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Lipid Lowering Drugs
| Question | Answer |
|---|---|
| Fats are broken down in the small intestine into ___________. | Triglycerides |
| Triglycerides are packaged into ___________ which are then absorbed and delivered to the liver. | Chylomicrons |
| Healthy Cholesterol | High Density Lipoproteins |
| Bad Cholesterol | Low Density Lipoproteins and Very Low Density Lipoproteins |
| What is the function of Acetyl Coenzyme A Reductase? | An enzyme that performs the final step in cholesterol synthesis. |
| Which drug class(es) is/are used when Triglycerides are too high? | Fibric Acid Derivatives |
| Which drug class(es) is/are used when triglycerides are high and HDLs are low? | Statins & Niacin Derivatives |
| List three circumstances that would initiate antilipidemic drug prescription. | 1. If lifestyle changes fail to fix the problem 2. Diabetes Mellitus 3. Previous myocardial infarction or angina |
| What is another name for Statin Drugs? | HMG CoA Reductase Inhibitors |
| Statins are the primary drug class for what? | LDL reduction, they reduce LDL by up to 60% |
| Give three examples of specific Statin Drugs. | Lipitor (atorvastatin), Zocor (simvastatin), Crestor |
| Statins decrease the risk of three potentially lethal conditions, what are they? | myocardial infarction (IM), coronary heart disease (CAD), stroke |
| How do Statins work? | Decrease the function of HMG CoA Reductase (remember, the enzyme that performs the final step in cholesterol synthesis). This increases LDL receptors in the liver allowing HDL to bring more bad cholesterol from the tissues to the liver. |
| What time of day are Statins usually taken...why? | Evening, because most body cholesterol is produced at night |
| What foods/drugs should be avoided when taking Statins? Why? | Grapefruit Juice, Erythromycin, and some antifungals are CYP450 enzyme inhibitors, which can cause toxicity for drugs metabolized by these enzymes, such as Statins. |
| Im pregnant, should I be taking Statins? | No bitch! Statins are pregnancy category X, therefore women of childbearing age should be warned that they will be required to be on birth-control with Statin therapy. |
| List side effects associated with Statins. | G.I. Related (N/V, flatulence, constipation), Myopathy (myalgia, myositis), Hepatotoxicity |
| What is the difference between Myalgias, and Myositis? | Myalgias is muscle pain that goes away in a few days. Myositis is muscle pain that does NOT go away and gets worse, eventually the muscle can rupture releasing myoglobin. The myoglobin then clogs the glomerulus causing acute renal failure (rhabdomyolysis) |
| What is Rhabdomyolysis? | Renal failure caused by myoglobin |
| What tests should be performed prior to Statin therapy? | Liver function tests (ensure that ALT & AST are normal), Pregnancy test (remember, statins are pregnancy category X), LDL value (so progress can be followed) |
| Your patient Sally McFaggit is complaining of severe muscle pain. As the awesome nurse that you are, what action do you take? | Check the CPK (creatinine phosphokinase) level. CPK is released when muscles rupture, so this test determines if the patient is experiencing myositis. |
| Miley Cyrus is your patient and has just been prescribed a Lipitor (atorvastatin). What do you include in your patient teaching...because is would be a shame is Miley had a lethal drug interaction... | Teach her to report abdominal pain and muscle aches, and to stay away from CYP450 inhibitors (grapefruit juice, erythromycin). Your patient is female so inform her that she will need to be put on birth-control. |
| Are Bile Acid Sequestrants absorbed systemically or locally? | Locally in the G.I. Tract |
| How do Bile Acid Sequestrants work? | They cause the liver to use excess cholesterol, decreasing LDLs by 15-30%. |
| Name specific Bile Acid Sequestrant drug(s). | Welchol (colesevelam) |
| What should you keep in mind for patients taking Bile Acid Sequestrants with other medications? | Bile Acid Sequestrants should be separated from other drugs, because BASs will bind to other drugs and not be absorbed. Therefore other meds should be taken 1 hr. before or 4 hrs. after BASs. |
| Bile Acid Sequestrants decrease the absorption of what? Why is this a big deal? | Vitamins A, D, E, K. Decreased D can cause osteoporosis, decreased A can cause blindness, decreased E can cause heart disease, and decreased K can cause bleeding. |
| What are some side effects of Bile Acid Sequestrants? | N/V, flatulence, constipation, bloating, bowel obstruction |
| How can the side effects of Bile Acid Sequestrants be minimized? | drinking water, eating fiber, working up to the prescribed dose |
| List symptoms of Bowel Obstruction | severe abdominal pain, vomiting, diarrhea, severe constipation |
| Nicotinic Acid is used to treat what? | mixed hyperlipidemia (high triglycerides and LDLs, and low HDLs) |
| Give examples of specific Nicotinic Acids. | Niaspan, Slo-Niacin |
| List side effects of Nicotinic Acids | G.I. Related (burning of stomach, N/V, diarrhea), Increase PUD symptoms, Hyperglycemia, Skin (burning, itching, flushing), Worsen Gout, Hepatotoxicity |
| How can you prevent the skin side effects of niacin? | take 1 aspirin 30 minutes before niacin |
| The risk of hepatoxicity is increased with what factors in niacin therapy? | brand of niacin is changed, or sustained release niacin is used |
| How do Fibric Acid Derivatives Work? | decrease the production of triglycerides and increase their breakdown in the liver |
| What are Fibrates used to treat? | hypertriglyceridemia, and hypercholesterolemia, and CAD prevention in diabetics |
| List side effects of Fibrates | GI (N/V), Cholelithiasis (Gallstones), Myalgia & Myositis, hepatotoxicity |
| Concurrent use of Fibrates with Statins or Niacin increases the risk of what side effects? | Myalgia & Myositis, and Hepatotoxicity |
Created by:
littlejohnson
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