Lipid Lowering Agents Flashcards
(53 cards)
1
Q
Modifiable Risk Factors of Coronary Artery Disease
A
- Cigarette Smoking
- Sedentary Lifestyle
- High Stress levels
- Hypertension
- Obesity
- Diabetes
2
Q
Non-Modifiable Risk Factors of CAD
A
- Family History (onset under age of 55)
- Age
- Sex at birth (males >pre-menopausal women)
3
Q
What are low-density lipoproteins?
A
*Tightly packed cholesterol, triglycerides, and lipids
* Carried by proteins with the purpose to be broken down for energy or stored for future energy
4
Q
What are High-Density Lipoproteins?
A
- Loosely packed lipids
- Used for energy and to pick up leftovers of the LDL breakdown process (fats and cholesterol) to be excreted from the body
5
Q
What is cholesterol?
A
*Necessary for normal function –> steroid hormones and cell membrane formation and maintenance
* Obtained through diet and through fat metabolism
* Body can make cholesterol if we don’t eat enough through diet
6
Q
What is the enzyme responsible for cholesterol synthesis?
A
HMG-CoA reductase
7
Q
What is Coronary Artery Disease?
A
Plaque build up in the arteries
8
Q
What is Hyperlipidemia?
A
Increased levels of lipids in the blood
9
Q
What are causes of lipidemia?
A
- Excess dietary intake
- Genetic alterations in fat metabolism
- Hypercholesterolemia
- Hypertriglyceridemia
- Alterations in HDL and LDL concetrations
10
Q
What are the reasons for drug therapy in hyperlipidemia?
A
Genetic factors
Patients unwilling or unable to make lifestyle changes
11
Q
Lipid Lowering Agents
in Children
A
- Genetic causes
- Dietary measures first
- Fibrates and Statins
12
Q
Lipid Lowering Agents
in Adults
A
- Lifestyle changes first
- First choice: Statins
*Category X: Not to be used in pregnancy or women of child bearing age (without contraception)
First choice for pregnancy: Bile Acid Sequestrants
13
Q
Lipid Lowering Agents
in Older Adults
A
- Lifestyle changes first
- Lower dose statins
- Higher risk of adverse effects => monitor renal and hepatic labs; monitor for muscle pain => rhabdomyolysis
14
Q
Bile Acid Sequestrants
Mechanism of Action
A
Binds bile acids in the intestine; allows for excretion in feces instead of reabsorption
15
Q
Bile Acid Sequestrants
Indications
A
- Hypercholesterolemia (high cholesterol or high LDLs)
- Pruritis associated with partial biliary obstruction
16
Q
Bile Acid Sequestrants
Drug names
A
“Chole-“ or “Cole-“
Cholestyramine
Colestipol
Colesevelam
17
Q
Bile Acid Sequestrants
Contraindications
A
Absolute: Allergy
Relative: complete biliary obstruction; abnormal intestinal function
Caution: pregnancy - because of Vitamin decrease
18
Q
Bile Acid Sequestrants
Adverse Effects
A
- Direct GI irritation: Nausea, constipation
- Vitamin A, D, E, K deficiencies
- Increased Bleeding times due to Vit. K def.
19
Q
Bile Acid Sequestrants
Drug Interactions
A
- Malabsorption of fat-soluble vitamins
- Affects absorption of other oral drugs
- Do not take at same time as other drugs or food
20
Q
Bile Acid Sequestrants
Assessment
A
- History: Allergy, pregnancy, lactation, impaired intestinal function/obstruction
- Physical: Skin - looking for bruising with Vit. K def, GI system
- Labs: Cholesterol and lipid levels
21
Q
Bile Acid Sequestrants
Nursing Conclusions
A
- Impaired comfort (adverse effects)
- Constipation
- Injury Risk (Vit. K def)
- Knowledge Deficit
22
Q
Bile Acid Sequestrants
Interventions/Patient Teaching
A
- Powdered drugs must be mixed in liquid
- Tablets cannot be cut, chewed, or crushed
- Take before meals
- Administer other drugs 1 hour before or 4-6 hours after
- Arrange for a bowel program as appropriate
- Comfort and Safety measures
- Provide thorough PT
23
Q
HMG-CoA Reductase Inhibitors
(Statins)
Mechanism of Action
A
- HMG-CoA Reductase is needed to synthesize cholesterol in the liver
- this drug blocks that enzyme, serum cholesterol and LDLs decrease since liver cannot produce it
- HDL levels increase
**Most effective for people who ALREADY have CAD
24
Q
HMG-CoA Reductase Inhibitors (Statin)
Indications
A
- elevated cholesterol
- elevated triglycerides
- elevated LDLs
25
**HMG-CoA Reductase Inhibitors**
Drug Names
**"-statin"**
* Atorvastatin
* Lovastatin
* Pravastatin
* Rosuvastatin
* Simvastatin
26
**HMG-CoA Reductase Inhibitors**
Contraindications
**Absolute**: Allergy
**Relative**: Liver Disease *(significant first pass effect)*
**Cautions**:
* Renal impairment, (can be worsened if rhabdomyolysis occurs)
* impaired endocrine function
27
**HMG-CoA Reductase Inhibitors (Statins)**
Adverse Effects
GI system: Nausea, constipation, flatulence, abdominal pain
Liver: Elevated liver enzymes and acute liver failure
Muscle soreness, cramps, aches => Rhabdomyolysis: breakdown of muscles which releases waste products that can injure the glomerulus and result in acute renal failure
28
