Antilipid Medications Overview (ch 16)

These flashcards cover important vocabulary terms and definitions related to antilipid medications as discussed in lecture notes.

ezetimibe/zetia

A cholesterol absorption inhibitor used to reduce cholesterol absorbed by the body.

Statin

A class of drugs that inhibit HMG-CoA reductase, lowering cholesterol production in the liver.

gemfibrozil/Lopid

A fibrate that activates cell lipid receptors to break down lipids for elimination.

Cholestyramine/Questran

A bile acid sequestrant that binds with cholesterol in the small intestine to prevent fat absorption.

rhabdomyolysis

A serious side effect of statins characterized by muscle breakdown.

LDL cholesterol

Low-density lipoprotein cholesterol, often referred to as 'bad' cholesterol.

HDL cholesterol

High-density lipoprotein cholesterol, often referred to as 'good' cholesterol.

Angioedema

A severe allergic reaction that can cause swelling of the face, throat, and other areas.

creatine levels

A measure used to assess kidney function, monitored when taking gemfibrozil.

Internationalized Ratio (INR)

A standardized measure of blood coagulation for patients on anticoagulants like warfarin.

musculoskeletal discomfort

General pain or discomfort in muscles and joints, a common side effect of statins.

niacin extended-release (g) Niaspan (B)

DRUG CLASS: Antilipid-Nicotinic Acid Agent

MOA: niacin extended-release (g) Niaspan (B)

Special form of vitamin B that helps decrease triglyceride total cholesterol and LDL cholesterol levels. Help increase HDL cholesterol.

TU: niacin extended-release (g) Niaspan (B)

Decrease triglyceride, total cholesterol, LDL cholesterol levels, Increase HDL cholesterol level

SE: niacin extended-release (g) Niaspan (B)

Nasal inflammation and general itching because vessels dilate. GI symptoms, nausea, indigestion, gas, vomiting, diarrhea, abdominal pain. Flushing and hot flashes, chills, dizziness, fainting, headaches, swelling, sweating (diaphoresis) shortness of breath (dyspnea). tachycardia

AE: niacin extended-release (g) Niaspan (B)

toxicity but liver failure is rare. Gout (painful swelling and redness of the toes, feet, or ankles, because of excess uric acid and calcium. Hyperglycemia, stomach ulcer flair ups, BOT for people with hypertension, peptic ulcer or active bleeding.

CE: niacin extended-release (g) Niaspan (B)

Start with low dose and gradually increase, Notify prescriber of side effects or AE. Take with meals, if taking with statin notify of any muscle soreness, ,muscle pain, tenderness or weakness. Monitor glucose levels closely because people with diabetes can increase serum glucose levels. Take bile drugs 4-6 hours after if dr agrees take aspirin (325 mg tablet) 15 to 60 min before to prevent hot flushing. Do not substitute a sustained release form for a immediate release form, extended-release forms swallowed whole and not mixed w water can lead to overdose. Before surgery or dental work must tell DR because this can slow clotting. Worse with aspirin or a NSAID.

LC: niacin extended-release (g) Niaspan (B)

P+L mod likelihood birth defects. Secreted into breast milk. Avoid BF or discontinue

SE: ezetimibe/zetia

Abdominal pain, diarrhea, fatigue, joint pain, muscle pain.

AE: ezetimibe/zetia

Hypersensitivity reactions (including rash, urticaria, angioedema), hepatitis, pancreatitis, thrombocytopenia.

CE: ezetimibe/zetia

Take at the same time daily, with or without food. If taking with a statin, follow statin client education. If taking with bile acid sequestrants, take ezetimibe at least 2 hours before or 4 hours after the sequestrant. Report muscle pain or tenderness if taking with a statin.

LC: ezetimibe/zetia

Pregnancy Category C. Unknown if secreted into breast milk. Not recommended for children under 10. Dosage adjustments not usually needed for elderly unless severe hepatic impairment.

