Drugs that lower cholesterol

other products used to fight bad lipid levels

lovaza fish oil plant stanol estrogen cholestin

What are some adverse effects of Ezetimibe?

myopathy rhabdomyolysis hepatitis pancreatitis thrombocytopenia

What are the prototype FAD's?

gemfibrozil fenofibrate fenofibric acid

What are the four classes of drugs used for high LDL?

1. HMG-CoA reductase inhibitiors 2. Bile acid sequestrants 3. Nicotinic acid (niacin) 4. Fibrates ( reduces levels of TGs, not LDL's)

Drug combos used to fight bad cholesterol

1. niacin/lovastatin 2. simvastatin/niacin or ezetimbe 3. statin/aspirin 4. statin/amlodipine

What class is the drug Ezetimibe in ?

Bile acid sequestrants

Nursing considerations for cholestyramine ?

Can impair absorption of fat soluble vitamins (A,D,E,K) vitamin sups may be required Causes constipation

What are the prototype drugs for this class?

Cholestyramine Colestipol Colesevelam - Newest and best tolerated drug.

Adverse effects of statins?

Common: headache, rash facial flushing, GI issues, constipation, *confusion/memory disturbance* Rare: Myopathy/rhabdomyolysis, heptatoxicity, new onset diabetes, cataracts. Some clients experience muscle pain when using statins.

Why is Colesevelam the superior drug choice?

Does not decrease uptake of fat soluable vitamins ( as other bile sequestrants do) Does not significantly reduce the absorption of statins, warfarin, digoxin, and most other drugs studied

Nursing implications for Statins?

Dosing: once daily in the evening Statins have greatest impact at evening bc this is when cholesterol synthesis occurs. We need to monitor liver enzymes before starting a statin

What class are the statins in?

HMG CoA-reductase inhibitors

TU for statin?

Hypercholesterolemia Primary and secondary prevention of CV events Post -MI therapy Diabetes

What levels should we monitor when a patient is on gemfibrozil

INR frequently

What is the first line change for people with high cholesterol ?

Life style changes

what is the MOA for statins?

Mechanism of cholesterol reduction

HMG- CoA Reductase inhibitors (STATINS) uses?

Most effective drug for loweing LDL Reducation of LDL Cholesterol Elevation of HDL Cholesterol Reduction of triglycerides levels Nonlipid beneficial cardiovascular actions 1. Promote plaque stability 2. Reduce the risk for cardiovascular events. 3. Increase bone formation

What are Fibric acid derivatives useful for ?

Most effective drugs available for lowering TG levels Can raise HDL littler of no effect on LDL cholesterol

DI of statins?

Other lipid lowering drugs *except bile acid sequestrants* Drugs that inhibit CYP3A4 Preg cat X

Colesevelam

Reduces LDL Increases VLDL levels in some patients MOA: increases LDL receptors on hepatocytes & prevents reabsorption of bile acids S/E: constipation ( however this can be used to treat patients with chronic diarrhea.

What are the effects of Nicotinic acid?

Reduces LDL & TG levels Increases *HDL* levels more effectively than any other drug Lowers TG and Raises HDL

What are some adverse effects of Niacin?

Skin flushing itching ( can treat with aspirin) GI effects Hepatoxicity Hyperglycemia Gouty arthritis Can Raise blood levels of uric acid

The nurse will teach a patient who is prescribed niacin to prevent flushing of the face by doing what?

Taking 325mg aspirin 30 minute before each dose

Bile acid sequestrants MOA

They bind to bile acids in the intestine and increase the excretions of bile acids in the stool. This reduces the amount of bile acids returning to the liver and forces the liver to produce more bile acids to replace the bile acids lost in the stool. Which then lowers cholesterol blood levels.

Bile Acid sequestrants

Used to be first line.. not anymore used as adjuncts to statins

A nurse is prescribed lovastatin. The nurse will teach the patient to take the medication when?

With the evening meal.. given at night

What other class of drug can Ezetimibe be paired with?

approved for monotherapy and combined use with stains

Gemfibrozil effects on plasma fats?

decreases TG loweres VLDL raises HDL

What is the MOA of Ezetimibe?

impacts plasma lipid and inhibits cholesterol absorption in the small intestine.. lowers cholesterol, It does not affect the absorption of triglycerides or fat soluable vitamins

Adverse effects of Fibric acid derivaives?

increase the risk for bleeding in patients taking warfarin increase the risk for rhabdomyolysis in patients taking statins

Gemfibrozil MOA

interacts with a receptor subtype to block the production of cholesterol

Adverse effects of gemfibrozil

rashes GI Gallstones Myopathy liver injury (hepatoxic)

DI of ezetimbe ?

statins fibrates bile acid seq cyclosporine