Drugs for Lipid Disorders

1. Drugs for Lipid Disorders Chapter 22

2. Lipids Compare and Contrast the three types: Triglycerides Phospholipids Steroids Identify the most commonly known sterol and discuss its role in the body. Identify the AHA daily recommendations for this sterol.

3. Lipoproteins Common Types: HDL LDL VLDL Compare and contrast the composition and function of these lipoproteins.

4. Terms: Define: Hyperlipidemia Hypercholesterolemia Dyslipidemia Discuss the associated etiology.

5. Measuring Cholesterol Levels Your patient has a total cholesterol level of 250. What does this mean? What should be done next and why? What is the goal of maintaining +/or achieving normal cholesterol levels.

6. Lifestyle Changes Discuss the rationale for lifestyle changes associated with hyperlipidemia. What is the goal of lifestyle changes. List lifestyle changes that will lower lipid levels.

7. HMG-Co A Reductase Inhibitors What is HMG-Co A Reductase? What is the role of HMG-Co A Reductase Inhibitors? Describe the MOA of these drugs. What is the term commonly used for this drug class?

8. Statins Prototype: atorvastatin (Lipitor) Slow progression of CAD Decrease mortality 2° CVD Generally well tolerated Minor side effects: HA, fatigue, muscle or joint pain, heartburn Rare, serious side effects: Myopathy, rhabdomyolisis

9. Statins Drug contraindications: Macrolide antibiotics Azole antifungals Fibric acid agents Certain immunosuppressants Cholesterol biosynthesis is increased at night. How does this fact affect dosing?

10. Statins: Nursing Considerations What baseline data should be obtained? Developmentally, when is statin use contraindicated? What diagnostics should be monitored before and during early therapy? Discuss rationale for monitoring for muscle pain, tenderness, weakness. What diagnostic will aid in diagnosis of myopathy?

11. Statins: Patient Teaching keep all lab appointments No other meds unless approved by HCP No alcohol Reliable contraception Take with eve meal to ? GI Upset Immediately report: unexplained muscle symptoms, esp. if accompanied by malaise and fever; unexplained numbness, tingling, weakness or pain in feet/hands

12. Bile Acid Resins These drugs are not absorbed from small intestines. Describe the MOA. What effect can these drugs have on LDL levels? Why are these drugs no longer 1st line therapy?

13. Bile Acid Resins: Nursing Considerations Significant GI effects possible May worsen PUD, hemorrhoids, IBD, chronic constipation Monitor closely in dysphagia or esophageal strictures Assess bowel sounds at intervals Administer other meds: 1 hour before or 4 hours after Cholestyramine- mix powder as directed; do not inhale powder

14. Bile Acid Resins: Patient Teaching Take before meals High bulk diet Increased fluids Vitamin supplements to replace folic acid, fat soluble vitamins Can cause hypokalemia No meds without HCP approval Immediately report: Jaundice, severe constipation, flatulence, nausea, heartburn, straining, tarry stools, abnormal bleeding

15. Nicotinic Acid What is nicotinic acid? How does dosing of nicotinic acid differ in supplementation vs. decreasing lipid levels? What is the primary effect regarding control of lipid levels? When will optimal effect be anticipated?

16. Nicotinic Acid: Nursing Considerations Not mono-therapy Baseline LFTs and during Rx Contraindicated: ? liver enzymes, history of liver disease of PUD May precipitate gout ASA 1 tab 30 min before If diabetic, closely monitor glucose Give with food to limit GI upset

17. Nicotinic Acid: Patient Teaching Do not self-mediate No mega-doses of niacin Take with cold water Take with meals ASA 30 min before dose No other meds without HCP approval Immediately report: Flank, joint, or stomach pain; jaundice Skin color changes: avoid sun if changes occur

18. Fibric Acid Agents Drug of choice for severe hypertriglyceridemia and VLDL levels. Fenofibrate (Tricor) Gemfibrozil (Lopid) Synergistic effect when combined with a statin. MOA: unknown

19. Fibric Acid Agents:Nursing Considerations Prior to administration assess for: Abdominal pain, nausea, vomiting Obtain current drug history Avoid in pregnancy and lactation Avoid in gallstone or biliary disease Give with meals Monitor s/s of ? clotting time Monitor of cholecystitis/cholelithiasis

20. Fibric Acid Agents:Patient Teaching Keep all follow-up and lab appts Immediately report: Unusual bruising or bleeding RUQ pain Change in stool color Muscle cramping

21. Cholesterol Absorption Inhibitors Newest class (early 2000s) Only one drug in class: Ezetimibe (Zetia) Discuss the MOA. Mono-therapy: ~ 20% ? in LDL Exetimibe + statin: additional 15 – 20% decrease in LDL Vytorin = ezetimibie + simvastatin (Zocor)