Ati Cardiovascular System Meds (Antilipemic Agents)

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HMG COA reductase inhibitors

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prototype: atorvastatin (Lipitor)

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suffix

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-statin

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HMG COA reductase MOA

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decrease manufacture of LDL cholesterol, VLDL
increase manufacture of HDL
promote vasodilation, decrease in plaque site inflammation, decreased risk of thromboembolism

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HMG COA reductase USE

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hypercholesterolemia
prevention of coronary events
prevention of MI and stroke for clients with diabetes

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HMG COA reductase adverse

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hepatotoxicity
myopathy
myositis, rhabdomyosis
peripheral neuropathy

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HMG COA reductase interventions

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obtain baseline liver function
avoid alcohol
monitor CK values

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HMG COA reductase Contraindication

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hepatitis
Rosvastatin- Asians
older adults
renal and kidney disease

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HMG COA reductase interactions

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fibrates
ezetimibe
(increase risk of myopathy)
grapefruit juice
meds that supress CYP3A4 (erythromycin, ketoconazole)

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HMG COA interventions

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avoid atorvastatin, lovastatin, and simvastitin with meds that supress CYP3A4

limit grapefruit juice

obtain CK levels

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HMG COA administration

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administer with evening meal- mot choleserol is synthesized at night
atorvastatin and fluvastatin should be used with clients who have renal deficiency

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Cholesterol absorption inhibitor

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proto: ezetimibe (Zetia)

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cholesterol absorption inhibitor MOA

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inhibits absorption of cholesterol secreted in the bile and from food

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cholesterol absorption inhibitor USe

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adjunct to help lower LDL cholesterol
can be used in combination with a statin or alone

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cholesterol absorption inhibitor adverse

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hepatitis
myopathy

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cholesterol absorption inhibitor interventions

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baseline liver function
avoid alcohol
obtain CK level
report muscle aches and pains
D/C if CK levels are elevated or LFT are abnormal

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cholesterol absorption inhibitors contraindications

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moderate to severe liver disorders

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cholesterol absorption inhibitors interactions

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bile acid sequesterants ( cholestyramine)- interfere with absorption
statins increase risk of liver dysfunction or myopathy
fibrates increase risk of cholithiasis and myopathy
levels of ezetimibe ca be increased with concurrent use of cyclosporine

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cholesterol absorption inhibitor

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monitor liver and kidney during treatment
report muscle aches and pain

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Bile-acid sequesterants

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proto: colesevelam HCL (Welchol)
other: colestipol (Colestid)

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bile-acid sequesterant MOA

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decrease in LDL cholesterol

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bile-acid sequesterant USE

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used as adjunct with HMG CoA reductase inhibitor and dietary measures to reduce cholesterol levels

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bile-acid adverse

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constipation

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bile-acid sequesterants interventions

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increase high-fiber food
take other meds 4 hours before
inform provider of any other meds taken

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bile-acid sequesterants contraindications

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pancreatitis caused by high triglycerides and bowel obstruction
biliary obstruction
DM
older adults

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bile-acid sequesterants interactions

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these meds interfere with absorption of many medications: sulfonylureas, fat-soluble vitamins, oral contraceptives

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bile-acid sequesterants admin

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give 30 min before meal
colesevelam HCL should be taken with food and 8oz of water- not concurrently with other meds

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Nicotinic acid, Niacin

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Niacor, Niaspan

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Nicotinic acid, Niacin MOA

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decrease in LDL and triglyceride levels

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Nicotinic acid USe

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for clients at risk for pancreatitis and elevated triglyceride levels
lower LDL cholesterol and triglycerides and to raise HDL levels

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Nicotinic acid, Niacin Adverse

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GI distress
facial flushing and feeling of warmth, tingling of feet and hands
hyperglycemia
hepatotoxicity
hyperuricemia

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Nicotinic acid, Niacin interventions

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take aspirin 30 min before each dose
monitor blood glucose levels
monitor for liver dysfunction
monitor kidney function- administer allopurinol if uric acid level is elevated

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nicotinic acid, niacin contraindications

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clients with liver disease or gout

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nicotinic acid, niacin admin

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standard form 3 times a day with or after meals
adminster time-released formulations once in evening
advise clients that dosage is a much larger dosage when taken as a vitamin supplement

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nicotinic acid, niacin effectiveness

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decreased LDL
decreased triglycerides (VLDL)
absence of cardiovascular events such as stroke, MI, or thrombosis

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Fibrates

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proto: gemfibrozil (Lopid)
fenofibrate (Tricor, lofibra)

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Fibrates MOA

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decrease in triglyceride levels
increase in HDLs

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Fibrates use

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reduction of plasma triglycerides (VLDL)
increase in HDLs

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Fibrates adverse

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GI distress
gallstones-observe for indications of gallbladder disease
myopathy-monitor CK levels
hepatotoxicity- monitor LFT

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Fibrates contraindications

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liver, renal dysfunction, gallbladder disease

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Fibrates interactions

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warfarin (Coumadin)- can increase risk of bleeding- obtain baseline prothrombin time and INR
report indications of bleeding
statins increase risk of myopathy- do not use concurrently