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Pharm1 Chapter28
| Question | Answer |
|---|---|
| Antilipemic | A drug that reduced lipid levels |
| apolipoprotein | The protein component of a lipoprotein |
| cholesterol | A fat-soluble crystalline steroid alcohol found in animal fats and oils and egg yolk and widely distributed in the body. |
| Chylomicrons | Minute droplets of lipoproteins |
| Exogenous lipids | Lipids originating outside the body or an organ or produced as the result of external causes. |
| Foam cells | The characteristic initial lesion of atherosclerosis |
| fatty streak | Foam cells |
| HMG-CoA reductase inhibitors | a class of cholesterol-lowering drugs that work by inhibiting the rate-limiting step in cholesterol synthesis |
| Statins | HMG-CoA reductase inhibitors |
| Hypercholesterolemia | a condition in which greater-than-normal amounts of cholesterol are present in the blood. |
| Lipoprotein | Conjugated protein in which lipids form an internal part of the molecule |
| Triglycerides | Compound consisting of a fatty acid and a type of alcohol know as glycerol. |
| What is the principal lipid in blood | triglycerides |
| List lipids from highest lipid content to lowest lipid content. | Chylomicron, VLDL, LDL, IDL, HDL |
| What are the two primary forms of lipids in the blood? | triglycerides and cholesterol |
| This substance is found in may areas of the body, especially in the bile, blood, brain tissue, liver, kidneys, adrenal glands, and myelin sheaths of nerve fibers. | cholesterol |
| This is the form in which dietary fats are absorbed from the small intestines. | chylomicrons |
| What conditions can hypercholesterolemia (and other lipids)lead to? | atherosclerosis and coronary heart disease |
| Where are lipoproteins synthesized? | Liver |
| What do lipoproteins contain? | varying amounts of triglycerides, cholesterol, phospholipids, and protein |
| How are lipoproteins classified? | according to their composition and density |
| This type of lipoprotein is produced in the liver and transports endogenous lipids to the cells | very low density lipoprotein (VLDL) |
| This type of lipoprotein is responsible for "recycling" of cholesterol and is know as "good cholesterol"; it is also cardioprotective. | High density lipoprotein (HDL) |
| This type of lipoprotein is known as "bad cholesterol" | Low density lipoprotein (LDL) |
| What do studies show can reduce CHD (coronary heart disease)? | drug therapy with Antilipemic agent |
| What are the risk factors for CHD? | Male 45 or older, female 55 or older, family history, current smoker, hypertension, low HDL levels, diabetes mellitus |
| What should be done for CHD before drugs are started? | all reasonable non-drug means such as diet and exercise for six months and failed. |
| S/S of metabolic syndrome | waist circumference greater than 40 in in men and 30 in in women, serum triglycerides of 150 mg/dL or more, HDL less than 40 mg/dL in men or less than 50 mg/dL in women, BP at 130/50 or higher, fasting serum glucose more than 110 mg/dL. |
| Desired total cholesterol level should be? | < 200 mg/dL |
| Desired HDL level? | > 60 mg/dL |
| Desired LDL level? | < 130 mg/dL |
| Desired triglycerides level? | < 150 mg/dL |
| What are the most potent LDL reducers? | statins |
| HMG-CoA reductase inhibitors (statins) Mechanism of action. | Inhibit HMG-CoA reductase, which is used by the liver to produce cholesterol. It lowers the rate of cholesterol production |
| What is the first line drug therapy for hypercholesterolemia? | statins (HMG-CoA reductase inhibitors) |
| Indications for using statins. | reduces LDL by 30-40%, increases HDL levels by 2-15%, reduces triglycerides by 10-30% |
| Adverse effects of statins | Headache, dizziness, blurred vision, opthalmoplegia, fatigue, nightmares, insomnia, constipation, cramps, diarrhea, nausea, changes in bowel function, Myalgias, skin rashes. |
| Two other names for bile Acid Sequestrants | Bile acid-binding resins and ion-exchange resins |
| Name three Bile Acid Sequestrants | Colesevelam (welchol), cholestyramine (Questran) and colestripol hydrochloride (Colestid) |
| bile acid sequestrants mechanism of action | prevent reabsorption of bile acids from small intestine |
| what are bile acids necessary for | absorption of cholesterol |
| indications for using bile acid sequestrants | relief of pruritus associated with partial biliary obstruction (cholestyramine) |
