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pharm exam 3: lipid lowering drugs

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
Created by: 1818554924