Drugs for Lipid Disorders

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Drugs for Lipid Disorders

• Chapter 22

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Lipids

• Compare and Contrast the three types
• Triglycerides
• Phospholipids
• Steroids
• Identify the most commonly known sterol and
  discuss its role in the body.
• Identify the AHA daily recommendations for this
  sterol.

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Lipoproteins

• Common Types
• HDL
• LDL
• VLDL
• Compare and contrast the composition and function
  of these lipoproteins.

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Terms

• Define
• Hyperlipidemia
• Hypercholesterolemia
• Dyslipidemia
• Discuss the associated etiology.

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Measuring Cholesterol Levels

• Your patient has a total cholesterol level of
  250.
• What does this mean?
• What should be done next and why?
• What is the goal of maintaining /or achieving
  normal cholesterol levels.

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Lifestyle Changes

• Discuss the rationale for lifestyle changes
  associated with hyperlipidemia.
• What is the goal of lifestyle changes.
• List lifestyle changes that will lower lipid
  levels.

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HMG-Co A Reductase Inhibitors

• What is HMG-Co A Reductase?
• What is the role of HMG-Co A Reductase
  Inhibitors?
• Describe the MOA of these drugs.
• What is the term commonly used for this drug
  class?

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Statins

• Prototype atorvastatin (Lipitor)
• Slow progression of CAD
• Decrease mortality 2 CVD
• Generally well tolerated
• Minor side effects
• HA, fatigue, muscle or joint pain, heartburn
• Rare, serious side effects
• Myopathy, rhabdomyolisis

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Statins

• Drug contraindications
• Macrolide antibiotics
• Azole antifungals
• Fibric acid agents
• Certain immunosuppressants
• Cholesterol biosynthesis is increased at night.
  How does this fact affect dosing?

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Statins Nursing Considerations

• What baseline data should be obtained?
• Developmentally, when is statin use
  contraindicated?
• What diagnostics should be monitored before and
  during early therapy?
• Discuss rationale for monitoring for muscle pain,
  tenderness, weakness.
• What diagnostic will aid in diagnosis of
  myopathy?

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Statins Patient Teaching

• keep all lab appointments
• No other meds unless approved by HCP
• No alcohol
• Reliable contraception
• Take with eve meal to ? GI Upset
• Immediately report
• unexplained muscle symptoms, esp. if accompanied
  by malaise and fever
• unexplained numbness, tingling, weakness or pain
  in feet/hands

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Bile Acid Resins

• These drugs are not absorbed from small
  intestines.
• Describe the MOA.
• What effect can these drugs have on LDL levels?
• Why are these drugs no longer 1st line therapy?

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Bile Acid Resins Nursing Considerations

• Significant GI effects possible
• May worsen PUD, hemorrhoids, IBD, chronic
  constipation
• Monitor closely in dysphagia or esophageal
  strictures
• Assess bowel sounds at intervals
• Administer other meds 1 hour before or 4 hours
  after
• Cholestyramine- mix powder as directed do not
  inhale powder

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Bile Acid Resins Patient Teaching

• Take before meals
• High bulk diet
• Increased fluids
• Vitamin supplements to replace folic acid, fat
  soluble vitamins
• Can cause hypokalemia
• No meds without HCP approval
• Immediately report
• Jaundice, severe constipation, flatulence,
  nausea, heartburn, straining, tarry stools,
  abnormal bleeding

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Nicotinic Acid

• What is nicotinic acid?
• How does dosing of nicotinic acid differ in
  supplementation vs. decreasing lipid levels?
• What is the primary effect regarding control of
  lipid levels?
• When will optimal effect be anticipated?

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Nicotinic Acid Nursing Considerations

• Not mono-therapy
• Baseline LFTs and during Rx
• Contraindicated
• ? liver enzymes, history of liver disease of PUD
• May precipitate gout
• ASA 1 tab 30 min before
• If diabetic, closely monitor glucose
• Give with food to limit GI upset

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Nicotinic Acid Patient Teaching

• Do not self-mediate
• No mega-doses of niacin
• Take with cold water
• Take with meals
• ASA 30 min before dose
• No other meds without HCP approval
• Immediately report
• Flank, joint, or stomach pain jaundice
• Skin color changes avoid sun if changes occur

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Fibric Acid Agents

• Drug of choice for severe hypertriglyceridemia
  and VLDL levels.
• Fenofibrate (Tricor)
• Gemfibrozil (Lopid)
• Synergistic effect when combined with a statin.
• MOA unknown

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Fibric Acid AgentsNursing Considerations

• Prior to administration assess for
• Abdominal pain, nausea, vomiting
• Obtain current drug history
• Avoid in pregnancy and lactation
• Avoid in gallstone or biliary disease
• Give with meals
• Monitor s/s of ? clotting time
• Monitor of cholecystitis/cholelithiasis

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Fibric Acid AgentsPatient Teaching

• Keep all follow-up and lab appts
• Immediately report
• Unusual bruising or bleeding
• RUQ pain
• Change in stool color
• Muscle cramping

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Cholesterol Absorption Inhibitors

• Newest class (early 2000s)
• Only one drug in class Ezetimibe (Zetia)
• Discuss the MOA.
• Mono-therapy 20 ? in LDL
• Exetimibe statin additional 15 20 decrease
  in LDL
• Vytorin ezetimibie simvastatin (Zocor)

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