Pharm test two (Antilipemic Drugs) Flashcards
Antihyperlipidemic, lipid lowering drugs Goal
**To lower total cholesterol <150 normal
105-199 Borderline high
200-499 High
500+ Very High
Antilipemic Drugs are
Bile-acid binding resins
oldest and safest because they are not absorbed from intestine
they do this by binding with bile acids in intestine to help excrete stool
cause an increase in cholesterol being oxidated to bile acids, and are increased in excretion
cause LDL and cholesterol decrease secondary to: increased clearance of LDL from plasma
antilipemic Drugs are primarily used for
Type II hyperlipoproteinemia
upward effects for antilipemic drugs
untoward effects – dose related
Therapeutic uses for antilipemic drugs
*use with attempting vigorous diet therapy for first 6 months
lower saturated fats, lower cholesterol
oatbran, high fiber
exercise, weight loss
may add Niacin for greater efficacy
not used with severe hypertriglyceridemia –> will increase TG’s
Binds several drugs in gut (digoxin, thiazides, furosemide, thyroid, warfarin, statins) DO NOT TAKE AT SAME TIME
bile-acid binding resins agent
Cholestyramine (Questran)
Hmg-CoA Reductasae Inhibitors “the Statins”
goal
the rate-limiting step in cholesterol synthesis
lowers total and LDL cholesterol–up to 20-50% depending on agent and dose, lowers TG’s, especially with very high TG’s
reduce CHD risk, ACS, stroke, total mortality
May help stabilize plaques in vessels (plaque rupture leads to thrombosis)
Decrease CPR (c-reactive protein), and independent marker of inflammation and CHD risk
For Type II hyperlipoproteinemia
Hmg-CoA reductase Inhibitors Untoward effects
“low incidence of adverse effect
Generally mild and transient
Gi upset (4-6%)
Hepatic function test elevated –ALT, AST (1% incidence, dose related)
myalgia, muscle cramps, myopathy (0.01% incidence)
increased in high risk, elderly, multi system disease, use of fibrated, other drugs (related to hepatic metabolism)
could cause rare Rhabdomyolysis(muscle breakdown)
Hmg-Coa reductase inhibitors
nursing implications
monitor cholesterol monitor hepatic functions (AST, ALT @ 3 months, and then based on risk factors) teach diet and exercise teach to repot muscle aches, weakness not safe in pregnancy
Hmg-Coa Reductase Inhibitors Agents
**Atorvastatin (Lipitor) **
***Niacin–Nicotinic acid–Vitamin B3 (higher than vitamin doses)
Mechanism not clear
affects cyclis AMP–control activity of lipase and thus lipolysis
decrease rate of synthesis of VLDL (TG’s) and LDL in liver
***Niacin–Nicotinic acid–Vitamin B3 (higher than vitamin doses) used for
lowers serum LDL and VLDL and increase HDL
decrease triglycerides 20-50%
***Niacin–Nicotinic acid–Vitamin B3 (higher than vitamin doses)
adverse effects
GI upset – N/V, bloating, gas, hunger (give with food)(take at night)
elevated hepatic function test
flushing (face and neck & pruritis) ((give with aspirin 30 min before to decrease flushing)
related to prostaglandin release
worse with first doses
start therapy with low doses– increase over 6 weeks
slow release Niacin– less flushing
Niacin–Nicotinic acid*
Need too know
caution with diabetes can increase insulin resistance will cause increased BG
not a first line drug
combine with statins, diet
OTC niacin not as effective, more adverse effects
Niacin (Niaspan)**
Extended release
