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46 Cards in this Set
- Front
- Back
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Action of Antihyperlipidemic Agents
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Lower serum levels of cholesterol and lipids
Prevention of CAD Atheromatous plaques or atheromas Narrows interior of blood vessel – limiting blood flow Damage to vessel walls – coronary vessels unable to meet demand for oxygen |
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Atheroma Development
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Evidence that atheromas develop more quickly in people with elevated cholesterol and lipid levels
Consuming high fat diet – more likely to develop high lipid levels People without elevated lipid levels can also develop atheromas |
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Unmodifiable Risk Factors for CAD
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Genetic predisposition
Age Gender |
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Modifiable Risk Factors for CAD
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Gout
Cigarette smoking Sedentary lifestyle High stress levels Hypertension Obesity Diabetes Untreated bacterial infections Treatment with tetracycline and fluororoentgenography |
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Treatment of CAD
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Decrease dietary fats
Lose weight Eliminate smoking Increase exercise levels Decrease stress Treat hypertension Treat diabetes Treat gout |
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Metabolism of Fats
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Fat taken into body through diet
Broken down in stomach to fatty acids, lipids and cholesterol Contraction of gallbladder with release of bile Bile acids contain cholesterol – act like detergent in the small intestine to break up fats Fats broken into small units called micelles – can be absorbed into wall of small intestine Bile acids reabsorbed and recycled to gallbladder Fat taken into body through diet Broken down in stomach to fatty acids, lipids and cholesterol Contraction of gallbladder with release of bile Bile acids contain cholesterol – act like detergent in the small intestine to break up fats Fats broken into small units called micelles – can be absorbed into wall of small intestine Bile acids reabsorbed and recycled to gallbladder Micelles carried into plasma on chylomicron (package of fats and proteins) Travel through small intestine into lymphatic system Travel into heart and are sent into circulation Some broken down for energy, some stored in fat deposits Some continue to liver to be processed into lipoproteins |
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Lipoproteins Produced in the Liver Low-density lipoproteins (LDL)
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Enter circulation as tightly packed cholesterol, triglycerides, and lipids
Carried by proteins that enter circulation; broken down for energy or stored for future use as energy |
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Lipoproteins Produced in the Liver High-density lipoproteins (HDL)
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Enter circulation as loosely packed lipids
Used for energy; pick up remnants of fats and cholesterol left in the periphery by LDL breakdown |
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Cholesterol
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Needed to maintain normal bodily function
Basic unit for steroid hormones Basic unit in formation and maintenance of cell membranes Produced through diet and fat metabolism HMG-CoA reductase regulates cellular synthesis of cholesterol If dietary cholesterol is severely limited, cellular synthesis will increase |
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Causes of Hyperlipidemia
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Excessive dietary intake of fats
Genetic alterations in fat metabolism leading to a variety of elevated fats in the blood Hypercholesterolemia, hypertriglyceridemia, and alterations in LDL and HDL concentrations |
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Drugs Used to Treat Hyperlipidemia
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Bile acid sequestrants
HMG-CoA inhibitors Fibrates Niacin Cholesterol absorption inhibitors Hormones (women) |
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Bile Acid Sequestrants Actions
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Bind bile acids in the intestine, allow excretion in feces instead of reabsorption, and cause cholesterol to be iodized in the liver and serum cholesterol levels to fall
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Bile Acid Sequestrants Indications
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Reduce elevated serum cholesterol in patients with primary hypercholesterolemia and pruritus associated with partial biliary obstruction
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Bile Acid Sequestrants Pharmacokinetics
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Not absorbed systemically
Excreted in the feces |
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Bile Acid Sequestrants Contraindications
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Allergy
Complete biliary obstruction Abnormal intestinal function Pregnancy and lactation |
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Bile Acid Sequestrants Adverse effects
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Headache, fatigue, and drowsiness
Direct GI irritation: nausea and constipation Increased bleeding times Vitamin A and E deficiencies |
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Bile Acid Sequestrants Drug-to-drug interactions
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Malabsorption of fat-soluble vitamins
Thiazide diuretics, digoxin, warfarin, thyroid hormones, and corticosteroids |
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Nursing Considerations for Bile Acid Sequestrants Assessment
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Allergies
Impaired intestinal function or biliary obstruction which could be exacerbated by the drugs Pregnancy and lactation |
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Nursing Considerations for Bile Acid Sequestrants Implementation
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Mix powdered drugs in fluids
Do not cut, chew or crush tablets – designed to break down in GI track Give before meals and give other meds 1 hour before or 4-6 hours after these meds Bowel program if constipation occurs Pt teaching, comfort measures and support |
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Nursing Considerations for Bile Acid Sequestrants Evaluation
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Monitor response to drug
Monitor for adverse effects Evaluate effectiveness of teaching plan Monitor effectiveness of comfort measures and compliance with the regimen |
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HMG-CoA Inhibitors
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Drugs in focus – statins
Atorvastatin – Lipitor Pravastatin – Pravachol Rosuvastatin – Crestor Simvastain - Zocor |
