Antihyperlipidemic & Vasodilators - Unit 6 PDF

Antihyperlipidemic & Vasodilators - Unit 6 Antihyperlipidemic & Vasodilators Unit 6 NUR 210/BSL 101  Antihyperlipidemic & Vasodilators - Unit 6 Lipoproteins - review Major categories High-density lipoprotein (HDL) (H for healthy) Removes cholesterol from blood Transports...

Antihyperlipidemic & Vasodilators - Unit 6 Antihyperlipidemic & Vasodilators Unit 6 NUR 210/BSL 101  Antihyperlipidemic & Vasodilators - Unit 6 Lipoproteins - review Major categories High-density lipoprotein (HDL) (H for healthy) Removes cholesterol from blood Transports cholesterol to liver for elimination Low-density lipoprotein (LDL) (L for lethal) Contains higher percent of cholesterol Very low-density lipoprotein (VLDL) Contains mostly triglycerides, less cholesterol Chylomicrons Contain mostly triglycerides Transport fatty acids and cholesterol to liver  Antihyperlipidemic & Vasodilators - Unit 6 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 Stop smoking  Antihyperlipidemic & Vasodilators - Unit 6 Antihyperlipidemic 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  Antihyperlipidemic & Vasodilators - Unit 6 HMG CoA reductase inhibitors(Statins) Uses Hyperlipidemia (high cholesterol) Action Inhibit the enzyme HMG CoA reductase in cholesterol biosynthesis Decreases LDLs, increases HDLs Abrupt discontinuation may lead to rebound effect  Antihyperlipidemic & Vasodilators - Unit 6 HMG CoA reductase inhibitors(Statins) Side effects and adverse effects Rare to have side effects GI issues, headache Photosensitivity Cataracts Liver impairment Hyperglycemia Rhabdomyolysis (skeletal muscle disorder)  Antihyperlipidemic & Vasodilators - Unit 6 HMG CoA reductase inhibitors(Statins) Contraindications Active liver disease Pregnant Caution History of liver disease Alcohol use Interactions Antacids  Antihyperlipidemic & Vasodilators - Unit 6 Nursing Process: Statins Assessment Assess vital signs and baseline serum cholesterol levels Liver function Obtain a medical history/medication history Pregnancy test  Antihyperlipidemic & Vasodilators - Unit 6 Nursing Process: Statins Nursing interventions/Teaching Monitor the client?s blood lipid levels, liver function. Observe for signs and symptoms of GI upset. Report unexplained muscle tenderness, weakness, fever and malaise Inform client that it may take several weeks or months before blood lipid levels decline, and importance of compliance Take at bedtime Diet ? low fat/low cholesterol Instruct client to have annual eye examinations and report changes in visual acuity. Do not stop abruptly  Antihyperlipidemic & Vasodilators - Unit 6 Peripheral Vascular Disease Peripheral vascular disease due to: Arteriosclerosis Hyperlipidemia Signs/symptoms Numbness, coolness and pain in extremities Claudication, leg ulcers Treatment Peripheral vasodilators increase blood flow such as cilostazol  Antihyperlipidemic & Vasodilators - Unit 6 Drugs to Improve Peripheral Blood Flow - Cilostazol Cilostazol Action Causes peripheral vasodilation Inhibits platelet aggregation - weak Use Intermittent claudication, other peripheral vascular diseases Side effects/Adverse reactions Dizziness, headache, GI distress, peripheral edema Tachycardia, palpitations Possible bleeding Orthostatic hypotension  Antihyperlipidemic & Vasodilators - Unit 6 Drugs to Improve Peripheral Blood Flow - Cilostazol Contraindications Severe heart failure Bleeding disorders Liver and renal disease ? caution Interactions Other drugs that cause vasodilation or bleeding Grapefruit juice  Antihyperlipidemic & Vasodilators - Unit 6 Nursing Process: Cilostazol Assessment Obtain baseline vital signs for future comparison Assess for signs of inadequate blood flow to extremities Medication/medical history  Antihyperlipidemic & Vasodilators - Unit 6 Nursing Process: Cilostazol Nursing interventions Monitor vital signs, especially blood pressure and heart rate Inform client that 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 but frequently to avoid orthostatic hypotension Take with food ? no grapefruit juice Evaluation  Antihyperlipidemic & Vasodilators - Unit 6 Practice Question #1 A client?s serum lipids are cholesterol 197 mg/dL, low-density lipoprotein (LDL) 110 mg/dL, and high-density lipoprotein (HDL) 35 mg/dL. The nurse knows what about these values? Serum lipids are within desirable values. Cholesterol is within desirable value, but LDL and HDL are not. Cholesterol is not within desirable value, though LDL and HDL are. Cholesterol, LDL, and HDL are not within desirable values.  Antihyperlipidemic & Vasodilators - Unit 6 Practice Question #1 ANS: B 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. You will not be tested on these labs in this class  Antihyperlipidemic & Vasodilators - Unit 6 Practice Question #2 A nurse who is administering atorvastatin calcium realizes the importance of monitoring for which serious adverse reaction? Pharyngitis Rash/pruritus Rhabdomyolysis Agranulocytosis  Antihyperlipidemic & Vasodilators - Unit 6 Practice Question #2 ANS: C Serious adverse reactions of atorvastatin include rhabdomyolysis, myalgia, photosensitivity, and cataracts. Less serious side effects include headache, rash, pruritus, constipation, diarrhea, sinusitis, and pharyngitis.  Antihyperlipidemic & Vasodilators - Unit 6 Practice Question #3 A client is receiving medication therapy for peripheral vascular disease. Which medication does the nurse identify as an antiplatelet drug? Cilostazol Papaverine Prazosin Nifedipine  Antihyperlipidemic & Vasodilators - Unit 6 Practice Question #3 ANS: A Cilostazol (Pletal) is an antiplatelet drug. Papaverine (Para-Time) is a direct-acting peripheral vasodilator. Prazosin (Minipress) is an alpha blocker, and nifedipine (Procardia) is a calcium channel blocker.  Antihyperlipidemic & Vasodilators - Unit 6 Practice Question #4 Which herb is most often associated with the treatment of intermittent claudication? Ginseng Valerian St. John?s wort Ginkgo biloba  Antihyperlipidemic & Vasodilators - Unit 6 Practice Question #4 ANS: D The herb Ginkgo biloba, taken with an antiplatelet drug, has been used to treat intermittent claudication, because of its vasodilating and antioxidant effects, although this herb has not been approved by the FDA.