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dyslipidemia
pharm exam 3: lipid lowering drugs
| Question | Answer |
|---|---|
| 3 forms of lipid in blood | triglycerides; phospholipids; cholesterol |
| work of triglycerides in cell | provide energy for cellular metabolism |
| work of phospholipids in cell | essential component of cell membrane |
| Cholesterol is a component of... | cell membrane |
| cholesterol is essential for... | steroid synthesis and to form bile salts |
| define apoproteins | carriers for blood lipids |
| define lipoprotein | lipid + apoprotein |
| How are blood lipids transported in the plasma? | by lipoproteins |
| 3 types of lipoproteins | HDL, LDL, VLDL |
| define hdl | high-density lipoprotein |
| define ldl | low-density lipoprotein |
| define vldl | very-low density lipoprotin |
| What lipoproteins carry cholesterol? | HDL and LDL |
| What lipoproteins carry triglycerides? | VLDL and chylomicron |
| Where do LDL carry cholesterol? | cholesterol to cells |
| Where do HDL carry cholesterol? | cholesterol from cells |
| Bile is necessary for what? | fats to be absorbed by the small intestine |
| What does bile do to fats? | breaks it down into micelles |
| Where are micelles absorbed? | into small intestine wall |
| What happens when dietary fats go into small intestine? | gallbladder contracts to release bile into small intestine |
| liver processes fats into what? | LDLs and HDLs |
| Where do HDLs and LDLs go after being processed by the liver? | enter circulation and reach periphery |
| define atherosclerosis | where fatty material collects along the walls of arteries; fatty material thickens, hardens (forms calcium deposits) and may block the arteries |
| define the traditional dyslipidemia | hypertriglyceridema, high LDL levels; low HDL levels; all abnormalities are metabolically linked |
| Why are LDL and VLDL cholesterols bad lipoproteins? | LDL delivers cholesterol to peripheral tissues |
| Atherosclerosis may cause... | heart disease, stroke, hypertension |
| What lipoproteins are elevated in intra-abdominal obesity? | chylomicron and VLDL remnants |
| Why is HDL the good lipoprotein? | HDL delivers cholesterol from tissues to the liver and carries LDLs away from artery walls |
| What happens under pro-atherogenic conditions? | chylomicron remnants, VLDL remnants, and small LDL deliver cholesterol to artery wall |
| define anti-atherogenic | HDL removes cholesterol from the artery wall |
| define primary dyslipidemia | genetic or familial (95% of cases) |
| define secondary dyslipidemia | dietary habit, DM, medicaitons |
| What medications can cause secondary dyslipidemia? | beta blockers; cyclosporine; oral estrogens; clucocorticoids; sertraline; thiazide diuretics; AIDS drugs (protease inhibitors) |
| treatment goals for patients with dislipidemia | low total cholesterol low bad cholesterol high good cholesterol |
| desired total cholesterol level | below 200 |
| desired LDL level | below 130 |
| desired triglyceride level | below 150 |
| desired HDL level | above 35 |
| What are the first line drug for dyslipidemia? | statins |
| What type of drug is atorvastatin (Lipitor)? | statin |
| What type of drug is lovastatin (Mevacor) | statin |
| What type of drug is simvastatin (Zocor) | statin |
| What type of drug is fluvastatin (Lipidor) | statin |
| what is the most widely used drug in the USA? | atorvastatin |
| action of statin | inhibit liver enzyme that synthesized cholesterol |
| When is cholesterol production most active | at night (2-4 AM) |
| what is the enzyme in the liver that synthesizes cholesterol? | HMG-CoA Reductase |
| Why are most statins given at night | cholesterol production is most active at night |
| what statin is not given at night? | atorvastatin |
| side effects of statins | elevated liver enzymes, myopathy, rhabdomyolysis, GI symptoms |
| Statin drug interaction | antifungal drugs, cyclosporine, verapamil, erythromycin, grapefruit juice |
| embarrassing side effects of statins | headache, flatulence, n/v, diarrhea |
| serious side effects of statins | muscle aches (myalgias); rhabdomyolysis, hepatotoxicity |
| What are considered high risk patients with statin drugs? | renal dysfunction, liver disease, polypharmacy |
