What are the 5 other drugs that can be taken for dyslipidemia?
Niacin Bile-Acid sequestrates Ezttimibe Fibrates Fish Oil
Niacin (nicotinic acid, Vit. B3)
What does niacin do to our lipoproteins and triglycerides?
What are the 4 adverse effects of niacin?
- Intense flushing, itching
- GI upset
- Increases uric acid
- Hepatoxicity (rare)
If someone is taking niacin and keeps experiencing the adverse effect of intense flushing, what can we tell them to do?
Take aspirin 30 minutes before taking niacin
Because bile is made out of cholesterol, the bile acid sequestrates keep the bile in the GI tract to prevent ____ and promote ___
Prevent absorption and promote excretion
What is the name of the drug that is a bile acid sequestrate?
What does cholesevelam do to our lipoproteins and triglycerides?
Lowers LDL Increases triglycerides (bad!)
What side effects may your patient experience if taking cholesevelam?
Mild GI side effects (nausea, bloating)
Why can cholesevelam bind with other drugs? What does this mean to us as nurses?
It can bind to other drugs because its a sticky substance; it may interfere with the absorption of other drugs so we need to avoid mixing with other meds
If a patient is experiencing constipation, what can we teach them?
Increase their fiber and fluids
If our patient takes the powder form of cholesevelam, what should we teach them?
These bile acid squestrants are not lipid soluble, so when you mix your powder form with a liquid, it will appear cloudy and not clear
If our patient is taking several other meds along with cholesevelam, what should we teach them?
Take cholesevelam 1 hour before other meds or 4 hours after other meds
What is the MOA of ezemtimibe?
Acts on the cells of the small intestine to inhibit dietary cholesterol absorption; inhibits reabsorption of cholesterol secreted in the bile
What does ezemtimibe do to our lipoproteins?
Ezemtimibe adverse effects are similar to _____.
Does ezemtimibe cause GI issues? Do we need to take these drugs with food?
No; can be taken with or without food
Can we combine ezemtimibe with a statin?
Can we combine ezemtimibe with bile-acid sequestrate?
You can combine exemtimibe with a statin, although it may increase risk of hepatoxicity and rhabdo. Can be taken at the same time
Yes, you can be taking both ezemtimibe with bile-acid but would need to take ezemtimibe 2 hours before the bile-acid or 4 hours after
What is the MOA of fibrates?
Activates PPAR alpha receptors which increases the breakdown of fatty acids
What do fibrates do to our triglycerides?
What are the most common adverse effects seen with fibrates?
Rash (very common) and GI disturbances (N/V, diarrhea)
What are the two drugs that are fibrates?
Taking gemifibrozil (fibrate) may increase _______ in a patient
Fibrates may also cause _____.
When should we tell our patient to take gemifibrozil?
30 minutes prior to morning and evening meals
What do fibrates interact with? Why is this important for client education?
Interacts with warfarin. We need to know if our patient is on this drug, because BOTH fibrates and warfarin is highly protein bound! Levels would need to be checked
Fish oil: Do recent studies reveal consuming fish oil has high advantage in preventing heart disease in high-risk populations?
No; the studies reveal that it provides no advantage in prevention of heart disease in high risk population
What does fish oil do to our lipoprotein and triglycerides?
What should we do with our fish oil to prevent fish burps?
Fish oil reduces _______
What does more work for a surrogate endpoint (LDL, HDL, triglycerides): Statin or non-statin
What does more work for a clinical endpoint (Number of MI, strokes, etc): Statin or nonstatin?