Antihyperlipidemic and Vasodilators

• Antihyperlipidemic and Vasodilators

Lipoproteins

• Lipoproteins are reviewed
• Major categories of lipoproteins include:
  • High-density lipoprotein (HDL): "H for healthy," removes cholesterol from the blood, and transports cholesterol to the liver for elimination.
  • Low-density lipoprotein (LDL): "L for lethal," contains a higher percentage of cholesterol.
  • Very low-density lipoprotein (VLDL): contains mostly triglycerides, less cholesterol.
  • Chylomicrons: Contain mostly triglycerides and transport fatty acids and cholesterol to the liver.

Nonpharmacologic Methods for Cholesterol Reduction

• Reduce saturated fats and cholesterol in diet
• Reduce total fat intake to 30% or less of caloric intake
• Reduce cholesterol intake to 300 mg/day or less
• Exercise regularly
• Stop smoking

Types of Antilipidemics

• Hepatic 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins)
• Bile-acid sequestrants
• Fibrates (fibric acid)
• Nicotinic acid
• Cholesterol absorption inhibitor

HMG CoA Reductase Inhibitors (Statins)

• Used for hyperlipidemia (high cholesterol)
• Inhibit the enzyme HMG CoA reductase in cholesterol biosynthesis.
• Decrease LDLs and increase HDLs
• Abrupt discontinuation may lead to a rebound effect.
• Side and adverse effects are rare, but can include GI issues, headache, photosensitivity, cataracts, liver impairment, hyperglycemia, and rhabdomyolysis (skeletal muscle disorder).
• Contraindications include active liver disease and pregnancy
• Caution is advised with a history of liver disease and alcohol use
• Interactions can occur with antacids

Statins Nursing Process - Assessment

• Assess vital signs and baseline serum cholesterol levels.
• Check liver function
• Obtain a medical/medication history
• Perform a pregnancy test.

Statins Nursing Process - Interventions/Teaching

• Monitor blood lipid levels and liver function
• Observe for signs and symptoms of GI upset
• Report unexplained muscle tenderness, weakness, fever, and malaise
• Inform the client that it may take several weeks or months before blood lipid levels decline
• Stress the importance of compliance and to take medications at bedtime
• Follow a low-fat/low-cholesterol diet
• Instruct the client to have annual eye examinations and report any changes in visual acuity
• Avoid abrupt cessation of medication

Peripheral Vascular Disease

• Peripheral vascular disease can be caused by arteriosclerosis and hyperlipidemia
• Signs and symptoms include numbness, coolness, pain in extremities, claudication, and leg ulcers
• Peripheral vasodilators, such as cilostazol, can increase blood flow

Cilostazol - Drugs to Improve Peripheral Blood Flow

• Action: Peripheral vasodilation
• Weakly inhibits platelet aggregation
• Used for intermittent claudication and other peripheral vascular diseases
• Side effects/Adverse Reactions include dizziness, headache, GI distress, peripheral edema, tachycardia, palpitations, possible bleeding, and orthostatic hypotension.
• Contraindications include severe heart failure and bleeding disorders
• Caution: Liver and renal disease
• Interactions: Other drugs that cause vasodilation or bleeding, grapefruit juice

Cilostazol Nursing Process

• Assessment:
  • Obtain baseline vital signs for future comparison
  • Assess for signs of inadequate blood flow to extremities
  • Obtain medication/medical history.
• Interventions
  • Monitor vital signs.
  • Inform client a desired therapeutic response may take 1.5 to 3 months.
  • Advise client not to smoke or ingest alcohol.
  • Encourage client to change position slowly and frequently to avoid orthostatic hypotension
  • Take with food, but avoid grapefruit juice.

Practice Questions

Practice Question #1

• A client’s serum lipids show the following: cholesterol 197 mg/dL, LDL 110 mg/dL, HDL 35 mg/dL.
• Answer: Cholesterol is within desirable value, but LDL and HDL are not.
  • The normal range for cholesterol is 150 to 200.
  • The normal range for LDL is less than 100.
  • The normal range for HDL is 45 to 60.

Practice Question #2

• A nurse is administering atorvastatin calcium.
• Answer: Rhabdomyolysis
  • Serious adverse reactions of atorvastatin include rhabdomyolysis, myalgia, photosensitivity, and cataracts.
  • Less serious side effects include headache, rash, pruritus, constipation, diarrhea, sinusitis, and pharyngitis.

Practice Question #3

• A client is receiving medication therapy for peripheral vascular disease.
• Answer: Cilostazol
  • Cilostazol (Pletal) is an antiplatelet drug.
  • Papaverine (Para-Time) is a direct-acting peripheral vasodilator.
  • Prazosin (Minipress) is an alpha blocker.
  • Nifedipine (Procardia) is a calcium channel blocker.

Practice Question #4

• Which herb is most often associated with the treatment of intermittent claudication?
• Answer: Ginkgo biloba
  • Taken with an antiplatelet drug, has been used to treat intermittent claudication, because of it's vasodilating and antioxidant effects, but has not been approved by the FDA.

This lesson reviews lipoproteins, including HDL, LDL, VLDL, and chylomicrons. It also covers nonpharmacologic methods for cholesterol reduction, such as diet and exercise. Finally, it describes types of antilipidemics.