CAD and dyslipidemia drugs 1262

Atorvastatin class, moa, use

HMG-CoA reductase inhibitor (statin)

Hyperlipidemia; lowers LDL cholesterol

Inhibits HMG-CoA reductase, an enzyme responsible for cholesterol synthesis in the liver → increases removal of LDL from the blood

Atorvastatin A/E- major complications

GI upset, flatulence, abdominal pain, cramping

Elevated liver enzymes, rare liver failure, severe myopathy, and rhabdomyolysis

Can cause hepatitis but show now symptoms

Check CK serum if myopathy is suspected

Atorvastatin nursing considerations- education, drug interactions, when to administer, contraindications

Grapefruit can inhibit metabolism and increase atorvastatin exposure

Not for people with liver disease, pregnancy category X, not for asian patients

Clients need to report joint pain

Give at night for the short half life

Statins lower LDL by 50% and increase HDL by 10% and decrease triglycerides by 15%

Admin cholestyramine 4 hours before if they are adjunct

Cholestyramine class, use, moa,

Bile acid sequestrates

To decrease cholesterol levels,

Decrease ldl by 20%- second line therapy to statins

Creates a bile acid fatty complex that binds cholesterol-

Ends up lowering ldl in the blood

Also is a powder not a pill

Cholestyramine A/E major complications

Constipation, bloating, nausea

Fecal impaction, increased bleeding risk, and fat-soluble vitamin deficiencies

Decreases absorption of fat-soluble vitamins A, D, E, and K

Cholestyramine Nursing considerations- education, drug interactions, contraindications

Not for allergy or biliary obstructed people,

This prevents absorption of fat soluble vitamins and many drugs

Must give other meds 1 hour before or 4-6 hours after

Ezetimibe class, use, MOA

Cholesterol absorption inhibitor- ADJUNCT to statin or fenofibrate

Hypercholesterolemia; lowers LDL cholesterol, often combined with statins

Blocks cholesterol absorption in the small intestine → less cholesterol reaches the liver → liver removes more LDL from the blood

Ezetimibe A/E major complications

Diarrhea, abdominal discomfort, fatigue

Elevated liver enzymes and myopathy, especially when combined with statins

Ezetimibe nursing considerations- general info

Space out 2 hours before or 4 hours after bile sequestrates

Risk of myopathy and liver dysfunction when using statins in adjunct

Evolocumab class, use, MOA,

PCSK9 inhibitor; monoclonal antibody

Lowers LDL cholesterol; primarily used in familial hypercholesterolemia. adjunctive use with statins and fiberate

Binds and inhibits PCSK9, preventing destruction of LDL receptors in the liver → more LDL receptors remain available to remove LDL from the blood

injection

Evolocumab A/E- nursing considerations

Injection-site reactions, allergic reactions, and infection risk

Allergy is the biggest risk- rash, itching and vasculitis

Injection every 2-4 weeks

Gemfibrozil class, use, moa

Fibrate

Severe hypertriglyceridemia; lowers VLDL by up to 50% and increases HDL

Activates lipoprotein lipase, increasing the elimination of triglyceride-rich particles from the blood

Gemfibrozil a/e major complications

Dyspepsia, diarrhea, abdominal pain

Gallstones (cholelithiasis), myopathy, and hepatotoxicity

Gemfibrozil nursing considerations- contraindications, labs, education

Not for Hepatic impairment and gallbladder disease

Combining with statins increases the risk of myopathy and rhabdomyolysis

• monitor CK if muscle injury is suspected ⬆

Niacin class, use, moa

Vitamin B3; high prescription doses are used to treat hyperlipidemia

Inhibits the release of free fatty acids from adipose tissue, reducing triglyceride production

Niacin A/E major complications

Intense flushing, hot flashes, nausea, and abdominal pain

Hyperuricemia → gout;