| can bile acid seqestrants be used with statins? | yes they can |
| adverse effects of bile acid sequestrants | heartburn, nausea, belching, bloating, bleeding, headache, tinnitus, burnt odor of urine |
| Only Questran has this common side effect. | constipation. |
| Is niacin used alone or with other drugs | both but more commonly in conjunction with other lipid lowering agents or in patients intolerant to statins |
| niacin (Nicotinic Acid) mechanism of action | thought to increase activity of lipase which breaks down lipids and reduces the metabolism or catabolism of cholesterol and triglycerides |
| indications of niacin | lower triglycerides, lower serum cholesterol levels, lower LDL and increase HDL levels |
| adverse effects of niacin | abdominal discomfort, gastrointestinal distress, Cutaneous flushing, pruritus, hyper pigmentation, blurred vision, glucose intolerance, hyperuricemia, dry eyes, and hepatotoxicity. |
| Name two fibric acid derivatives | gemfibrozil (Lopid) and fenofibrate (Tricor, Antara) |
| Mechanism of action of fibric acid derivatives | activate lipase which breaks down cholesterol, also suppresses the release of free fatty acids from adipose tissue, inhibits synthesis of triglycerides in the liver and increases the secretion of cholesterol in bile. |
| indications of fibric acid derivatives | decrease triglyceride levels, increase HDL by as much as 25% |
| Do fibric acid derivatives have an effect on cholesterol? | Not really - little to no effect. |
| adverse effects of fibric acid derivatives | nausea, vomiting, diarrhea, gallstone, acute appendicitis, impotence, decreased urine output, hematuria, increased risk for urinary track infections and viral infections, drowsiness, dizziness, rash, pruritus, alopecia, eczema, vertigo, headache |
| name a cholesterol absorption inhibitor | exetimibe (Zetia) |
| Mechanism of action of cholesterol absorption inhibitors | inhibits absorption of cholesterol and related sterols in the small intestine |
| indications of cholesterol absorption inhibitors | indicated only when patients cant tolerate a therapeutic statin dose |
| What are some contraindications of drug therapy? | biliary obstruction, liver dysfunction, active liver disease |
| what should you always obtain before starting lipid altering drugs? | baseline liver functions studies |
| what may patients on long term therapy need a supplement of? | fat-soluble vitamins A,D and K. |
| how would you instruct your patient to take their meds to avoid GI upset? | take with meals. |
| When should statins be taken for better effectiveness? | In the evening. |
| what side effect does Clofibrate have that is bothersome to the patient? | constipation. |
| what should you instruct the patient to do who has constipation? | increase fiber and fluid |
| How long will it take for antilipemic meds to take effect? | several weeks |
| The nurse is administering a bile acid sequestrant drug, and implements which action to help reduce adverse effects? | Increasing dietary fiber intake |
| when administering niacin, the nurse needs to monitor for what adverse effect? | cutaneous flushing |
| Which point is important to emphasize to a patient taking antilipemic medication? | it is important to report muscle pain as soon a possible. |
| when assessing a patient before giving a new order for an antilipemic med what condition would be a potential contraindication? | elevated liver studies |
| a patient currently taking a statin may have a higher risk of developing rhabdomyolysis when also taking what? | Gemfibrozil |
| Patients taking cholestryamine may experience what side effects? | belching and bloating |
| dietary measures for the patient on antilipemic therapy include: | taking supplements of fat-soluble vitamins; increasing fluid intake; choosing foots that are lower in cholesterol and saturated fats; increasing the intake of raw veggies, fruit and bran |
| in reviewing the history of a newly admitted cardiac patient, the nurse recognizes that which condition is a contraindication for antilipemic therapy? | liver disease |
| a patient who has started taking niacin complains that he "hates the side effects." How should the nurse respond? | "Try taking a small dose of ibuprofen or another NSAID 30 minutes before taking the niacin" |
| which lipoprotein is often called the "good cholesterol?" | HDL - High-density lipoprotein |
Created by:
cspearsall
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