Cardio part 4 Adult Health

Bile Acid Sequestrants

• Lower cholesterol, especially for hyperlipidemia not responding to diet/exercise.
• These drugs prevent bile acid reabsorption by binding to bile acids in the intestine.
• Binding to bile acids prevents the liver from using them to emulsify fats.
• The liver uses more cholesterol to produce more bile acids, reducing overall cholesterol levels.
• Indicated for hyperlipidemia unresponsive to diet and exercise.
• Adverse effects include constipation, abdominal cramps, flatulence/gas, nausea, and liver damage.
• Contraindications are complete biliary obstructions and pancreatitis.
• Interactions can occur with sulfonylureas, thyroid hormones, fat-soluble vitamins, folic acid, and oral contraceptives, potentially decreasing their effectiveness or absorption.

HMG-CoA Reductase Inhibitors (Statins)

• Statins lower cholesterol by inhibiting cholesterol production in the liver.
• Statins are also known as HMG-CoA reductase inhibitors.
• Promote the breakdown of LDLs and VLDLs.
• Statins raise HDL levels.
• Inhibit cholesterol production, promote LDL and VLDL breakdown.
• Decrease LDL ("bad" cholesterol) and VLDL ("very bad" cholesterol).
• Increase HDL ("good" cholesterol).
• Used as adjunct therapy for hyperlipidemia.
• Reduce the risk of myocardial infarction (MI) in clients without evident heart disease.
• Reduce the risk of coronary death in those with heart disease.
• Adverse effects include hepatotoxicity and rhabdomyolysis.
• Monitor CPK (creatine phosphokinase) levels.

Cholesterol Management: General Considerations

• Target serum cholesterol levels should be less than 200 mg/dL.
• Cholesterol agents take time to be effective.
• Use in conjunction with diet and exercise.

Key Lab Values

• CPK (Creatine Phosphokinase) monitors for rhabdomyolysis, especially with statin use.
• CPK is primarily found in the heart, brain, and skeletal muscles.
• Elevated CPK in the blood indicates muscle damage or other medical conditions.
• CPK in general relates to muscles.
• Elevated CPK levels signify complications or muscle pain.
• Patients experiencing muscle pain should consult a doctor immediately.

Statins

• Statins lower cholesterol levels in the blood.
• Statins primarily work by inhibiting an enzyme in the liver responsible for producing cholesterol.
• Statins affect the liver and can be harmful to it.
• Regular liver function tests are essential because of the impact the drugs have one the liver.
• Liver function tests should be done at baseline and then every 3-6 months.
• Contraindicated in serious liver disorders (Category X for pregnancy), pregnancy, breastfeeding, and lactation.
• Interactions can increase the risk of myopathy (muscle disease).
• Consumption of grapefruit juice may cause toxicity.

Fibrates (Fibric Acid Derivatives)

• Lower triglyceride levels, increasing high-density lipoprotein (HDL) cholesterol levels.
• Reduce lipids by decreasing triglycerides and increasing HDL.
• Can cause mild GI issues that usually resolve.
• Other adverse effects include cholelithiasis (gallstones) and myopathy (muscle disease).
• May also cause Hepatotoxicity (liver toxicity).
• Contraindicated in hepatic (liver) disease, renal (kidney) disease, and with gallstones.
• May increase the anticoagulant effect of Warfarin.
• May increase the risk of rhabdomyolysis when used with statins.
• May increase the hypoglycemic effect of sulfonylureas.

Niacin

• Niacin (Vitamin B3) is an adjunctive therapy to lower cholesterol.
• Particularly useful for patients at risk for pancreatitis.
• Used as adjunctive therapy for those at risk for pancreatitis who need to lower cholesterol.
• Adverse effects include nausea, vomiting, diarrhea, generalized flushing, and a sensation of warmth.

Rhabdomyolysis

• Characterized by the breakdown of muscle tissue, leading to the release of muscle fiber contents into the bloodstream.
• Can cause kidney damage and other complications.
• Risk factors include certain medications, including statins and fibrates.
• Muscle pain, weakness, and dark urine are common symptoms.
• Kidney failure is a major concern.

