Unit 6.3 Antihyperlipidemics & Vasodilators PDF

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

Antihyperlipidemic & Vasodilators NUR 210/BSL 101 Unit 6  Major categories High-density lipoprotein (HDL) (H for healthy) ◦ Removes cholesterol from blood ◦ Transports cholesterol to liver for elimination Lipoproteins - Low-density lipoprotein (LDL) (L for lethal) review ◦ 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 Nonpharmacologic Reduce saturated fats and cholesterol in Methods for diet Cholesterol Reduce total fat intake to 30% or less of Reduction caloric intake Reduce cholesterol intake to 300 mg/day or less Exercise Stop smoking  Types of antilipidemics **Hepatic 3-hydroxy-3-methylglutaryl- coenzyme A (HMG-CoA) reductase inhibitors (statins) Antihyperlipidemic Bile-acid sequestrants Fibrates (fibric acid) Nicotinic acid Cholesterol absorption inhibitor  Uses Hyperlipidemia (high cholesterol) HMG CoA reductase inhibitors Action (Statins) Inhibit the enzyme HMG CoA 1 reductase in cholesterol biosynthesis Decreases LDLs, increases HDLs Abrupt discontinuation may lead to rebound effect  Side effects and adverse effects Rare to have side effects HMG CoA ◦ GI issues, headache reductase inhibitors ◦ Photosensitivity (Statins) Cataracts 1 Liver impairment Hyperglycemia Rhabdomyolysis (skeletal muscle disorder)  Contraindications Active liver disease HMG CoA Pregnant reductase inhibitors Caution (Statins) History of liver 1 disease Alcohol use Interactions Antacids  Assessment Nursing Process: Assess vital signs and baseline serum cholesterol levels Statins Liver function Obtain a medical history/medication history Pregnancy test  Nursing interventions/Teaching Monitor the client’s blood lipid levels, liver function. Observe for signs and symptoms of GI upset. Report unexplained muscle tenderness, Nursing Process: weakness, fever and malaise Statins 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  Peripheral vascular disease due to: Arteriosclerosis Hyperlipidemia Peripheral Vascular Signs/symptoms Disease Numbness, coolness and pain in extremities Claudication, leg ulcers Treatment Peripheral vasodilators increase blood flow such as cilostazol  Cilostazol Action ◦ Causes peripheral vasodilation Drugs to Improve ◦ Inhibits platelet aggregation - weak Peripheral Blood Use ◦ Intermittent claudication, other Flow - Cilostazol peripheral vascular diseases Side effects/Adverse reactions ◦ Dizziness, headache, GI distress, peripheral edema ◦ Tachycardia, palpitations ◦ Possible bleeding ◦ Orthostatic hypotension  Contraindications Drugs to Improve Severe heart failure Bleeding disorders Peripheral Blood Liver and renal disease – Flow - Cilostazol caution Interactions Other drugs that cause vasodilation or bleeding Grapefruit juice  Assessment Nursing Process: Obtain baseline vital signs for future comparison Cilostazol 1 Assess for signs of inadequate blood flow to extremities Medication/medical history  Nursing interventions Monitor vital signs, especially blood pressure and heart rate Inform client that a desired therapeutic response may take Nursing Process: 1.5 to 3 months Cilostazol Advise client not to smoke or 1 ingest alcohol Encourage client to change position slowly but frequently to avoid orthostatic hypotension Take with food – no grapefruit juice Evaluation  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 Practice Question values? #1 A. Serum lipids are within desirable values. B. Cholesterol is within desirable value, but LDL and HDL are not. C. Cholesterol is not within desirable value, though LDL and HDL are. D. Cholesterol, LDL, and HDL are not within desirable values.  ANS: B Practice Question The normal range for cholesterol is 150 #1 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  A nurse who is administering atorvastatin calcium realizes the importance of monitoring for which Practice Question serious adverse reaction? #2 A. Pharyngitis B. Rash/pruritus C. Rhabdomyolysis D. Agranulocytosis  ANS: C Serious adverse reactions of Practice Question atorvastatin include #2 rhabdomyolysis, myalgia, photosensitivity, and cataracts. Less serious side effects include headache, rash, pruritus, constipation, diarrhea, sinusitis, and pharyngitis.  A client is receiving medication therapy for peripheral vascular disease. Which medication does the nurse identify as Practice Question an antiplatelet drug? #3 A. Cilostazol B. Papaverine C. Prazosin D. Nifedipine  ANS: A Practice Question Cilostazol (Pletal) is an antiplatelet drug. Papaverine #3 (Para-Time) is a direct- acting peripheral vasodilator. Prazosin (Minipress) is an alpha blocker, and nifedipine (Procardia) is a calcium channel blocker.  Which herb is most often associated with the treatment of intermittent Practice Question claudication? #4 A. Ginseng B. Valerian C. St. John’s wort D. Ginkgo biloba  ANS: D Practice Question The herb Ginkgo biloba, taken with an #4 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.