Pharm Exam #4: Cholesterol Drugs

Hyperlipidemia

elevated blood lipids

- major risk factor for CAD and atherosclerosis

- narrowing of arterial wall by build up of hard, thick deposits and stiffening of arterial walls

Metabolic Syndrome

Places a person at higher risk for CVD

central obesity

high BP

high triglycerides

low HDL

insulin resistance

HMG-CoA Inhibitor

atorvastatin

Indications Atorvastatin

Lower total cholesterol, lower LDLs, improve vascular endothelium function, stabilize plaques in vessels

MOA of Atorvastatin

works on hepatic enzymes to reduce rate of cholesterol production

Contraindications for Atorvastatin

Unexplained elevated LFTs

Liver disease

Adverse effects of Atorvastatin

Muscle aches

HA

Elevated LFTs

Rhabdomyolysis

Nursing Considerations for Atorvastatin

best taken at bed time

report muscle aches and pains

Gemfibrozil and Fenofibrate

Fibric Acid Derivatives / Fibrates

MOA of Gemfibrozil

Activate Lipoprotein lipase

Decrease triglycerides

Decrease VLDLs

Increase HDLs

Increase plasma fibrinolysis

Contraindications for Gemfibrozil

Cirrhosis

Liver disease

Severe CKD

Gall bladder disease

Pregnancy cat C

Adverse effects of Gemfibrozil

N/V/D

Increase risk of Gallstones ***

urinary retention

hematuria

drowsiness, dizziness

Nursing considerations for Gemfibrozil

Can enhance action of oral anticoagulants **

Careful adjustment of warfarin required***

Increased risk of Rhabdo if used with statins

Blood dyscrasias: monitor CBC, LFTs, Bili, and Lactic Acid

Ezetimibe

Cholesterol Absorption Inhibitor

Ezetimibe importance

selectively inhibits absorption of cholesterol from the small intestine

enhanced effect when given with statin

contraindications for ezetimibe

severe liver disease

concurrent use with fenofibrates

Cholestyramine

Bile Acid Sequestrant

MOA of Cholestyramie

Binds with bile acid in the intestines

Lower bile acid prompts cholesterol to be used to make more bile acid

Increases LDL receptors on the liver

Used for hyperlipidemia

Contraindications for Cholestyramine

Biliary obstruction

Bowel obstruction

Phenylketonuria

Adverse effects of Cholestyramine

Constipation

Heart burn

bloatin g

nausea

tinnitus

HA

Nursing Considerations for Cholestyramine

Many drug interactions

Other meds given hour before or 4-6hrs after

Very bad taste

Increased fiber and use psyllium lax

increased fluids

high doses may decrease absorption of fat soluble vitamins