Drugs for Blood Cholesterol, Anticoagulants (PDF)

1 DRUGS FOR DYSLIPIDEMIA Pg. 174 Overview of dyslipidemia: Lipid sources are endogenous and dietary Cholesterol—component of cell membrane, essential Lipoproteins—vary in density HDL—high density lipoprotein “good cholesterol” LDL—low density lipoprotein “bad cholesterol” VLDL—mostly triglycerides T...

1 DRUGS FOR DYSLIPIDEMIA Pg. 174 Overview of dyslipidemia: Lipid sources are endogenous and dietary Cholesterol—component of cell membrane, essential Lipoproteins—vary in density HDL—high density lipoprotein “good cholesterol” LDL—low density lipoprotein “bad cholesterol” VLDL—mostly triglycerides Term to know: Atherosclerotic Cardiovascular Disease (ASCVD) ASCVD Risk Assessment is now based on the absolute risk of developing clinical coronary disease over the next 10 years. Pediatric patients are a growing concern for cholesterol screening No longer targeting specific cholesterol goals—patients benefit from cholesterol-lowering therapy even if lab values don’t improve. Management includes Therapeutic Lifestyle Changes (TLC), especially exercise, smoking cessation, and weight control, but still give drugs. HMG-CoA Inhibitors also called statins Prototype: atorvastatin pg. 178 Oral medication, one of the most widely used drugs in the U.S. Used to treat hypercholesterolemia and to prevent CV events (MI, stroke, angina) even for patients with diabetes without high cholesterol. Adverse effects are mild, but can include myopathy (injury to muscle tissue), rhabdomyolysis, hepatotoxicity, and cataracts Other common drugs: lovastatin and simvastatin Bile acid Prototype: cholestyramine pg. 183 sequestrants Reduces LDL, used in conjunction with statins. Binds bile acids in the intestine so excreted in the stool Fibric Acid Prototype: fenofibrate pg. 184 Derivatives Decreases triglycerides, raises HDL. (fibrates) Only GI discomfort and diarrhea Cholesterol Prototype: ezetimibe pg. 186 Absorption Inhibits absorption of cholesterol in the small intestine Inhibitor Used as adjunct; if taking with other lipid lowering meds—watch for liver toxicity. PCSK9 Inhi alirocumab: SQ medication, significantly lowers LDL pg. 187 Miscellan- Niacin (nicotinic acid)—a vitamin that decreases LDL pg. 188 eous and increases HDL 2 DRUGS FOR COAGULATION DISORDERS Anticoagulant, Antiplatelet, and Thrombolytic Drugs Overview of coagulation: Various factors, platelets and thromboplastin prothrombin thrombin fibrinogen fibrin Hemostasis—stopping blood loss (forms a clot) Thrombosis—formation of a blood clot Terms to Know: ANTICOAGULANTS (reduce formation of fibrin) Anticoagulant that suppresses fibrin by inactivating Heparin pg. 147 thrombin, must be injected Uses: When given IV in high dose, it achieves anticoagulation. When given SQ in low dose, it prevents post-op thomboemboli Adverse Effects: Hemorrhage. Requires two nurses to check the dosage and regular lab values Contraindications—GI ulcers, or other bleeding conditions, severe kidney or liver disease, Overdose treatment—protamine sulfate Low Molecular Weight Heparins enoxaparin Prevents and treats deep vein thrombosis Given SQ Dose is based on body weight Vitamin K antagonist 155 warfarin—oral anticoagulant for home use Produces a Vitamin K deficiency. May drug interactions. Side effects: hemorrhage---requires blood monitoring INR Overdose treated with Vitamin K Other Newer anticoagulants 157 Direct thrombin inhibitor: dabigatran Direct Factor Xa inhibitor: rivaroxaban Oral meds, no lab tests needed, lower risk for bleeding. 3 ANTI-PLATELET DRUGS 160 (c.f. anticoagulants which prevent thrombosis in veins) General Suppress platelet formation in arteries Information Prototype: clopidogrel Oral medication. Adverse effects are pruritis, rash, diarrhea; hemorrhage less likely aspirin—low dose, prevents MI or another MI, prevents stroke THROMBOLYTIC, also called FIBRINOLYTIC General Remove thrombi that are already formed. Information All pose serious risk for bleeding Uses—MI, ischemic stroke, acute pulmonary edema Prototype: alteplase (tPA): tissue plasminogen activator Watch for bleeding 166 HEMATOPOIETIC DISORDERS 196 Hematopoietic Making red blood cells—for patients with cancer, HIV, and (erythropoietin) anemia epoetin alfa Granulocyte Stimulate blood cell production by bone marrow for those with Colonyneutropenia. Neutrophils prevent infections, mostly for patients Stimulating on chemo or bone marrow transplants filgrastim DRUGS FOR DEFICIENCY ANEMIAS IRON Not getting enough iron. Treated with iron. DEFICIENCY RBC are microcytic hypochromic ENEMIA Drug: ferrous sulfate—can stain teeth and darken stool; absorption increased with vitamin C and decrease with antacids Pg. 715 VITAMIN Treated with Vitamin B-12. B12 RBC are megaloblastic macrocytic anemia DEFICIENCY Drug: cyanocobalamin (Vitamin B-12) ANEMIA Pg. 713 FOLIC ACID Often associated with poor diet or chronic alcoholism DEFICIENCY Treated with folic acid ANEMIA Pg. 713