Drugs for Lowering Cholesterol

Question 1

hyperlipidemia

Answer 1

high levels of lipids in the blood

Question 2

hypercholesterolemia

Answer 2

high levels of cholesterol

Question 3

dyslipidemia

Answer 3

abnormal levels of lipoproteins

Question 4

Are lipid problems typically symptomatic or asymptomatic?

Answer 4

ASYMPTOMATIC!
Can cause big problems

Question 5

triglycerides

Answer 5

• HDL vs. LDL
• makes up 90% of lipids in the body
• fuels the body in times of need/energy source
• saturated vs. unsaturated fats

Question 6

phospholipids

Answer 6

essential to building plasma membranes

Question 7

steroids (cholesterol)

Answer 7

• sterol nucleus (ring structure)
• natural and vital component of plasma membranes
• plays a role in the development of atherosclerosis

Question 8

cholesterol

Answer 8

• building block for many essential biochemicals like Vitamin D, bile acids, cortisol, and sex hormones (estrogen, progesterone, testosterone)
• essential for life
• 75% from the body
• 25% from diet

Question 9

Where is cholesterol manufactured?

Answer 9

the LIVER

Question 10

optimal level for total cholesterol

Answer 10

<200

Question 11

optimal level for LDL cholesterol

Answer 11

<100

Question 12

optimal level for HDL cholesterol

Answer 12

> 60

Question 13

optimal level for serum triglycerides

Answer 13

<150

Question 14

lifestyle changes to decrease lipid levels

Answer 14

• diet (low fat dairy/poultry, fish/seafood and nuts, veggies, fruits, whole grains, legumes, reduce saturated fats, increase soluble fiber)
• weight control
• physical activity (3-4 sessions, 40 minutes)
• stop smoking!
• reduce alcohol consumption

Question 15

therapeutic class of atorvastatin

Answer 15

dyslipidemic or lipid lowering medication

Question 16

pharmacologic class of atorvastatin

Answer 16

HMG-CoA reductase inhibitor

Question 17

What does atorvastatin do?

Answer 17

it inhibits HMG-CoA reductase which is needed for the biosynthesis of cholesterol in the liver

Question 18

trade name of atorvastatin

Answer 18

Lipitor

Question 19

actions/uses of atorvastatin

Answer 19

• decreases LDL cholesterol
• decreases triglycerides
• increases HDL cholesterol
• action only occurs while taking medication, so must stay on statins for life for cholesterol reduction

Question 20

benefits of atorvastatin

Answer 20

slows progression of coronary artery disease and reduces mortality from coronary artery disease

Question 21

administration of atorvastatin

Answer 21

• PO only (give with food to reduce GI distress)
• GIVE AT NIGHT when liver is making cholesterol
• pregnancy category X (teratogenic)

Question 22

side effects of atorvastatin

Answer 22

• headache
• GI cramping, diarrhea, and constipation
• liver damage in small number of patients– monitor LFT’s first few months of therapy

Question 23

serious adverse effects of atorvastatin

Answer 23

• rhabdomyolosis: can be fatal; breakdown of muscle tissue that can lead to renal failure
• can increase digoxin levels
• grapefruit juice inhibits metabolism of atorvastatin

Question 24

therapeutic class of cholestyramine

Answer 24

antihyperlipidemic

Question 25

pharmacologic class of cholestyramine

Answer 25

bile acid sequestrant

Question 26

administration alerts of cholestyramine

Answer 26

- comes in a powder (take at least 60-180 mL of water and drink immediately) - give other drugs either 2 hours before or 4 hours after

Question 27

contraindications of cholestyramine

Answer 27

- patients with biliary obstruction (gallbladder issues) - taking with food could impair absorption of nutrients and minerals

Question 28

side effects of cholestyramine

Answer 28

gas, bloating, constipation, nausea

Question 29

action of cholestyramine

Answer 29

- binds with bile acids in an insoluble complex that is excreted in the feces - because of their large size, these drugs are NOT absorbed in the small intestine - they bound bile acids and cholesterol are eliminated in feces - liver responds by making more LDL receptors which reduce the level of cholesterol in the blood - can produce a 20% drop in LDL cholesterol

Question 30

therapeutic class of gemfibrozil

Answer 30

antihyperlipidemic

Question 31

pharmacologic class of gemfibrozil

Answer 31

fibric acid drug

Question 32

action of gemfibrozil

Answer 32

- not well understood, but they increase the breakdown of lipoprotein lipase which increases breakdown and elimination of triglyceride rich particles from plasma - can reduce VLDL by 50% and increase HDLs

Question 33

cautions when taking gemfibrozil

Answer 33

- may increase the likelihood of gallstones - may affect liver function-- don't use in people with hepatic impairment - may increase the effect of anticoagulant medications - increased risk of myopathy and rhadomyolysis with statins

Question 34

side effects of gemfibrozil

Answer 34

all GI: nausea, diarrhea, abdominal pain, dyspepsia