| What baseline level should you obtain with high risk patients before starting statins? | CK levels |
| What are exacerbating factors for statins? | grapefruit juice, consumption, accompanying medications, herbal medications |
| What damage is rare in statin therapy? | irreversible liver damage |
| what should you monitor for statin therapy in terms of liver function | symptoms of jaundice, malaise, fatigue, lethargy |
| Should you monitor LFTs with statin therapy | no need to |
| nursing considerations with statin therapy | report therapeutic effects, take at night, caution with patients complaining of muscle symptoms, avoid giving with grapefruit juice, careful with drug-drug interactions |
| what effect do "azole" antifungals (fluconazole, itraconazole) have on lovastatin | increaase lovastatin effects |
| What effect does cyclosporine have on lovastatin? | increase lovastatin effects |
| What effect does erythromycin have on lovastatin? | increase lovastatin effects |
| What effect do fibrate dyslipidemics have on lovastation? | increase lovastatin effects |
| What effect does Niacin have on lovastatin? | increase lovastatin effects |
| What effect does alcohol cimetidine have on fluvastatin? | increase fluvastatin effects |
| What effect does ranitidine have on fluvastatin? | increase fluvastatin effects |
| What effect does omeprazole have on fluvastatin? | increase fluvastatin effects |
| What effect do bile acid sequestrant dyslipidemics have on lovastatin? | decrease lovastatin effect |
| What effect do antacids have on lovastatin? | decrease lovastatin effect |
| What effect does iradipine have on lovastatin? | decrease lovastatin effect |
| what effect does rifampin have on lovastatin? | decrease lovastatin effect |
| What effect does St. John's wort have on lovastatin? | decrease lovastatin effect |
| what type of medication is cholestyramine (Questran)? | bile acid binding agents |
| What type of medication is colesevelem (welchol)? | bile acid binding agent |
| how do bile acid binding agents lower cholesterol levels in the blood? | bind bile acids in intestine; liver consumes more cholesterol to make bile acids |
| How are bile acid binding agents eliminated? | in feces |
| Why do you mix bile acid binding agents with fluids that are easily swallowed? | may be hard to tolerate |
| How are bile acid binding agents introduced into the body? | powder mixed with water or other fluids |
| Why are bile acid binding agents given with food? | bile acid will be secreted when foods are in the small intestine |
| side effects of bile acid binding agents | increase in GI (bloating, constipation, gas) |
| What substances have decreased absorption when taking bile acid binding agents? | fat soluble vitamins (ADEK) and many other medications |
| When should bile acid binding agents be given? | 1 hour before or 4-6 hours after other medications |
| nursing considerations with bile acid binding agents | report therapeutic effects, ,take with water/fluids, avoid giving with other medications |
| role of niacin in lowering cholesterol | inhibits mobilization of free fatty acids from peripheral tissues |
| niacin dosing | start with low dose and titrate up; take at night |
| Why is niacin dosing started low and titrated up | side effects |
| what should be taken 30 minutes before taking niacin | aspirin |
| What should be avoided when taking niacin | alcohol |
| side effects of niacin | flushing of the face and neck in 85% of patients taking niacin |
| nursing roles when taking niacin | report therapeutic effects, given aspirin/ibuprofen 30 minutes before, take with cold water, observe for side effects (flushing of the neck) |
| What type of medication is fenofibrate (Tricor) | fibric acid agents |
| What type of medication is gemfibrozil (Lopid) | fibric acid agent |
| Are fibric acid agents first line cholesterol drugs? | no |
| fibric acid agents are the most effective drugs for what? | reducing serum triglycerides |
| What type of medication is ezetimibe (Zetia) | cholesterol absorption inhibitor |
| what does DOA do? | inhibits absorption of cholesterol in small intestine |
| side effects of cholesterol absorption inhibitors? | hypersensitivity reactions; rash and nausea |
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