PHM Chap 16

Drug Therapy for High Blood Lipids

Overview of Antihyperlipidemic Drugs

  • Definition: Antihyperlipidemic drugs work against high levels of lipids in the blood.

  • Usage: Often combined with dietary changes to reduce fats and cholesterol in the blood.

  • Mechanisms: Some drugs lower Low-Density Lipoprotein (LDL), while others reduce fat absorption or promote cholesterol loss in stool.

Learning Objectives for Lesson 16

Objectives 1 of 2

  • Explain antihyperlipidemic drug mechanisms: Understand how these drugs function to lower blood lipid levels.

  • Identify common drug types: Describe common names, actions, usual adult dosages, possible side effects, and adverse effects of:
      - Statins
      - Bile Acid Sequestrants
      - Cholesterol Absorption Inhibitors
      - Fibrate Drugs

  • Pre-administration actions: Discuss priority actions before and after giving drugs to lower blood lipid levels.

  • Patient education: Prioritize essential information that needs to be taught to patients on lower blood lipid medications.

Objectives 2 of 2

  • Life span considerations: Describe age-related factors influencing drug treatment for blood lipid levels.

  • Nicotinic acid specifics:
      - Identify common names, actions, usual adult dosages, possible side effects, and adverse effects of nicotinic acid.
      - Discuss priority actions before and post-administration of nicotinic acid.
      - Teach patients about nicotinic acid usage.

Cholesterol and Related Concepts

  • Cholesterol:
      - The body requires only small amounts of cholesterol.
      - Triglycerides: The chemical form of most fats in foods and human body.
      - Plasma lipids consist of cholesterol and triglycerides.

  • Hyperlipidemia: High levels of plasma lipoproteins, which can lead to health issues such as:
      - Atherosclerosis
      - Coronary artery disease
      - Hypertension
      - Pancreatitis
      - Peripheral vascular disease
      - Stroke
      - Xanthomas

Familial Hyperlipidemia

  • Definition: High blood fat levels caused by genetic factors, resulting in the liver producing excessive cholesterol and fats.

  • Clinical Implication: Lifestyle changes alone are insufficient; drug therapy is necessary.

Lipid-Lowering Drugs

Pre-administration Checks

  • Before Administering:
      - Check for a complete list of other medications.
      - Assess for history of liver or muscle issues.
      - Obtain baseline blood lipid and liver function tests (LFTs).

  • Post-administration Checks:
      - Monitor LFTs.
      - Assess symptoms indicative of muscle or liver damage.

Patient Teaching Priorities

  • Lifestyle Modifications: Include low-fat diet, exercise, and weight control.

  • Follow-up Lab Testing: Schedule tests for lipid profile and LFTs.

  • Long-term Commitment: Treatment with lipid-lowering drugs is typically lifelong.

Statins

  • Mechanism of Action: Statins inhibit HMG-CoA reductase, an enzyme that regulates cholesterol production in the body.
      - Intended Responses: Decrease total cholesterol, triglycerides, and LDL cholesterol levels.

  • Side Effects (Rare): Include upset stomach, gas, constipation, abdominal pain, cramps, musculoskeletal discomfort, and liver issues.

  • Adverse Effects: Potential for serious conditions such as rhabdomyolysis and decreased liver function.

Administering Statins

  • Before Administration:
      - Assess baseline kidney function.
      - Inquire about alcohol consumption.

  • After Administration:
      - Monitor liver function, signs of muscle breakdown, urine output, Blood Urea Nitrogen (BUN), and creatinine levels.

  • Patient Teaching:
      - Medications should be taken exactly as prescribed.
      - Grapefruit and grapefruit juice should be avoided as they can interact with statins.

Life Span Considerations for Statins

  • Pediatric Usage: May be used for children with familial hypercholesterolemia.

  • Pregnancy and Lactation: Not recommended during pregnancy or breastfeeding.

  • Older Adults: Generally safe for those without myopathy or liver diseases.

Bile Acid Sequestrants

  • Mechanism of Action: These agents bind to cholesterol in the intestine, thus preventing fat absorption.
      - Intended Responses: Decrease LDL cholesterol and increase HDL cholesterol levels.

  • Side Effects: Include gastrointestinal discomfort, nausea/vomiting, constipation, gas.

  • Adverse Effects: Can inhibit absorption of fat-soluble drugs and vitamins (A, D, E, K), and affect warfarin action.

Administering Bile Acid Sequestrants
Pre-administration Checks (1 of 2)

  • BEFORE Administration:
      - Do not administer within 2 hours post other oral medications.
      - Assess history of constipation issues.
      - Review any prescribed warfarin.

