liver disease, gallbladder disease
Drug-Drug:
- other cholesterol meds (avoid statins- rhabdomyolysis risk)
- Warfarin (increased bleed risk)
Nursing considerations:
- intended outcome: cholesterol reduction
- unintended outcome: myopathy, hepatotoxicty, gallstones
Garlic
Herbals
Used to treat:
-High cholesterol
MOA:
- lowers LDL and TG and raises HDL
- suppresses platelet aggregation
- may lower BP
AE:
- GI upset
- Bleeding risk
Nursing considerations:
- can increase risk of bleeding when on NSAIDs, anticoagulants
- when on warfarin, avoid herbals that start with “F or G”
Fish Oil / Lovaza
Herbal
Used to treat:
-high cholesterol
MOA:
- lowers LDL, TG and raises HDL
- suppresses platelet aggregation
- may lower BP
AE:
-GI upset/ nasuea/ belching
Nursing considerations:
- can increase the risk of bleeding when on NSAIDs, anticoagulants
- when on Wardarin, avoid herbals that start with “F or G”
Nitrates/ Nitrities
Nitroglycerin, Isosorbide
Nitroglycerin
Nitrates/ Nitrites
Used to treat:
-acute (SL tablets, IV drip, ointment, spray) and chronic angina (patch)
AE:
- headache
- hypotension (can lead to reflex tachycardia)
- Tolerance w/ chronic therapy
Drug-drug interactions
-PDE5 inhibitors ex. sildenafil (viagra), tadalafil (cialis) - sudden death, MI, extreme hypotension- both drugs would synergistically to drop BP
CI:
-severe head trauma- can increase intracranial pressure (rx causes headache from dilation of arteries in brain –> trauma will cause bleeding from the dilation)
Nursing considerations:
-SL tablets/ spray: keep tablets in dark/amber vial
-patches: remove the patch at night to reduce the risk of developing tolerance to nitroglycerin. Be medication-free 10 to 14 hr/ day.
-IV nitroglycerin (emergences)
Never stop IV nitroglycerin abruptly (wean off)- rebound hypertension/ ischemia can occur
When giving a dose, check blood pressure before administration! (SBP<90)
General reminder: educate patients to change positions slowly with all nitroglycerins
Nitroglycerin Patch Admin
Once daily patches
- Place the patch on a hairless area of skin (chest, back or abdomen) and rotate sites to prevent skin irritation
- Remove old patch, wash skin with soap and water (not alcohol) and dry thoroughly before applying new patch
- Remove the patch at night to reduce the risk of developing tolerance to nitroglycerin. Be medication-free 10 to 14 hr/ day.
Nitroglycerin Ointment Admin
- Remove the prior dose before a new dose is applied
- Measure specific dose with applicator paper and spread over 2.5 to 3.5 inches of the paper
- Apply to a clean, hairless area of the body, and cover with clear plastic
- Avoid touching ointment with the hand
Other Angina Drugs
Beta Blockers
- selective: metoprolol
- non selective: cavedilol, propranolol, labetalol
Calcium channel blockers (stable angina)
DHP (selective to arteries) “dipines”
-amlodipine