Myopathy

• Refers to a disease of the muscles in which the muscle fibers do not function properly, resulting in muscular weakness.
• The risk of myopathy can be increased when statins are combined with other medications.
• Symptoms include muscle weakness, cramping, and stiffness.

Hepatic and Renal Disease

• Hepatic disease refers to conditions affecting the liver.
• Renal disease involves the kidneys.
• Both can significantly impact drug metabolism and excretion.
• Many cholesterol-lowering drugs are contraindicated in patients with significant hepatic or renal disease.
• Regular liver and kidney function tests are crucial for patients on these medications.

Gallstones (Cholelithiasis)

• Gallstones are hard deposits that form in the gallbladder.
• Certain medications, like fibrates, can increase the risk of gallstone formation.
• Fibrates are known to potentially cause gallstones.
• Symptoms: Abdominal pain, nausea, and vomiting
• Patients with existing gallstones may need to avoid certain cholesterol-lowering drugs.

Hypoglycemic Effect

• Hypoglycemia refers to low blood sugar levels.
• Some cholesterol-lowering medications can interact with diabetic medications to increase the risk of hypoglycemia.
• Fibrates can increase the hypoglycemic effect of sulfonylureas.
• Patients taking both types of medications should monitor their blood sugar levels closely.

Pancreatitis

• Pancreatitis is the inflammation of the pancreas.
• Niacin is sometimes used as an adjunctive therapy for patients at risk for pancreatitis who also need to lower their cholesterol.
• Niacin can be used in conjunction with other treatments for patients at risk for pancreatitis.
• Niacin helps lower cholesterol levels, which can contribute to pancreatitis risk.

Flushing and Warmth Sensation

• Niacin can cause generalized flushing and a sensation of warmth as common side effects.
• Flushing and warmth are unusual but common reactions to niacin.
• These effects can be mitigated by taking niacin with food or using extended-release formulations.

Zetia (Ezetimibe)

• Inhibits the absorption of cholesterol in the small intestine.
• Reduces cholesterol absorption.
• When combined with statins, it increases the risk of myopathy.

Important Considerations for Cholesterol-Lowering Drugs

• All cholesterol drugs affect the liver, necessitating regular liver function tests.
• Liver function tests should be done at baseline and every 3-6 months.
• Patients should be educated about potential side effects and drug interactions.
• Treatment should be tailored to the individual patient's needs and risk factors.
• Regular monitoring of lipid levels and liver/kidney function is essential.

Cholesterol-Lowering Medications: Key Considerations

• Many cholesterol-lowering drugs share similar adverse reactions and contraindications.
• Specific to some medications, blood sugar can be elevated.
• Gout is contradicted due to the potential for hypouricemia.
• Liver dysfunction is a significant contraindication, as some medications can cause hepatitis.
• Pregnancy and lactation are generally contraindicated due to potential harm to the fetus or infant.
• Some medications can cause myopathy (muscle disease).
• Patients with high cholesterol should adhere to a low-fat, low-cholesterol diet and perform moderate exercise.

Lab Monitoring

• Essential to establish baseline values for cholesterol (total, HDL, LDL, VLDL), triglycerides, liver function, and kidney function.
• Regular assessment of these labs is necessary throughout therapy to monitor drug efficacy and detect potential adverse effects.

Fibric Acid Derivatives: Specific Considerations

• Administer with food to minimize gastrointestinal (GI) upset.
• Closely monitor patients for chest pain, shortness of breath, chills, fever, and sore throat. These could indicate serious adverse reactions.