**HMG-CoA Reductase Inhibitors (Statins)**
Drug Interactions
**Drug**: Antibiotics, antifungals, immunosuppressants => may increase drug levels of the statin => increased adverse effects
**Food:** Grapefruit Juice => increased risk of toxicity (affects excretion)
**Supplement:** St. John's Wort => decreases statin effectiveness
29
**HMG-CoA Reductase Inhibitors (Statins)**
Assessment
**History**:
Allergy, pregnancy, lactation, liver disease, impaired endocrine function, renal impairment
**Physical:**
Abdomen - r/t GI effects
**Labs:**
Hepatic and Renal function tests
Lipid Levels
Possible pregnancy test
30
**HMG-CoA Reductase Inhibitors (Statins)**
Nursing Conclusions
* Injury risk r/t liver and renal effects
* Impaired comfort r/t myalgia, GI effects
* Knowledge Deficit r/t drug therapy
31
**HMG-CoA Reductase Inhibitors (Statins)**
Implementation/Interventions/Patient Teaching
* Take at Bedtime
* Monitor serum cholesterol, LDLs, LFTs
* Lifestyle modifications - diet and exercise
* Withhold in any serious medical condition
* Use of barrier contraception
* Comfort measures: small, frequent meals, take with a small meal
* Provide PT
* Takes 1-2 weeks to reach effective levels
32
Memory Technique
STAT
**S**ore Muscles
**T**oxic to Liver (ALT/AST)
**A**void Grapefruit Juice and St. John's Wort
**T**ake at night
33
**Cholesterol Absorption Inhibitor**
Mechanism of Action
* Works in small intestine
* Decreases absorption of cholesterol
Less cholesterol => liver
* Liver is able to clear more cholesterol from the blood, less circulating cholesterol
* Decreases total cholesterol, LDL, and triglycerides
34
**Cholesterol Absorption Inhibitor**
Indication
Hypercholesterolemia
35
**Cholesterol Absorption Inhibitor**
Drug Names
ONE DRUG
ezetimibe
36
**Cholesterol Absorption Inhibitor**
Contraindications
**Absolute**: Allergy
**Caution**: Liver Disease
37
**Cholesterol Absorption Inhibitor**
Adverse Effects
GI: Abdominal pain and diarrhea
38
**Cholesterol Absorption Inhibitor**
Drug Interactions
Drug: Cyclosporine (Increased risk of ezetimibe toxicity)
39
**Cholesterol Absorption Inhibitor**
Assessment
**History:**
Allergy, pregnancy, lactation, liver disease
**Physical:**
Abdomen - BS & elimination patterns
**Labs**:
Cholesterol, lipids, ALT/AST
40
**Cholesterol Absorption Inhibitor**
Nursing Conclusions
Impaired Comfort
Knowledge Deficit
41
**Cholesterol Absorption Inhibitor**
Interventions/Patient Teaching
* Monitor labs before and during therapy
* Lifestyle Changes
* Comfort and Safety measures
* Provide PT
42
**Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitors**
Mechanism of Action
* Monoclonal antibodies that prevent PCSK9 enzymes from attaching to the LDL receptors on the liver cells
* This allows for LDLs to attach to those liver cells and be metabolized and then excreted from the body
* Decreases LDL levels and total cholesterol
43
**Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitors**
Indications
* hypercholesterolemia
* Used with a statin drug or alone if statins cannot be taken.
44
**Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitors**
Drug Names
**"-ocumab"**
* Alirocumab
* Evolocumab
45
**Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitors **
Contraindications
**Absolute**: Allergy
46
**Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitors**
Adverse Effects
* Risk of infection (respiratory infections)
* Injection Site Reactions
Not taken orally.... so NO first-pass effect
NO liver toxicity
47
**Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitors **
Drug Interactions
NONE/Unknown
48
**Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitors**
Assessment
**History:**
* Allergy, pregnancy, lactation
**Physical:**
* Skin at intended injection site
* Vital Signs and lung sounds
**Labs:**
* Cholesterol, lipids
49
**Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitors**
Nursing Conclusions
* Impaired comfort
* Infection risk
* Impaired skin integrity
* Knowledge deficit
50
**Proprotein Convertase Subtilisin/Kexin Type 9 (PCSK9) Inhibitors**
Interventions/Patient Teaching
* Monitor labs periodically
* Encourage lifestyle changes
* Provide comfort and safety measures r/t injection site and infection risk
* Provide thorough PT
51
What are the indications and drug names for fibrates?
* Hypercholesterolemia
* Lowers triglycerides and LDL
* Increases HDL
**Drug Names:**
* feno**fib**rate
* gem**fib**rozil
* feno**fib**ric acid
51
What are the indications and side effect for Vitamin B3?
**AKA: Niacin**
* Hypercholesterolemia
* Lowers triglycerides and LDL
* Increases HDL
Could cause skin flushing - usually goes away after a few minutes
52
What are the indications and drug names for Omega 3 Fatty Acids (prescription strength)?
* Hypertriglyceridemia
* Lowers triglycerides
**Drug names:**
* Omega-3-acid ethyl esters
* Omega-3-carboxylic acids
