chapter 10 cardiac pharm

where are lipids / lipoproteins

- in the blood and contains cholesterol, phosolipid, and triglyceride bound to protein

- derived from diet

dyslipedmia or hyperlipemia (abnormal lipid levels in blood)

- associated with atherosclerosis and CAD

- then can lead to heart attack, CVA and or peripheral arterial disease

non pharmacological treatment

-asesss for and treat conditions known to increase blood lipids

- stop meds that increase blood lipids; if possible

- start low fat diet; mediterranean diet

- increase soluble fiber intake

- emphasize regular aerobic excersise

- stop smoking

action of atorvastin aka statins

helps us to stop producing cholesterol

adverse effects of atorvastatin

- mostly mild (nausea, constipation, headache)

-slightly hard on the liver

- MYOPATHIES (myalgias) ranging from mild muscle pain to full on RHABDOMYOLYSIS

- dark tea colored urine is sign for rhabdomyolysis

Contraindications for Atorvastatin

pregnancy

nursing implications for atorvastin

- need to take at night; cholesterol highest at night

- AVOID GRAPE FRUIT JUICE

- lab values (liver and lipid levels)

- educate pt on s+s of rhabdomyolysis

action of cholestyramine

breaks down cholesterol (LDL) used in combo with other meds

pharmacokinetics of cholestyramine

excreted in the stool

adverse effects of cholestyramine

-GI effects

- constipation

- farting, dirahrrea

Contraindications of Cholestyramine

biliary obstruction

nuring implications of cholestyramine

-prevent absorption of a lot of meds

- patient should take other meds 1 hour before or 4-6 hours after

action of fenofibrate

decreases the livers production of LDL and triglycerides and increases production of HDL

contraindications effects of fenofibrate

gallbladder disease

Contraindications of fenofibrate

gallbladder disease d/t risk of gallstones

nursing implications of fenofibrate

-teach pts on signs of gallstones

-sudden intense pt

- middle of abdomen and radiate to back and shoulder

- happens more often eating fatty meals

- may lead to jaundice

action of ezetimibe

decrease LDLs levels

adverse effects of ezetimibe

mild headache and diarrhea

Contraindications of Ezetimibe

pregnancy

Nursing Implications for Ezetimibe

- if taking a statin, take at the same time as the statin

- med works better with statins

action of alirocumab

lowers cholesterol

pharmacokinetics of alirocumab

ONLY GIVEN SUB Q

adverse effects of alirocumab

injection site reactions, itching, nasopharyngitis

what does niacin do

- increases healthy LDL

- only for pts with super high triglycerides (greater than 500) who cannot tolerate other drugs

-requires high doses with serious adverse reactions

adverse effects of niacin

hepatoxicity: facial flushing, gastric irritation, INCREASES BLOOD SUGAR

contraindications of niacin

-liver issues

-stomach ulcers

THESE DRUGS SHOULD NOT BE COMBINED TOGETHER

- fibrate + statin --> severse myopathy (rhabdomyolysis)

- niacin + staton --> hepatotoxicity (lots of these drugs discontinued)