Questions and Answers
What are antilipemic drugs used for?
To lower lipid levels as an adjunct to diet therapy.
Which of these are established classes of antilipemics? (Select all that apply)
What is the mechanism of action for HMG-CoA reductase inhibitors?
Inhibit HMG-CoA reductase to lower cholesterol production.
What are the adverse effects of HMG-CoA reductase inhibitors?
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What must be limited when taking HMG-CoA reductase inhibitors?
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What is the mechanism of action for bile acid sequestrants?
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What is a common side effect of bile acid sequestrants?
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What is niacin also known as?
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What are potential adverse effects of niacin?
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What is the main indication for fibric acid derivatives?
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What should be avoided when taking gemfibrozil?
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What should a nurse assess when a patient is prescribed niacin?
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What effect does simvastatin have?
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Which assessment finding requires immediate action by the nurse in a patient taking pravastatin sodium?
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Which information should the nurse give to a patient taking cholestyramine?
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Patients who take statins such as atorvastatin should take the medication in the _____ for better results.
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Which is a common side effect of fenofibrate?
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Study Notes
Antilipemic Drugs Overview
- Antilipemic drugs are utilized to lower lipid levels in conjunction with diet therapy.
- Drug selection depends on the patient's specific lipid profile.
- Non-drug approaches to manage cholesterol must be attempted for at least 6 months before pharmacotherapy is considered.
Established Classes of Antilipemic Drugs
- Four main classes:
- HMG-CoA reductase inhibitors (Statins)
- Bile acid sequestrants
- Niacin (Nicotinic acid)
- Fibric acid derivatives
- Other types include cholesterol absorption inhibitors, antisense oligonucleotides, and PCSK9 inhibitors.
HMG-CoA Reductase Inhibitors (Statins)
- Most effective at reducing LDL cholesterol.
- Available statins: lovastatin (Mevacor), pravastatin (Pravachol), simvastatin (Zocor), atorvastatin (Lipitor).
- Mechanism: Inhibit HMG-CoA reductase, reducing cholesterol production and increasing LDL recycling.
- Indicated as first-line therapy for hypercholesterolemia; lowers LDL, raises HDL, reduces triglycerides.
- Common adverse effects: mild GI disturbances, rash, headache, myopathy (risk of rhabdomyolysis with fibrates), liver enzyme elevation. Contraindications include liver dysfunction and biliary obstruction.
- Nursing considerations: Limit grapefruit juice to less than 1 quart daily due to CYP3A4 interactions impacting statin metabolism.
Bile Acid Sequestrants
- Names include colesevelam (Welchol) and cholestyramine (Questran).
- Mechanism: Prevent bile acid resorption, forming insoluble complexes for excretion.
- Indications: Pruritus from biliary obstruction, diarrhea; can be used with statins.
- Response includes reduction in LDL cholesterol.
- Side effects: constipation, heartburn, nausea, belching, bloating.
- Nursing implications: Administer other oral medications 1 hour before or 4-6 hours after.
Niacin (Nicotinic Acid)
- Used in much higher doses than as a vitamin, effective and inexpensive.
- Mechanism: Increases lipase activity, reducing cholesterol and triglycerides metabolism.
- Indications: Lowers triglycerides, total and LDL cholesterol; increases HDL levels.
- Adverse effects: pruritus, GI distress, liver dysfunction with sustained-release formulations.
- Nursing implications: Start low dose, increase gradually, and take with meals to minimize side effects.
Fibric Acid Derivatives (Fibrates)
- Examples: gemfibrozil (Lopid), fenofibrate (Tricor).
- Mechanism: Activate lipase, suppress free fatty acid release from adipose tissue, inhibit liver triglyceride synthesis.
- Indications: Decrease triglycerides, increase HDL.
- Side effects: abdominal discomfort, diarrhea, blurred vision, nausea, risk of gallstones, and prolonged prothrombin time.
- Nursing notes: Avoid combining gemfibrozil with statins; increases rhabdomyolysis risk.
Cholesterol Absorption Inhibitor
- Example: ezetimibe (Zetia).
- Mechanism: Inhibits cholesterol absorption in the intestine, reducing total cholesterol, LDL, and triglycerides, while raising HDL.
- Indications: Often used alongside statins, especially in patients with chronic kidney disease or those unresponsive to other therapies.