SE: Statins (general)

Myalgia, headache, GI upset (nausea, constipation/diarrhea), fatigue, insomnia.

AE: Statins (general)

Rhabdomyolysis, hepatotoxicity (elevated liver enzymes), new-onset diabetes, memory impairment.

CE: Statins (general)

Take at night (for certain statins like simvastatin, pravastatin, fluvastatin, lovastatin). Avoid grapefruit juice (especially with simvastatin, atorvastatin, lovastatin). Report unexplained muscle pain, tenderness, or weakness, especially if accompanied by fever or malaise. Adhere to diet and exercise. Monitor LFTs.

LC: Statins (general)

Pregnancy Category X (contraindicated). Excreted in breast milk, avoid breastfeeding. May be used in children with heterozygous familial hypercholesterolemia (check specific age limits). Increased risk of myopathy in elderly.

SE: gemfibrozil/Lopid

Dyspepsia, abdominal pain, nausea, diarrhea, fatigue, headache.

AE: gemfibrozil/Lopid

Elevated liver enzymes, gallstones (cholelithiasis), rhabdomyolysis (especially when co-administered with statins), prolonged International Normalized Ratio (INR) with warfarin.

CE: gemfibrozil/Lopid

Take 30 minutes before morning and evening meals. Do not take with statins due to increased risk of rhabdomyolysis. Report unexplained muscle pain, tenderness, or weakness. Monitor for signs of gallstones (e.g., severe abdominal pain, nausea/vomiting after fatty meals). If on warfarin, monitor INR closely.

LC: gemfibrozil/Lopid

Pregnancy Category C. Excreted in breast milk, avoid breastfeeding. Not recommended for pediatric use. Use with caution in elderly due to potential for impaired renal function.

SE: Cholestyramine/Questran

Constipation (most common), abdominal discomfort, bloating, flatulence, nausea.

AE: Cholestyramine/Questran

Malabsorption of fat-soluble vitamins (A, D, E, K), increased bleeding tendency (due to vitamin K deficiency), hyperchloremic acidosis (rare).

CE: Cholestyramine/Questran

Mix powder thoroughly with 60-180 mL of water or non-carbonated beverage before administration. Take other medications 1 hour before or 4-6 hours after cholestyramine to prevent impaired absorption. Maintain adequate fluid intake to minimize constipation. Supplement fat-soluble vitamins as advised. Report unusual bleeding or bruising.

LC: Cholestyramine/Questran

Pregnancy Category C. Unknown

What is the primary mechanism of action of statins, and what serious side effect should a patient be vigilant for?

Statins inhibit HMG-CoA reductase, lowering cholesterol production in the liver. Patients should be vigilant for rhabdomyolysis.

This drug works by inhibiting cholesterol absorption in the small intestine. What is the drug name, and what is its drug class?

The drug is ezetimibe/Zetia, and its drug class is a cholesterol absorption inhibitor.

A patient taking niacin extended-release (Niaspan) reports severe flushing and hot flashes. What are two client education points you could provide to help manage this side effect?

1. Start with a low dose and gradually increase. 2. Take aspirin (325 mg tablet) 15 to 60 minutes before taking niacin to prevent hot flushing.

A patient is taking warfarin (an anticoagulant) and is newly prescribed gemfibrozil (Lopid). What specific adverse effect should be closely monitored due to this drug interaction?

Prolonged International Normalized Ratio (INR), which increases the risk of bleeding.

A patient taking cholestyramine (Questran) complains of significant constipation and abdominal discomfort. What advice would you give to help mitigate these common side effects?

1. Maintain adequate fluid intake. 2. Supplement fat-soluble vitamins as advised (to prevent deficiencies that can exacerbate GI issues or be mistaken for side effect severity).

Which major class of antilipidemia drugs is contraindicated in pregnancy (Pregnancy Category X)? What is a common client education point for this class regarding grapefruit juice?

Statins are contraindicated