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