Agents Used to Treat Hyperlipidemia

1. Agents Used to Treat Hyperlipidemia Chapter 19

2. Hyperlipidemia • Atherosclerosis – accumulation of fatty substances on the inner wall of large and medium sized arteries • Can lead to CAD, cerebral vascular disease, peripheral vascular disease or renal disease and failure • Lipids bind to albumin • Forms chemical compound called lipoproteins

3. Hyperlipidemia • Fats in the blood • Chylomicrons • VLDL = very low-density lipoproteins • LDL = low-density lipoproteins • HDL = high-density lipoproteins • Target >40mg/dL male/>50mg/dL women

4. Lipoproteins • VLDL and LDL plays a role in developing arthrosclerosis • First line of defense is dietary management • Drug therapy may be indicated • Does not reverse existing arthrosclerosis • Long-term therapy • Standards established to reduce rate of CAD

5. Antihyperlipidemics • Help prevent heart disease • The risk for coronary heart disease is three times greater if the cholesterol level is at or above 260 mg/dL compared to a person with a level of 200 mg/dL or lower (Ignatavicius and Workman, Medical-Surgical Nursing: Critical Thinking for Collaborative Care, 2005)

6. Classification of antihyperlipidemics • Fibrinic acid derivatives • Gemfibrozil (Lopid), fenofibrate (Tricor) • HMG-CoA reductase inhibitors (HMGs or statins) • Atorvastatin (Lipitor), ezetimibe (Zetia), lovastatin (Mevacor), rosuvastatin (Crestor), simvastatin (Zocor)

7. Classification of antihyperlipidemics • Niacin (nicotinic acid) • Vitamin B3 • 1-2 grams 3x/day • Bile acid sequestrants – may bind other PO drugs; don’t give within 1 hour after or 4 hours before other drugs • cholestyramine • colestipol Hcl

8. Fibrinic Acid Derivatives • Reduce the synthesis of triglycerides in the liver • Decrease VLDL and LDL • Increase HDL • Side effects • Nausea, flatulence, bloating, diarrhea, and liver changes

9. HMG-CoA Reductase Inhibitors • Inhibit HMG-CoA reductase • Enzyme used by the liver to produce cholesterol • Lowers the rate of cholesterol production • Side effects • Liver changes • GI upset, constipation, or diarrhea • Atorvastatin is very effective

10. Vitamin B3 Niacin • Requires higher doses than when used as a vitamin • Decreases triglycerides • Increases HDL • Effective and inexpensive • Often used in combination with other lipid-lowering agents • Side effect • Hypotension from vasodilation

11. Bile Acid Sequestrants • Bile acids are necessary for absorption of cholesterol • Mechanism of action • Combine with bile acids • Form insoluble complex • Result • Prevent resorption of bile acids from small intestine

12. Bile Acid Sequestrants: Therapeutic Uses • Treatment of hyperlipidemia • Decrease the triglyceride levels • Increase HDL by as much as 25%

13. Side Effects of antihyperlipidemics • Abdominal discomfort • Diarrhea or constipation • Nausea • Headache • Increased risk of gallstones • Prolonged prothrombin time • Liver studies: dysfunctional changes, elevated enzymes

14. Antihyperlipidemics • Antihyper-lipidemic agents generally take several weeks to show effectiveness

15. Nursing Implications • Contraindications • Biliary obstruction and active liver disease • Liver function studies • Long-term therapy • Requires supplemental fat-soluble vitamins (A, D, E, and K) • Take with meals to decrease GI upset.

16. Nursing Implications • Obtain a thorough health and medication history • Assess dietary patterns, exercise level, height and weight, vital signs, and family history (genetics, and tobacco and alcohol use) • Teach patients that dietary modifications are important when treating elevated serum lipids