Drugs to Lower Cholesterol and Triglyceride Levels

Terminology

1. Lipids

2. Cholesterol

3. Lipoprotein:

4. LDL:

5. HDL:

6. Triglycerides:

7. Atherosclerosis:

8. ASCVD:

9. HMG-CoA-reductase:

10. Myopathy:

11. Rhabdomyolysis:

12. Creatine kinase (CK):

1. all fats in the blood

2. fatty substance used to build membranes/hormones

3. carries cholesterol/fat through blood

4. “Bad” cholesterol in artery walls

5. “good” cholesterol that carriers it back to liver

6. sugary fats stored for energy (alcohol, oil)

7. fat.plaque buildup→ narrow/stiffen

8. heart attack, stroke

9. liver enzyme statins block → less cholesterol

10. muscle pain or weakness caused by a drug

11. severe muscle breakdown (dark urine)

12. enzyme that rises when muscle is breaking down

Cholesterol

1. Function?

2. Orgin?

3. Education for diet?

4. VLDL:

5. High LDL and triglycerides →

6. Goal:

1. hormone synthesis and fat absorption

2. liver

3. decrease saturated fats

4. Very-low-density lipoprotein (transports triglycerides)

5. atherosclerosis, ASCVD

6. High HDL/ Low LDL = Lower CV risk

HMG-CoA Reductase Inhibitors

1. Prototype:

2. suffix:

3. MOA:

4. Therapeutic Uses:

5. Adverse Effects:

6. Contraindications:

7. Drug interactions:

8. Adminstration:

9. Client Teaching:

1. Atorvastatin

2. -statin

3. decrease LDL, triglycerides & increase HDL

4. Hypercholesterolemia, Primary/Secondary prevention of coronary events, Prevention of MI/stroke (diabetes)

5. Hepatotoxicity ( increased AST) & Myopathy/Rhabdomyolysis (muscle pain, dark urine)

6. Pregnancy, grapefruit juice, asian descent

7. fibrates, ezetimibe, CYP3A4 inhibitors

8. Evening dosing preferred ( cholesterol synthesized at night)

9. Avoid alcohol, report muscle pain or jaundice, use contraception

Fibrates (Fibric Acid Derivatives)

1. Prototype

2. MOA:

3. therapeautic uses:

4. Adverse effects:

5. Drug interactions:

6. Contraindications:

7. Education:

8. Admin?

1. gemifibrozil & Fenofibrate

2. decrease triglycerides, increase HDL & lipoprotein lipase

3. HIgh triglycerides not controlled by lifestyle & modest increased HDL

4. Myopathy/rhabdomyolysis, Hepatotoxicity, Gallstones ( increase biliary cholesterol), GI upset

5. Warfarin displacement (protein-bound) → increased INR/bleeding… Statins → increase myopathy risk

6. liver disease, renal impair, gallbladder disease, older adults, pregnancy

7. Report RUQ pain/fat intolerance, musclepain/weakness, dark urine, jaundice

8. BID, 30 min before breakfast & dinner

Nicotinic Acid (Niacin)

1. MOA:

2. Therapeutic Uses:

3. Adverse effects:

4. Education:

1. decrease LDL and triglycerides & increase HDL

2. adjunct for dyslipidedemia and decrease pancreatitis with hypertriglyceridemia

3. Flushing/burning/pruritus, hyperglycemia (DM watch), GI upset (take w/food)

4. Take with meals, take aspirin 30 min before, Report itching/dark urine/pain

Ezetimibe

1. MOA:

2. therapeuatic effects:

3. Used for?

4. Special charactersitic:

5. Contraindications:

6. Adverse effects:

7. Education

1. Block cholesterol absorption → decreased LDL

2. decrease total cholesterol, LDL, triglycerides; increase HDL

3. Primary hyperlipidemia

4. used alone or with statin

5. pregnancy, liver disease, CYP3A4 inhibitors (antifungals)

6. HA, sore throat, rare rhabdomyolysis

7. Can take with or without food, report pain/dark urine

PCSK9 Monoclonal Antibody Inhibitors

1. MOA:

2. Special characteristic?

3. Used for?

4. Adverse effects?

5. Contraindications?

6. Side effects?

7. Precautions?

8. Route?

9. Education?

10. Consideration/awareness:

1. preserve LDL receptors → increased LDL clearance by over half

2. may decrease total cholesterol

3. familial hypercholesterolemia, primary hyperlipidemia not controlled by statins, Clients with CV risk

4. hypersensitivity (angioedema, vasculitis, anaphylaxis)

5. hypersensitivity or latex allergy

6. mild injection site reactions, muscle pain, flu-like sx

7. watch out in those with prior severe allergic reactions

8. SQ every 2-4 weeks

9. refridgerate; bring to room temp before use. Report rash/swelling/SOB

10. Often combined with statin in long-term therapy & insurance usually required

CJMM: Applying Lipid-Lowering Medications

1. Recognize cues

2. Analyze cues

3. Prioritize hypotheses

1. muscle pain, flushing, constipation, RUQ pain, lipid panel, LFTs

2. increased CK (statin/fibrate problem)… Constipation (bile-acid)… flushing expected (niacin)

3. Jaundice/dark urine= hepatotoxicity… Myopathy over a GI upset