Lipid-Lowering Agents

What is the common suffix in the generic names of HMG-CoA Reductase Inhibitors?

-statin (e.g., atorvastatin, rosuevastatin, simvastatin).

How do statins work to lower cholesterol(MOA)?

They inhibit the HMG-CoA reductase enzyme, which prevents the liver from synthesizing cholesterol.

What are the two main reasons for prescribing statins?

1. To treat primary hypercholesterolemia.

2. To prevent cardiovascular events like heart attacks and strokes.

Who should generally NOT take statins(contradictions)? 

Patients who are pregnant, have active liver disease, or have a known allergy to the drug

What are two serious adverse effects of statins that require monitoring?

1. Hepatotoxicity (elevated liver enzymes - AST/ALT).

2. Rhabdomyolysis(myopathy) (severe muscle breakdown, monitored via Creatine Kinase/CK levels).

What are two common substances that can interact dangerously with statins?

1. Fibrates (e.g., gemfibrozil) - increases the risk of myopathy/rhabdomyolysis.

2. Grapefruit juice - can increase statin levels in the blood, leading to toxicity.

What is an example of a Bile Acid Sequestrants?

Colesevelam

How do bile acid sequestrants lower cholesterol?

They bind to bile acids in the intestine, forcing the liver to use more cholesterol to produce new bile acids, which lowers circulating cholesterol levels

What is the most common side effect of bile acid sequestrants?

Constipation

What is the crucial timing rule for taking other medications with a bile acid sequestrant?

Take other medications 1 hour before or 4 hours after the bile acid sequestrant to prevent binding and reduced absorption.

Name two contraindications for using bile acid sequestrants.

1. Bowel obstruction

2. Pancreatitis (especially if caused by high triglycerides)

Why do you take a Bile Acid Sequestrants?

hyperlipidemia

What is the drug class of Gemfibrozil?

Fibric Acid Derivative (Fibrate).

How does Gemfibrozil work to lower lipids?

It activates lipoprotein lipase, an enzyme that breaks down cholesterol and triglycerides.

What is the main indication for Gemfibrozil?

Hyperlipidemia (specifically to lower high triglycerides).

Name three contraindications for Gemfibrozil.

1. Liver disorders

2. Severe kidney dysfunction

3. Gallbladder disease

What are four important side effects of Gemfibrozil?

1. GI distress (e.g., nausea, bloating)

2. Gallstones

3. Myopathy (muscle pain/weakness)

4. Hepatotoxicity (liver damage)

What two drug interactions make Gemfibrozil particularly dangerous?

1. Warfarin (increases risk of bleeding)

2. Statins (greatly increases the risk of myopathy and rhabdomyolysis)

What is an example of a Cholesterol Absorption Inhibitor?

Ezetimibe

How does Ezetimibe work to lower cholesterol?

It blocks the absorption of cholesterol from food and the reabsorption of cholesterol from bile in the small intestine.

What is the main reason Ezetimibe is prescribed?

Hyperlipidemia. It is often used in combination with a statin.

Who should NOT take Ezetimibe?

Patients who are pregnant or have moderate to severe liver disorders.

What are two serious side effects of Ezetimibe?

1. Hepatitis (liver inflammation)

2. Myopathy (muscle pain/weakness)

What is a key interaction between Ezetimibe and other lipid-lowering drugs?

• It increases the risk of liver dysfunction and myopathy when combined with statins.

• fibrates increase the risk of cholelithiasis and myopathy.

What are the key assessments a nurse must complete BEFORE administering a thrombolytic like Alteplase?

• Obtain baseline vital signs.

• Draw baseline labs: CBC (Hgb/Hct, platelets), aPTT, PT/INR, and fibrinogen.

• Review medical and drug history for any contraindications (e.g., recent bleeding, stroke, surgery).