Antihyperlipidemic Medications Overview Unit 6.3

Antihyperlipidemic & Vasodilators

• Lipoproteins Review:
  • High-density lipoprotein (HDL) is healthy; it removes cholesterol from the blood and transports it to the liver for elimination.
  • Low-density lipoprotein (LDL) is lethal; it contains a high percentage of cholesterol.
  • Very low-density lipoprotein (VLDL) contains mostly triglycerides and 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 the diet.
• Reduce total fat intake to 30% or less of caloric intake.
• Reduce cholesterol intake to 300 mg/day or less.
• Exercise.
• Stop smoking.

Types of Antilipidemics

• Statins (HMG-CoA reductase inhibitors): Inhibit the enzyme HMG CoA reductase, reducing cholesterol synthesis. Decreases LDLs and increases HDLs.
• Bile-acid sequestrants
• Fibrates (fibric acid)
• Nicotinic acid
• Cholesterol absorption inhibitor

HMG-CoA Reductase Inhibitors (Statins)

• Uses: Hyperlipidemia (high cholesterol).
• Action: Inhibit the enzyme HMG CoA reductase in cholesterol biosynthesis. Decreases LDLs, increases HDLs.
• Side Effects:
  • Rare to have side effects; includes GI issues, headache, photosensitivity, cataracts, liver impairment, hyperglycemia, and rhabdomyolysis (skeletal muscle disorder).
• Contraindications:
  • Active liver disease
  • Pregnancy
• Caution:
  • History of liver disease
  • Alcohol use
• Interactions:
  • Antacids

Nursing Process: Statins

• Assessment:
  • Assess vital signs and baseline serum cholesterol levels.
  • Assess liver function.
  • Obtain a medical/medication history.
  • Pregnancy test.
• Nursing Interventions/Teaching:
  • Monitor the client's blood lipid levels and liver function.
  • Observe for signs/symptoms of GI upset.
  • Report unexplained muscle tenderness, weakness, fever, and malaise.
  • Inform the client that it may take several weeks or months for blood lipid levels to decline, and the importance of medication compliance.
  • Advise the client to take the medication at bedtime.
  • Advise the client on a low-fat/low-cholesterol diet.
  • Instruct the client to have annual eye examinations and report changes in visual acuity.
  • Do not stop the medication abruptly.

Peripheral Vascular Disease

• Causes: Arteriosclerosis, hyperlipidemia.
• Signs/Symptoms: Numbness, coolness, and pain in extremities; claudication, leg ulcers.
• Treatment: Peripheral vasodilators like cilostazol to increase blood flow.

Drugs to Improve Peripheral Blood Flow - Cilostazol

• Action: Causes peripheral vasodilation; inhibits platelet aggregation (weakly).
• Use: Intermittent claudication and other peripheral vascular diseases.
• Side effects: Dizziness, headache, GI distress, peripheral edema, tachycardia, palpitations, possible bleeding, and orthostatic hypotension.
• Contraindications: Severe heart failure, bleeding disorders, and liver/renal disease (use with caution).
• Interactions: Other drugs that cause vasodilation or bleeding, grapefruit juice.
• Nursing Process:
  • Assessment: Obtain baseline vital signs, assess for signs of inadequate blood flow to extremities, and obtain medication/medical history.
• Nursing Interventions:
  • Monitor vital signs (especially blood pressure and heart rate).
  • Inform clients that a desired therapeutic response may take 1.5-3 months.
  • Advise clients not to smoke or ingest alcohol.
  • Encourage clients to change positions slowly.
  • Take with food, not with grapefruit juice.

Practice Questions

• Practice Question #1: A client's serum lipids (cholesterol, LDL, HDL) are slightly outside the desirable range.
• Practice Question #2: Rhabdomyolysis is a serious adverse reaction to atorvastatin calcium.
• Practice Question #3: Cilostazol is an antiplatelet drug for peripheral vascular disease.
• Practice Question #4: Ginkgo biloba is a commonly used herb for intermittent claudication, though it's not FDA-approved.