Antilipemic Drugs Primary Forms of Lipids o Triglycerides and Cholesterol HMG CoA Reductase Inhibitors statins first line medication o Most potent of the drugs available for reducing plasma concentrations of LDL cholesterol o Provastatin Pravachol o Simvastatin Zocor Lower the total and LDL cholesterol levels as well as triglyceride levels Can also raise HDL o Atorvastatin Lipitor Raise levels of good cholesterol HDL Can be dosed at any time of day Administered at bedtime Important to report muscle pain immediately Mechanism of Action o Inhibit HMG CoA reductase which is used by the liver to produce cholesterol o Lower the rate of cholesterol production Indications o First line drug therapy for hypercholesterolemia most common and dangerous form of dyslipidemia Adverse Effects o First warning sign is myopathy unusual muscle pain do not give this medication and stop immediately o Rhabdomyolysis break down of muscle protein myoglobin carries oxygen to the muscle ischemia of the muscle worse than MI we cannot save these pt s Urinary elimination of the muscle protein myoglobin Interactions o Oral anticoagulants Warfarin bleeding o Long QT interval with erythromycin o Grapefruit juice inhibits the CYP enzyme o Increase risk for RHAB with erythromycin o Gemfibrozil and statins together o Verapamil and diltiazem CCB will have to be on higher doses Bile Acid Sequestrants o Cholestyramine Questran Prescription only often for constipating effects o Colestipol Colestid o Colesevelam Welchol Mechanism of Action o Prevent resorption of bile acids from small intestine o Bile acids are necessary for absorption of cholesterol Indications o Type II hyperlipoproteinemia o Organ transplant recipients o Severe liver or kidney disease o Itching related to liver failure o Most people are going to use this to lower cholesterol Adverse Effects o Constipation o Heartburn nausea belching bloating disappear over time o Headache tinnitus burnt odor of urine o Mild increases in triglyceride levels Nursing Interventions o Administer with meals o Take fiber o Increase fluid intake o Not administering the same time as other drugs Niacin Nicotinic Acid o Vitamin B3 OTC o 2 choice used at high doses o Lipid lowering properties require much higher doses than when used as a vitamin o Effective inexpensive often used in combination with other lipid lowering drugs o Before administering check uric acid levels do not give to pt with PUD Mechanism of Action o Thought to increase activity of lipase which breaks down lipids o Reduces the metabolism or catabolism of cholesterol and triglycerides o Causes the release of histamine which results in an increase in gastric motility and acid secretion Indications o Effective in lowering triglyceride total serum cholesterol and LDL levels o Increases HDL levels o Effective in the treatment of types IIa IIb III IV and V hyperlipidemias o Increase in lipase which breaks down lipids Adverse Effects o Flushing caused by histamine release o Pruritus o GI distress high dose upsets stomach give with food o Small doses of aspirin or NSAID s may be take 30 min before niacin dose to minimize flushing o Increase gradually Fibric Acid Derivatives Pt s with triglyceride problems if they cannot take statin o Fibrates o Gefibrozil Lopid prescription o Fenofibrate Tricor prescription If pt is currently taking a statin the nurse considers that the pt may have a higher risk for RHAB when taking which product A fibric acid derivative Mechanism of Action o Believed to work by activating lipase which breaks down cholesterol o Also suppress the release of free fatty acid from adipose tissue inhibit synthesis of triglycerides in the liver and increase secretion of cholesterol in the bile Indications o Treatment of types III IV and V hyperlipdemias o The fibric acid derivatives gemfibrozil and fenofibrate decrease the triglyceride level and increase the HDL cholesterol level by as much as 25 Adverse Effects o Abdominal discomfort diarrhea nausea take with food o Blurred vision headache increased risk for gallstones calcium o Prolonged prothrombin bleeding time Interactions o Gemfibrozil can enhance the action of oral anticoagulants o Laboratory test reactions Decreased hemoglobin level hematocrit value and WBC count Increased activated clotting time lactate dehydrogenase level and bilirubin level o Statins Risk for myositis myalgias and rhabdomyolysis is increased Herbal Product Ginger o Used as an antispasmodic antihypertensive antiplatelet lipid reducer o May enhance bleeding when taken with NSAID s o Possible interactions with warfarin diazepam o ADV dermatitis vomiting diarrhea flatulence antiplatelet activity o Have to be on it long term o High doses can cause bleeding problems o Don t want pt on anticoagulants to take the G herbs Herbal Product Flax o Both the seed and oil of the plant are used o Uses atherosclerosis hypercholesterolemia GI distress menopausal symptoms o May cause diarrhea and allergic reactions o Possible interactions antidiabetic drugs anticoagulant drugs QUESTIONS 1 A patient with a new prescription for a HMG CoA statin drug is instructed to take the medication with the evening meal or at bedtime The patient asks why it must be taken at this time of day The reason is A The medication is better absorbed at this time B This timeframe correlates better with the natural diurnal rhythm of cholesterol production Natural diurnal rhythm of cholesterol production C There will be fewer adverse effects if taken at night instead of with the morning meal D This timing reduces the incidence of myopathy 2 A patient will be taking niacin as part of antilipemic therapy The best way to avoid problems with flushing or pruritus would be to A take the medication at bedtime B take the medication with a small dose of a steroid C take the medication with a full glass of water on an empty stomach D start with a low initial dose and then increase it gradually 3 A patient wants to take garlic tablets to improve his cholesterol levels Which condition would be a contraindication A Hypertension B Bowel obstruction C Sinus infection D Scheduled surgery must be off garlic 2 months 4 Which patient would benefit from administration of simvastatin Zocor 80 mg A A patient newly diagnosed with hyperlipidemia B A patient with muscle aches who was taking another antilipidemic drug C A patient who is taking verapamil D A patient who has already been taking simvastatin Zocor for 12 months with no evidence of