Pharmacology: Statins and Bile Acid Sequestrants

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Questions and Answers

What is the primary mechanism of action of HMG-CoA reductase inhibitors?

Inhibits enzyme responsible for cholesterol synthesis (correct)

Inhibits bile acid synthesis

Reduces absorption of dietary cholesterol

Increases insulin sensitivity

Which of the following is a major adverse effect associated with statins?

Fatigue

Gastrointestinal bleeding

Myopathy (correct)

Platelet dysfunction

Which condition is contraindicated for the use of statins?

Hypertension

Pregnancy (correct)

Diabetes

Hyperglycemia

What is a key nursing implication for administering statins?

Instruct to take at evening/bedtime Signup and view all the answers

Which of the following drugs is known to increase the risk of statin side effects?

Fluconazole Signup and view all the answers

What physiological changes can statins cause besides lowering LDL cholesterol?

Lowering triglycerides and increasing HDL Signup and view all the answers

What serious condition can result from the use of statins, particularly at high doses?

Rhabdomyolysis Signup and view all the answers

Which aspect is NOT a reason for using statins in treatment?

Increasing insulin levels Signup and view all the answers

Which of the following is considered a benefit of statins in patients?

They reduce long-term cardiovascular risk. Signup and view all the answers

Statins are mainly indicated in patients with which condition?

Hypercholesterolemia Signup and view all the answers

What is the primary mechanism of action for fibric acid derivatives like fenofibrate?

Decrease hepatic production of triglycerides Signup and view all the answers

Which of the following is NOT a contraindication for the use of ezetimibe?

Mild renal impairment Signup and view all the answers

What adverse effect is most commonly associated with bile acid sequestrants such as cholestyramine?

Nausea and vomiting Signup and view all the answers

Why should patients on fibrates like fenofibrate be monitored for bleeding?

They can worsen effects of anticoagulants Signup and view all the answers

What is a significant nursing implication for administering PCSK9 inhibitors like alirocumab?

Administer by subcutaneous injection Signup and view all the answers

Which adverse effect might a nurse be concerned about in patients receiving fenofibrate for lowering triglycerides?

Severe renal impairment Signup and view all the answers

How do bile acid sequestrants like cholestyramine primarily lower LDL cholesterol levels?

By binding bile acids leading to cholesterol excretion Signup and view all the answers

Which drug class does not directly affect cholesterol absorption or production but rather focuses on recycling receptors?

PCSK9 inhibitors Signup and view all the answers

What nutritional consideration must be taken if patients are on bile acid sequestrants?

Supplement vitamins A, D, E, and K Signup and view all the answers

Which medication is primarily indicated for serum triglyceride levels greater than 500 mg/dL?

Fenofibrate Signup and view all the answers

Study Notes

HMG- CoA REDUCTASE INHIBITORS “STATINS”

Prototype: Atorvastatin
Primarily responsible for hepatic synthesis of cholesterol
Key use: Hypercholesterolemia
Key use (secondary): Reduce risk of Cardiovascular Events (CV events)
Main Adverse Effects: Myopathy, muscle pain/weakness, rhabdomyolysis
Contraindications: Pregnancy category X, medications that increase the risk of statin side effects (azoles, macrolides, fibrates)
Nursing Implications: Monitor for statin side effects (especially dark cola-colored urine), monitor liver function, counsel about appropriate dosage, potential interactions with other medications, avoid grapefruit juice, and educate patients about the potential effect on blood glucose.

BILE ACID SEQUESTRANTS

Prototype: Cholestyramine
Mechanism: Binds to bile acids in the gut, causing them to be excreted in feces. This leads to liver using excess cholesterol to make new bile acids.
Key Use: Decreases LDL cholesterol
Main Adverse Effects: Gastrointestinal (GI) concerns: nausea, vomiting, diarrhea
Contraindications: Decreases efficacy of some oral medications and statins.
Nursing Implications: Monitor for GI side effects, inform patient about effects on medications, monitor levels of Vitamins A, D, E, K, and supplement if necessary

FIBRIC ACID DERIVATIVES (FIBRATES)

Prototype: Fenofibrate
Mechanism: Decreases hepatic production of triglycerides, decreases VLDL cholesterol, and increases HDL.
Key Use: Most effective at lowering serum triglycerides, ideally when triglycerides are > 500 mg/dL.
Main Adverse Effects: Severe renal impairment or liver disease, can worsen bleeding from anticoagulants.
Contraindications: Severe renal impairment or liver disease, use with caution with anticoagulants.
Nursing Implications: Avoid use in patients with severe renal or liver disease, monitor for bleeding in patients taking anticoagulants, counsel patients on appropriate dosage.

CHOLESTEROL ABSORPTION INHIBITOR

Prototype: Ezetimibe
Mechanism: Blocks biliary and dietary cholesterol absorption
Key Use: Dyslipidemia (monotherapy or combination with statin)
Main Adverse Effects: Pregnancy and Lactation (not recommended)
Contraindications: Severe hepatic impairment
Nursing Implications: Counsel regarding possible effects on pregnancy and lactation, monitor liver function, administer with meals.

PCSK9 INHIBITORS

Prototype: Alirocumab
Mechanism: Increases activity of receptors that clear cholesterol
Key Use: Adults with ASCVD or familial hypercholesterolemia.
Main Adverse Effect: None to note
Contraindications: None to note.
Nursing Implications: Administered by subcutaneous (subQ) injection, may be very expensive.

MISC.

These categories are not exhaustive in addressing all lipid-lowering medications. All medications have potential adverse effects and contraindications.
Individualized assessment is crucial for determining the most appropriate treatment for individual patients.
There are many other lipid lowering medications available, including combination therapies.
Always consult with a healthcare professional to discuss the risks and benefits of medication before taking any medication.

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Description

This quiz focuses on the pharmacology of statins, specifically Atorvastatin, and bile acid sequestrants like Cholestyramine. It covers key uses, mechanisms, adverse effects, contraindications, and nursing implications relevant to these medications. Test your knowledge on lipid-lowering agents and their clinical relevance.