Post-administration Checks (2 of 2)

  • AFTER Administration:
      - Monitor for gastrointestinal symptoms.
      - If taking warfarin, monitor for bleeding and International Normalized Ratios (INRs).
      - Look for signs of constipation.

  • Teaching Priorities:
      - Advise patients to take other drugs at least 2 hours before or 4 to 6 hours after.
      - Instruct to take with at least 12 to 16 ounces of water to prevent bowel obstruction.
      - Should be ingested with meals to efficiently absorb intestinal cholesterol.

Life Span Considerations for Bile Acid Sequestrants

  • Pediatric Population: Avoid cholestyramine and colestipol due to risk of intestinal obstruction.

  • Pregnancy and Lactation: Considered low to moderate risk for the mother and fetus.

Cholesterol Absorption Inhibitors

  • Usage Indications: Utilized when dietary control is ineffective, when patients cannot tolerate statins, or in conjunction with statins to enhance results.
      - Intended Responses: Targeted to decrease LDL and total cholesterol levels.

  • Side Effects: Gastrointestinal disturbances, fatigue, back/joint pain, rash, sinusitis.

  • Adverse Effects (Rare): Risk of angioedema.

Administering Cholesterol Absorption Inhibitors

  • Before Administration:
      - Check for liver disease and muscle disorders.
      - Conduct liver function tests (LFTs).

  • After Administration:
      - Monitor for signs of decreased liver function, fatigue, abdominal pain, or facial swelling.

  • Patient Education:
      - Report any muscle pain, tenderness, or weakness.
      - Dosage should be taken once a day at the same time.
      - In cases of angioedema, immediate medical attention is required.

Life Span Considerations for Cholesterol Absorption Inhibitors

  • Pregnancy and Lactation: Safety has not been established; unknown if excreted in breast milk; use should only occur if potential benefits outweigh risks.

Fibrates

  • Mechanism of Action: Activate cellular lipid receptors, assisting in breaking down lipids for elimination.
      - Intended Responses: Reduces triglyceride levels and may moderately increase HDL cholesterol.

  • Side Effects (Mild): Stomach upset, diarrhea, gastrointestinal issues, muscle weakness, headache, pruritus, rash.

  • Adverse Effects: Increased creatinine levels may occur in patients with pre-existing kidney disease.

Administering Fibrates
Pre-administration Checks (1 of 2)

  • BEFORE Administration:
      - Assess history of kidney, liver, or gallbladder disease.
      - Inquire about warfarin prescriptions.
      - Check baseline kidney function and liver function tests (LFTs).

Post-administration Checks (2 of 2)

  • AFTER Administration:
      - Monitor for indications of kidney, liver, or gallbladder issues.
      - If the patient is on warfarin, observe for signs of bleeding.
      - Schedule follow-up lab tests for kidney and LFTs.

  • Teaching Priorities:
      - Take 30 minutes prior to meals.
      - Abstain from excessive alcohol consumption.
      - Grapefruit juice should be avoided due to potential interactions.
      - Report any signs/symptoms of bleeding if on warfarin.

Life Span Considerations for Fibrates

  • Pregnancy and Lactation: Considered moderate risk.

  • Older Adults: If the patient is on warfarin, there is a higher risk of bleeding complications; regular INR testing appointments should be kept.

Nicotinic Acid Agents

  • Overview: A specialized form of vitamin B.
      - Intended Responses: Effectively decrease triglyceride levels, total cholesterol, and LDL levels, while increasing HDL levels.

  • Side Effects: Includes itching, nasal inflammation, gastrointestinal symptoms, flushing, headache, dizziness, and tachycardia.

  • Adverse Effects: Risk of liver toxicity, gout, hyperglycemia, and stomach ulcers.

Administering Nicotinic Acid Agents
Pre-administration Checks (1 of 2)

  • BEFORE Administration:
      - Check baseline vital signs and liver function tests (LFTs).
      - Assess glucose levels, particularly for diabetic patients.
      - Examine for history of liver disease and diabetes.
      - Review the patient’s usual alcohol consumption.

Post-administration Checks (2 of 2)

  • AFTER Administration:
      - Monitor liver function tests (LFTs) and vital signs.
      - Regularly check glucose levels in diabetics.

  • Teaching Priorities:
      - Commence treatment with a low dose, gradually increasing as tolerated.
      - Notify the prescriber of any side effects promptly.
      - Take medication with meals to reduce gastrointestinal symptoms.

Life Span Considerations for Nicotinic Acid Agents

  • Pregnancy and Lactation: Use is of moderate risk; advised to avoid during pregnancy and breastfeeding.

Additional Information

  • Encourage questions and clarifications from students regarding this material to ensure comprehension and retention of knowledge concerning drug therapies for high blood lipids.