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Chapter 22

Lipid Disorders

What should patients do before starting pharmacotherapy for hyperlipidemia? Patients should seek to control the condition through lifestyle changes such as a restriction of dietary saturated fats and cholesterol, increased exercise, decreased alcohol consumption, and smoking cessation.
What is hyperlipidemia? General term, meaning high levels of lipids in the blood. Major rick for cardiovascular disease.
What is hypercholesterolemia? Elevated blood cholesterol, a type of hyperlipidemia and the most known to the general public.
What is Dyslipidemia? Is the term used to refer to abnormal (excess or deficient) levels of liproproteins.
What is HDL? High-density lipoprotein, contains the most apoprotein, up to 50% by weight.
What is LDL? Low-density lipoproteins, carries the highest amount of cholesterol.
What are triglycerides? First class of lipids, neutral fats, they account for 90% of total lipids in the body. Provide fuel for the body during times of energy need.
What are phospholipids? They are essential to building plasma membranes. The best known phospholipids are lecithins, which are found in high concentration of eggs yolks and soybeans. (2nd class)
What are steroids? Third class of lipid, has a common chemical structure called the sterol nucleus, or ring structure. Cholesterol is the most widely known of the steroids.
What is atherosclerosis? A disease of the arteries characterized by the deposition of plaques of fatty material on their inner walls.
What is cholesterol? Is a natural and vital component of plasma membranes. Cholesterol serves as a building block for a number of essential biochemicals, including vitamin D, bile acids, cortisol, estrogen, and testosterone. Main cause of atherosclerosis.
What are lipoproteins? What are the three classes of lipoproteins? Consist of varies amount of cholesterol, triglycerides, and phospholipids, along with a protein carrier. (Apoprotein) 3 clasess are HDL, LDL, VLDL.
What is VLDL? Very low-density lipoprotein, is the primary carrier of triglycerides in the blood. Through a series of steps VLDL is reduced in size to become LDL.
When should a patient take Statins? Take with evening meal; avoid grapefruit juice, which could inhibit the drug's metabolism, leading to toxic levels.
When should a patient take Bile Acid Sequestrants? Take before meals with plenty of fluids, mixing powders or granules thoroughly with liquid. Take other medications 2 hours before, or 4 hourse after, the bile acid sequestrant is taken.
When should a patient take Niacin? Take with cold water to decrease flushing. Take one adult-strength (81-325 mg) aspirin 30 minutes before the niacin dose.
When should a patient take Fibric Acid Agents? Take with a meal.
What should you encourage patients to eat to prevent lipid disorders? (Intervention) Encourage increased intake of omega-3 and coenzyme Q10-rich foods (e.g. fish such as salmon and sardines, nuts, extra virgin olive and canola oils, beef and chicken.)
What should you advise patients receiving lipid-lowering pharmacotherapy when long term therapy is used? Ensure adequate intake of fat-soluble vitamins (A,D,E,K) and folic acid in the diet or consider supplementation.
What adverse effects should the patient report of Statins? Report unusual or unexplained muscle tenderness, increasing muscle pain, numbness, or tingling of extremities, or effects that hinder normal ADL activities.
What adverse effects should the patient report of Bile Acid Sequestrants? Report severe nausea, heartburn, constipation, or straining with passing stools. Any tarry stools or yellowing of sclera or skin.
What adverse effects should the patient report for Niacin? Report flank, joint, or stomach pain, or yellowing of sclera or skin.
What adverse effects should the patient report for Fibric Acid Agents? Report unusual bleeding or bruising, right upper quadrant pain, muscle cramping, or changes in the the color of the stool.
How do Statin drugs work? They inhibit HMG-CoA reductase, which is a critical enzyme in the biosynthesis of cholesterol. These agents are safe and effective for most patients and are drugs of choice in reducing blood lipid levels.
How do Bile Acid Sequestrant drugs work? They bind bile and cholesterol and accelerate their excretion. Can reduce cholesterol and LDL levels but are not drugs of choice due to adverse effects.
How is Niacin effective in treating hyperlipidemia? When given in large amounts it can be effective at lowering LDL cholesterol. Not a drug of first choice, but is sometimes combined in smaller doses with statins.
How do Fibric Acid drugs work? Lower triglyceride levels but have a little effect on LDL. They are not preferred drugs because of their potential side effects.
What is a newer class of antilipidemic drugs? Ezetimibe (Zetia), which acts by inhibiting the absorption of cholesterol across the small intestine. Its role in treating hyperlipidemia is in combination with statins to achieve an addititive reduction in LDL cholesterol.
What are the adverse effects of Statin drugs? Headache, dyspepsia (indigestion), abdominal cramping, myalgia (pain in the muscle), rash or pruritus(severe itching of the skin). Rhabdomyolysis, severe myositis (inflammation degeneration of muscle tissue), elevated hepatic enzymes.
What is Rhabdomyolysis? Is a breakdown of muscle fibers/the destruction of striated muscle cells. Unknown how it is caused by drugs given (statin, fibric acid agents, cholesterol absorption inhibitor Ezetimibe) could cause fatal acute renal failure.
What are the adverse effects of Bile Acid Sequestrants? Constipation, nausea, vomiting, abdominal pain, bloating, dyspepsia(indigestion). Gastrointestinal (GI) tract obstruction, vitamin deficiencies due to poor absorption.
What are the adverse effects of Fibric Acid Agents? Myalgia (pain in the muscle), flu-like symptoms, nausea, vomiting, increased serum transaminase and creatine levels. Rhabdomyolysis, cholelithiais(formation of gallstones), pancreatitis (inflammation of the pancrease).
What are the adverse effects of Cholesterol Absorption Inhibitor Ezetimibe? Arthralagia (pain in the joint), fatigue, upper respiratory tract infection, diarrhea, elevation of hepatic enzymes. Rhabdomyolysis.
What are the adverse effects of Niacin? Flushing and hot flashes, nausea, excess gas, pruritus (severe itching of the skin), headache, bloating diarrhea .Hepatoxicity and goat. Dysrhythmias.
Created by: alexis8787



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