Antilipemic Drugs- Primary Forms of Lipidso Triglycerides and Cholesterol - HMG-CoA Reductase Inhibitors (“statins”) – first line medication o Most potent of the drugs available for reducing plasma concentrations of LDLcholesterolo Provastatin (Pravachol)o Simvastatin (Zocor) Lower the total and LDL cholesterol levels as well as triglyceride levels Can also raise HDLo 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 Actiono Inhibit HMG-CoA reductase, which is used by the liver to produce cholesterol o Lower the rate of cholesterol production- Indicationso First-line drug therapy for hypercholesterolemia (most common and dangerous form ofdyslipidemia)- Adverse Effectso First warning sign is myopathy – unusual muscle pain – do not give this medication andstop 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- Interactionso Oral anticoagulants Warfarin - bleedingo Long QT interval with erythromycino Grapefruit juice inhibits the CYP enzymeo Increase risk for RHAB with erythromycin o Gemfibrozil and statins togethero Verapamil and diltiazem (CCB) will have to be on higher doses- Bile Acid Sequestrantso Cholestyramine (Questran) Prescription only – often for constipating effectso Colestipol (Colestid)o Colesevelam (Welchol)- Mechanism of Action o Prevent resorption of bile acids from small intestineo Bile acids are necessary for absorption of cholesterol - Indications o Type II hyperlipoproteinemiao Organ transplant recipientso Severe liver or kidney diseaseo Itching related to liver failure o Most people are going to use this to lower cholesterol - Adverse Effectso Constipation o Heartburn, nausea, belching, bloating (disappear over time)o Headache, tinnitus, burnt odor of urineo Mild increases in triglyceride levels - Nursing Interventionso Administer with mealso Take fibero Increase fluid intakeo Not administering the same time as other drugs- Niacin (Nicotinic Acid)o Vitamin B3 (OTC)o #2 choice used at high doseso Lipid-lowering properties require much higher doses than when used as a vitamino Effective, inexpensive, often used in combination with other lipid-lowering drugso Before administering, check uric acid levels, do not give to pt with PUD- Mechanism of Actiono Thought to increase activity of lipase, which breaks down lipidso Reduces the metabolism or catabolism of cholesterol and triglycerideso Causes the release of histamine, which results in an increase in gastric motility and acidsecretion- Indicationso Effective in lowering triglyceride, total serum cholesterol, and LDL levelso Increases HDL levelso Effective in the treatment of types IIa, IIb, III, IV, and V hyperlipidemiaso Increase in lipase which breaks down lipids- Adverse Effectso Flushing (caused by histamine release) o Prurituso 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 minimizeflushing o Increase gradually - Fibric Acid Derivatives (Pt’s with triglyceride problems – if they cannot take statin)o Fibrateso 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 forRHAB when taking which product? A fibric acid derivative- Mechanism of Actiono Believed to work by activating lipase, which breaks down cholesterolo Also suppress the release of free fatty acid from adipose tissue, inhibit synthesis oftriglycerides in the liver, and increase secretion of cholesterol in the bile- Indicationso Treatment of types III, IV, and V hyperlipdemiaso The fibric acid derivatives gemfibrozil and fenofibrate decrease the triglyceride level andincrease the HDL cholesterol level by as much as 25%- Adverse Effectso Abdominal discomfort, diarrhea, nausea (take with food)o Blurred vision, headache, increased risk for gallstones (calcium)o Prolonged prothrombin (bleeding) time- Interactionso Gemfibrozil can enhance the action of oral anticoagulantso Laboratory test reactions Decreased hemoglobin level, hematocrit value, and WBC count Increased activated clotting time, lactate dehydrogenase level, and bilirubin levelo Statins Risk for myositis, myalgias, and rhabdomyolysis is increased- Herbal Product: Gingero Used as an antispasmodic, antihypertensive, antiplatelet, lipid reducero May enhance bleeding when taken with NSAID’so Possible interactions with warfarin, diazepamo ADV: dermatitis, vomiting, diarrhea, flatulence, antiplatelet activityo Have to be on it long-termo High doses can cause bleeding problemso Don’t want pt on anticoagulants to take the “G” herbs- Herbal Product: Flaxo Both the seed and oil of the plant are usedo Uses: atherosclerosis, hypercholesterolemia, GI distress, menopausal symptomso May cause diarrhea and allergic reactionso Possible interactions: antidiabetic drugs, anticoagulant drugsQUESTIONS1) 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 infectionD. Scheduled surgery (must be off garlic 2 months4) Which patient would benefit from administration of simvastatin (Zocor) 80 mg? A. A patient newly