Niacin education and general considerations

Take one ASA 30 minutes before niacin to reduce flushing

Given at bed time

lovaza class, use, moa

Omega-3 Fatty Acids

Treatment of elevated triglycerides; used alongside diet and exercise

Decreases triglyceride synthesis in the liver, reducing circulating triglyceride levels

Lovaza genral information

Decreaes chance of death to mi and stroke

PROLONGS BLEEDING TIME

needs to be combined with diet and exercise

General info on the lipid drugs- basic outline

Medication	Main Effect / MOA	Major Adverse Effects & Complications
Atorvastatin (Statin)	↓ LDL by inhibiting HMG-CoA reductase	Rhabdomyolysis, myopathy, hepatotoxicity
Cholestyramine (Bile Acid Sequestrant)	↓ LDL by preventing bile acid reabsorption	Constipation, fecal impaction, fat-soluble vitamin deficiencies
Ezetimibe (Zetia)	↓ LDL by blocking cholesterol absorption in the small intestine	GI upset, myopathy and liver dysfunction (especially with statins)
Evolocumab (PCSK9 Inhibitor)	↓ LDL by preventing LDL receptor destruction	Allergic reactions, injection-site reactions
Gemfibrozil (Fibrate)	↓ Triglycerides by activating lipoprotein lipase	Gallstones, myopathy, hepatotoxicity
Niacin (Vitamin B3)	↓ LDL and triglycerides; ↑ HDL	Flushing, hyperuricemia → gout
Lovaza (Omega-3 Fatty Acids)	↓ Triglycerides by reducing hepatic triglyceride synthesis	Prolonged bleeding time, GI disturbances

Genetic: Familial hypercholesterolemia. Lifestyle: Sedentary lifestyle, unhealthy diet, smoking, excessive alcohol. Medical: Diabetes, obesity, hypothyroidism, CKD. Other: Increasing age, male sex, stress, minority populations

Intake o f saturated fats and cholesterol

Metabolic Syndrome — Definition & Diagnostic Criteria

Cluster of conditions associated with obesity, inactivity, and insulin resistance that increases risk of heart disease, stroke, and type 2 diabetes. Diagnosis requires ≥3 of 5: (1) Large waist ≥40 in men/≥35 in women, (2) high triglycerides, (3) low HDL <40 men/<50 women, (4) hypertension, (5) elevated fasting glucose.

Stable Angina

Predictable chest pain triggered by exertion, emotional stress, or cold. Caused by fixed coronary artery narrowing from atherosclerosis. - same length, pain- expected

Unstable Angina

Unpredictable chest pain, often occurring at rest or becoming more frequent/severe. Caused by reduced coronary blood flow, often from plaque disruption and thrombus formation. Medical emergency because it can precede an MI.

Variant Angina (Prinzmetal)

Chest pain caused by a sudden coronary artery vasospasm, rather than fixed plaque narrowing. Can occur at rest and temporarily restrict blood flow to the myocardium.

CAD & Stable Angina — Pathophysiology- just for understanding

High LDL → arterial inflammation → smooth muscle and calcium accumulation → fibrous plaque → narrowed coronary arteries → reduced O₂ supply. Stable angina occurs when myocardial O₂ demand exceeds supply. Plaque rupture can trigger a thrombus → MI.

Smoking effects CAD

Nicotine: ↑ catecholamines, HR, BP, platelet aggregation; ↓ HDL. Carbon monoxide: Forms carboxyhemoglobin → ↓ O₂ delivery and cardiac contractility, ↑ dysrhythmia risk. Together, they increase the risk of MI, stroke, hypertension, and sudden death.