Hematopoietic Factors: Neupogen and Neutropenia

• Neupogen stimulates the production of neutrophils:
• Used to treat neutropenia (low neutrophil count).
• Bone pain: A common adverse reaction due to white blood cell production in the bone marrow.
• Neutrophils are white blood cells produced in the bone marrow increased.
• Neutrophil production causes bone pain.
• May cause elevated also cause hypouricemia.
• Contraindications: Gout and liver dysfunction.
• Pregnancy and lactation.
• Adverse reactions include hepatitis and myopathy Neupogen
• General Considerations: Many cholesterol-lowering drugs share similar uses, adverse reactions, and contraindications. Focus on learning the general principles and then noting the specific differences between drugs.
• Administer with food to minimize Gl upset.
• Monitor for chest pain, shortness of breath, chills, fever, and sore throat.
• Low-fat, low-cholesterol diet and undertake moderate exercise.
• Baseline testing to establish baseline values for cholesterol (total, HDL, LDL, LDL), triglycerides, liver function, and kidney function.
• Assess labs periodically throughout therapy.

Filgrastim (Neupogen)

• Stimulates the production of neutrophils
• Neutrophil count is increased
• May cause elevated white blood cell counts (Leukocytosis).
• May lead to elevations in uric acid levels, which is unusual.
• Can cause splenomegaly.
• Contraindicated in patients with hypothyroidism.
• Lithium is a main drug interaction.

Epoetin (Epogen) and Darbepoetin (Aranesp)

• Epoetin and Darbepoetin stimulate the production of red blood cells.
• Anemia associated with chronic renal failure (drug of choice).
• Used with chemotherapy to counteract blood cell lowering effects.
• Used in ongoing HIV treatment to address medication-induced anemia.
• Adverse reactions include hypertension and cardiac arrest.
• May experience Heart failure and increased risk of thrombotic events (DVT).
• Contraindications include uncontrolled hypertension,
• Contraindicated in patients needing emergency blood transfusions and Allergies to human albumin.
• Drug Names: Epogen (more common), Aranesp.
• Must Monitor blood pressure carefully.
• Administration: Do not shake the vials.
• Injection Safety: Never put the needle back in the vial after withdrawing the medication.

Iron Preparations

• Elevate serum iron levels and replenish hemoglobin
• Indicated for Iron deficiency anemia.
• May cause GI irritation, Nausea, Vomiting and Constipation.
• Dark Tarry Stools: Expected with iron supplementation.

Iron Supplementation

• Crucial mineral for the production of red blood cells:
• Liquid Iron Considerations: Liquid iron can stain teeth so Use a straw to minimize contact with teeth.
• Contraindications: Intramuscular (IM) iron injections are contraindicated in patients with hemolytic anemia.

Drug Interactions

• Iron decreases the absorption of certain antibiotics and Vitamin C: Vitamin C increases iron absorption.
• Avoid giving iron with milk, antacids, or coffee, as they can decrease absorption.

Common Iron Supplements

• Ferrous Sulfate (Feosol): The most common and least expensive form.
• Ferrogluconate
• Iron Dextran
• Oral Administration: If oral iron causes Gl upset, administer it with meals.

Dietary Sources

• Encourage consumption of iron-rich foods such as liver, egg yolks, muscle meats, yeast, grains, and green leafy vegetables.

Parenteral Iron Administration

• Administer IM iron via the Z-track method to prevent staining.
• Use a large muscle mass for IM injections.
• IV iron should be administered via the "re n mixture".
• Monitor for anaphylaxis during IV iron administration.
• Enhancing Absorption: Give iron with a vitamin C source, such as orange juice, to increase absorption.

Vitamin B12 (Cyanocobalamin)

• Is essential for red blood cell production, growth, and overall health
• Treats pernicious anemia and megaloblastic or macrocytic anemia resulting from B12 deficiency.
• Promotes the production, growth, and health of red blood cells and indicated for for Pernicious anemia.
• Used for Megaloblastic or macrocytic anemia related to vitamin B12 deficiency
• Adverse Reactions:Diarrhea, Itching and Hypokalemia
• Contraindications: No specific contraindications mentioned.
• Given intramuscularly (IM).
• Regularly re-evaluate B12 levels to ensure they are within the therapeutic range.
• Lifelong Treatment: Patients with pernicious anemia typically require lifelong B12 treatment.