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HMG-CoA Inhibitors Actions
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Inhibit HMG-CoA, decrease serum cholesterol levels, LDLs, and triglycerides, and increase HDL levels
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HMG-CoA Inhibitors Indications
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Adjunct to diet in the treatment of elevated cholesterol, triglyceride, and LDL levels; increase HDL-C in patients with primary hypercholesterolemia; treat familial hypercholesterolemia and two+ risk factors for CAD
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HMG-CoA Inhibitors Pharmacokinetics
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Absorbed from the GI tract and undergo first-pass metabolism by the liver
Excreted in the urine and feces |
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HMG-CoA Inhibitors Contraindications
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Allergy
Active liver disease and history of alcoholic liver disease Pregnancy and lactation |
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HMG-CoA Inhibitors Caution
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Impaired endocrine function
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HMG-CoA Inhibitors Adverse effects
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GI symptoms: flatulence, abdominal pain, cramps, nausea, vomiting, and constipation
CNS: headache, dizziness, blurred vision, insomnia, and fatigue Liver failure Rhabdomyolysis |
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HMG-CoA Inhibitors Drug-to-drug interactions
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Erythromycin, cyclosporine, gemfibrozil, and niacin
Digoxin and warfarin Estrogen Grapefruit juice |
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Nursing Considerations for HMG-CoA Inhibitors Implementation
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Administer at bedtime – highest rate cholesterol synthesis between midnight and 0500
Monitor serum cholesterol and LDL levels during tx Monitor liver function tests Attempt cholesterol lowering diet & exercise program for 3-6 months prior to drug tx to ensure need Encourage lifestyle changes May need to withhold during some serious medical conditions (infection, hypotension, surgery, trauma) |
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Nursing Considerations for HMG-CoA Inhibitors Evaluation
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Monitor response to drug
Monitor for adverse effects Evaluate effectiveness of teaching plan Monitor effectiveness of comfort measures and compliance with the regimen |
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Cholesterol Absorption Inhibitors Action
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Work in the brush border of the small intestine to inhibit the absorption of cholesterol
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Cholesterol Absorption Inhibitors Indications
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Lower serum cholesterol levels; treat homozygous familial hypercholesterolemia; treat homozygous sitosterolemia to lower sitosterol and campesterol levels
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Cholesterol Absorption Inhibitors Pharmacokinetics
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Absorbed in the GI tract
Metabolized in the liver; excreted in urine and feces |
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Cholesterol Absorption Inhibitors Contraindications
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Allergy
Pregnancy and lactation if combined with a statin |
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Cholesterol Absorption Inhibitors Cautions
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Pregnancy and lactation (monotherapy)
In elderly patients Liver disease |
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Cholesterol Absorption Inhibitors Adverse effects
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Abdominal pain and diarrhea
Headache, dizziness, fatigue, URI, and back pain Muscle aches and pain |
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Cholesterol Absorption Inhibitors Drug-to-drug interactions
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Cholestyramine, fenofibrate, gemfibrozil, and antacids
Cyclosporine Fibrates Warfarin |
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Nursing Considerations for Cholesterol Absorption Inhibitors Assessment
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Allergies
Pregnancy or lactation Liver dysfunction Advanced age |
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Nursing Considerations for Cholesterol Absorption Inhibitors Implementation
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Monitor cholesterol, triglyceride and LDL levels
Monitor liver function tests Attempt diet & exercise for months before therapy Lifestyle changes Contraceptives to avoid pregnancy Comfort measures and thorough patient teaching |
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Nursing Considerations for Cholesterol Absorption Inhibitors Evaluation
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Monitor response to drug
Monitor for adverse effects Evaluate effectiveness of teaching plan Monitor effectiveness of comfort measures and compliance with the regimen |
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Other Lipid Lowering Agents Fenofibrates
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Inhibit triglyceride synthesis in the liver: decreased LDL
Increase uric acid secretion: may stimulate triglyceride breakdown |
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Other Lipid Lowering Agents Gemfibrozil
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Inhibits peripheral breakdown of lipids
Reduces production of triglycerides and LDL Increases HDL |
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Other Lipid Lowering Agents Niacin
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Vitamin B3, inhibits release of free fatty acids from adipose tissue
Increases rate of triglyceride removal from plasma |
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Other Lipid Lowering Agents Peroxisome Proliferator Receptor Alpha Activator
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2009 – fenofibric acid (Trilipix)
Activates specific hepatic receptor – results in increased breakdown of lipids Can be used with statin Caution in renal impairment Adverse: HA, back pain, nausea, diarrhea, runny nose, resp. infections, gallstones |
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Other Lipid Lowering Agents Combination Therapy
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Strict dietary modification
Exercise and lifestyle changes One cholesterol lowering med May have to add additional meds Fixed combination therapies |
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Other Lipid Lowering Agents Endocannabinoids
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Important in regulation of appetite, satiety, and lipid metabolism
Weight loss Decreased growth hormone Decreased fat synthesis and levels cholesterol Decreased BS levels Decreased activity of tumor necrosis factor Further study – not yet approved |