Nitroglycerin class, use, moa

Nitrate

Treat acute angina attacks and prevent predictable exertional angina

Dilate veins and arteries, reducing preload and afterload, which decreases myocardial oxygen demand

Nitroglycerine A/E major complications

Headache, dizziness, flushing, sweating, pallor, contact dermatitis

Severe hypotension, orthostatic hypotension, reflex tachycardia, syncope

Nitroglycerine nursing considerations, contraindications, drug interactions, when to administer

hold if SBP <90 mmHg or HR >100 bpm

PDE-5 inhibitors (e.g., sildenafil) can cause life-threatening hypotension

Long-acting nitrate regimens generally require a 10–12-hour nitrate-free interval- tolerance can build

: Nitroglycerin every 5 minutes for up to 3 doses is the traditional dosing rule, but persistent chest pain after the first dose requires emergency escalation—not waiting for the third dose.

atenolol class, use, moa

Beta blocker, prophylaxis treatment of angina- prevent attacks, Selectively blocks beta-1 receptors, decreasing HR, contractility, BP, and myocardial oxygen demand

Atenolol a/e major complications

Bradycardia, hypotension

Severe bradycardia, bronchospasm, worsening cardiac conduction abnormalities

Black box warning: Abrupt withdrawal may worsen angina and increase the risk of ventricular arrhythmias or MI

Atenolol special considerations, education, contraindications,

Contraindicated for bradycardia, heartblock, asthma

Can mask hypoglycemia symptoms, particularly tachycardia and palpitations

Assess HR and BP before administration; monitor for symptomatic bradycardia and hypotension

nifedipine, class, use, moa

Calcium channel blocker

Stable and variant angina, hypertension, Raynaud phenomenon;

This one is peripheral acting

Blocks calcium influx into vascular smooth muscle → peripheral and coronary vasodilation- lowers BP- no affect on HR

Nifedipine A/E major complications

Headache, flushing, dizziness, peripheral edema, nausea, constipation

Gingival hyperplasia (gum overgrowth)

Orthostatic hypotension, reflex tachycardia

Nifedipine nursing considerations, food and drug, contraindications,

Grapefruit can increase nifedipine concentrations and intensify hypotension

Hypersensitivity- not for these peeps

Diltiazem class, use, moa

Calcium channel blocker

Blocks calcium entry into myocardial and arterial smooth muscle cells → vasodilation and decreased cardiac contractility

Treatment of chronic angina

Diltiazem A/E major complications

Headache, dizziness, nausea/vomiting, flushing, peripheral edema, rash

Bradycardia, hypotension, heart block

Diltiazem nursing considerations, contraindications, drug interactions

Allergy, heart block sick, sinus syndrome

Do not mix digoxin 

Lisinopril class, use, moa

ACE inhibitor

Decrease cardiac workload

Reduces production of angiotensin II  causes vasodilation

 decreases afterload  improves cardiac output

Reduces production of angiotensin II  reduces fluid

retention  decreases preload

Decreases afterload- easier to pump-

Decrease fluid volume- preload- drops BP

Lisinopril A/E major complications

Dry cough, hypotension, dizziness/syncope

Hyperkalemia and angioedema

Rapid swelling of the face, lips, tongue, or throat that can obstruct the airway

losartan class, use, moa

Block angiotensin II at the receptor site  causes

vasodilation  decreases afterload  improved CO

Reduces secretion of aldosterone  prevents sodium

and water retention  reduces preload  improved

CO

ARBS

used to lower BP

For people who can’t tolerate the cough or angioedema of lisinopril

Losartan A/E major complications

Lower chance for angioedema still can happen

Acute renal failure

hypokalemia and edema- common in people with impaired kidneys

Ranolazine nursing considerations, contraindications, drug interactions

Not for pre-existing prolonged QT intervals, hepatic impairment, pregnancy lactation

Interactions: don’t mix with cyclosporine, diltiazem, digoxin and vepramil- i don’t think we need to know this shit but maybe

Ranolazine use, class, moa

Piperazine acetamide antianginal agent

Chronic angina; not used for immediate relief of acute chest pain

MOA unkown- decreases myocardial workload and Oxygen demand

Ranolazine A/E

QT interval prolongation