- Side effects: back pain, diarrhea, abdominal pain; rare but serious outcomes include hepatitis and myopathy.
- Nursing considerations: Can be taken with or without food; avoid concurrent administration with fibrates.
Antisense Oligonucleotide
- Name: mipomersen (Kynamro).
- Mechanism: Inhibits apolipoprotein B-100 synthesis, decreasing LDL and total cholesterol.
- Indication: Homozygous familial hypercholesterolemia.
- Adverse effects: liver toxicity, nausea, headache, hypertension, musculoskeletal pain.
- Use caution in older adults, pregnant/breastfeeding women, and those with kidney disease.
PCSK9 Inhibitor Antibody
- Name: evolocumab (Repatha).
- Mechanism: Monoclonal antibody that aids in liver LDL clearance by inhibiting PCSK9.
- Indication: Used as adjunct to dietary changes and maximum tolerated statin therapy.
- Contraindications: Previous serious hypersensitivity reactions to the drug.
- Adverse effects: hypersensitivity reactions, nasopharyngitis, respiratory infections, injection site reactions.
General Nursing Implications for Antilipemics
- Obtain baseline liver function tests; long-term therapy may necessitate fat-soluble vitamin supplementation (A, D, K).
- Administer with meals to reduce GI upset; inform patients about proper medication preparation (e.g., mixing powder forms).
- Educate on reporting persistent GI upset, changes in urine/bowel habits, muscle pain, and jaundice.
- Monitor for therapeutic outcomes: reduced cholesterol and triglyceride levels.
Drug Interactions and Patient Education
- Gemfibrozil enhances bleeding risk when taken with warfarin; vitamin K absorption may be hindered.
- Educate patients using cholestyramine to take other medications at appropriate times to prevent reduced absorption.
- Highlight the importance of timing medications related to food and other drugs to avoid complications and maximize effectiveness.
Cholestyramine and Nursing Interventions
- Cholestyramine is a bile acid sequestrant that can cause constipation, bloating, and decreased peristalsis.
- Interventions to relieve symptoms include providing a high-fiber diet and increasing fluid intake to facilitate peristalsis.
- Monitoring weight is unnecessary as cholestyramine does not affect weight.
- Milk intake should be avoided because it can decrease peristalsis.
Gemfibrozil and Patient Assessment
- Gemfibrozil is contraindicated in patients with renal dysfunction, hepatic dysfunction, and gallbladder disease due to potential worsening of these conditions.
- No need to assess muscular reflexes or level of consciousness as these are not affected by the drug.
Colesevelam and Contraindications
- Colesevelam can cause intestinal obstruction due to binding bile and forming insoluble complexes.
- Contraindicated in patients with a history of intestinal impaction.
- Not contraindicated for patients with glaucoma, renal disease, or hepatic disease.
Alternatives to Atorvastatin
- Colestipol is a bile acid sequestrant available in powder form, suitable for patients averse to pills.
- Patients should mix Colestipol with at least 4 to 6 ounces of fluid or food.
- Other alternatives like fluvasatin and colesevelam are only available in tablet form.
- Cholestyramine, while also in powder form, is not recommended for this patient due to its use for constipation relief.
Niacin Therapy Considerations
- Important to check the patient's medical history for gout and diabetes, as these may worsen with niacin therapy.
- Extended-release niacin offers benefits over immediate-release forms by reducing adverse effects like hepatotoxicity and skin flushing.
- Checking white blood cell counts is unnecessary as niacin does not affect leukocyte levels.
Simvastatin Instructions for Patients
- Patients should avoid grapefruit juice while taking simvastatin, as it inhibits CYP3A4 metabolism leading to increased drug levels and risks of rhabdomyolysis.
- Discoloration of urine may indicate rhabdomyolysis due to muscle protein breakdown; patients should notify their provider if this occurs.
- Muscle pain should be reported, especially if it occurs within 1 day after starting treatment, as it may signify a dangerous condition.
- Aspirin may be taken before simvastatin to reduce the risk of flushing upon administration.
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Description
Explore the essential guidelines and classes of antilipemic drugs used to manage lipid levels. This quiz provides insights into the treatment protocols and drug choices based on patient profiles. Test your knowledge on this critical area of pharmacology.
