Antihyperlipidemics

Question 1

Statins

Answer 1

• PO

Medications:

• Atorvastatin
• Simvastatin
• Rosuvastatin

Mechanism of Action:
inhibit cholesterol synthesis in the liver

Indication:
- hyperlipidemia

Contraindication:

• Pregnancy
• Lactation

Adverse reactions:

• Liver failure: elevated LFT, check base line and q8wks
• Myopathy & cramps –> hold with muscle aches
• Rhabdomyolysis, check baseline CK & q8wks

Nursing Interventions:

• Abruptly stopping cause rebound effect and acute MI
• Grapefruit juice reduce statins level
• Take at night (cholesterol biosynthesis is higher at night)
• May cause cataract formation (annual eye exam)

“Lets Frequently Monitor Cholesterol Rates”

Question 2

Bile Acid Resins (Sequestrants)

Answer 2

Medications:

• Cholestyramine (also an adsorbent)
• Colesevelam

Mechanism of Action:
- Bind bile acid and increase excretion of cholesterol & LDL

Indication:
- hyperlipidemia

Contraindication:
- abdominal pain = possible small bowel obstruction (SBO)

Side effects:

• constipation, SBO, flatulence, cramping –> increase intake of high-fiber food, fluid, activity
• poor absorption of fat-soluble vitamins and many drugs so take 4 hours apart from other drugs & vitamins

Patient Education:

• Take 30 min before meal
• Take with at least 8 oz of water to avoid impaction of esophagus

Question 3

Nicotinic Acid

Answer 3

Medication:
- Niacin

• PO
• Vitamin dose 25 mg/day (OTC)
• Anticholesterol dose 2500 mg/day (Rx)

Mechanism of Action:
- inhibits breakdown of triglycerides to free fatty acids, synthesis of LDL and breakdown of HDL

Indication:
- hyperlipidemia

Contraindication:

• Pregnancy
• Liver disease
• Gout

Side effects:

• flushing of face/neck, feeling warmth, paresthesia
• Hyperglycemia (caution with DM, monitor BG closely in DM patients)

Adverse reactions:

• Hepatotoxicity –> LFT, avoid alcohol and acetaminophen
• Hyperuricemia => gout & RF (monitor renal panel, increase fluid, may need allopurinol)

Think of fat, pregnant women –> hot, epidural (paresthesia), gestational diabetes, they drink wine & have gout

Question 4

Omega-3 Acid Ethyl Esterase

Answer 4

Medication:

• omega3 (Rx)
• fish oil (OTC)

Mechanism of Action:
- Inhibits triglyceride production in the liver

Indication:
- preventive/treat hyperlipidemia

Off Label Use:
- HTN & rheumatoid arthritis (RA)

Side effects:
- GI distress (acidic), nausea, fishy aftertaste, rash

Patient Education:
- Take with food