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Premium member Presentation Transcript CHAPTER 28Antilipemic Drugs : CHAPTER 28Antilipemic Drugs Antilipemics : Antilipemics Drugs used to lower lipid levels Triglycerides and Cholesterol : Triglycerides and Cholesterol Two primary forms of lipids in the blood Water-insoluble fats that must be bound to apolipoproteins, specialized lipid-carrying proteins Lipoprotein is the combination of triglyceride or cholesterol with apolipoprotein Lipoproteins : Lipoproteins Very-low-density lipoprotein (VLDL) Produced by the liver Transports endogenous lipids to the cells Low-density lipoprotein (LDL) High-density lipoprotein (HDL) Responsible for “recycling” of cholesterol Also known as “good cholesterol” Coronary Heart Disease : Coronary Heart Disease The risk of CHD in patients with cholesterol levels of 300 mg/dL is three to four times greater than that in patients with levels less than 200 mg/dL Coronary Heart DiseasePositive Risk Factors : Coronary Heart DiseasePositive Risk Factors Age Male 45 years or older Female 55 years or older, or women with premature menopause not on estrogen replacement therapy Family history: history of premature CHD Current cigarette smoker Coronary Heart DiseasePositive Risk Factors (cont’d) : Coronary Heart DiseasePositive Risk Factors (cont’d) Hypertension BP 140/90 or higher, or on antihypertensive medication Low HDL levels: less than 35 mg/dL Diabetes mellitus Coronary Heart DiseaseNegative (Beneficial) Risk Factor : Coronary Heart DiseaseNegative (Beneficial) Risk Factor High HDL (“good” cholesterol): 60 mg/dL or higher Treatment Guidelines : Treatment Guidelines Antilipemic drugs are used as an adjunct to diet therapy Drug choice based on the specific lipid profile of the patient Treatment Guidelines (cont’d) : Treatment Guidelines (cont’d) All reasonable non-drug means of controlling blood cholesterol levels (e.g., diet, exercise) should be tried for at least 6 months and found to fail before drug therapy is considered Antilipemics : Antilipemics HMG-CoA reductase inhibitors (HMGs, or statins) Bile acid sequestrants Niacin (nicotinic acid) Fibric acid derivatives Cholesterol absorption inhibitor Combination drugs Antilipemics: HMG-CoA Reductase Inhibitors (HMGs, or statins) : Antilipemics: HMG-CoA Reductase Inhibitors (HMGs, or statins) Most potent LDL reducers lovastatin (Mevacor) pravastatin (Pravachol) simvastatin (Zocor) atorvastatin (Lipitor) fluvastatin (Lescol) HMG-CoA Reductase Inhibitors (cont’d) : HMG-CoA Reductase Inhibitors (cont’d) Mechanism of action Inhibit HMG-CoA reductase, which is used by the liver to produce cholesterol Lower the rate of cholesterol production HMG-CoA Reductase Inhibitors (cont’d) : HMG-CoA Reductase Inhibitors (cont’d) Indications First-line drug therapy for hypercholesterolemia Treatment of types IIa and IIb hyperlipidemias Reduce LDL levels by 30% to 40% Increase HDL levels by 2% to 15% Reduce triglycerides by 10% to 30% HMG-CoA Reductase Inhibitors (cont’d) : HMG-CoA Reductase Inhibitors (cont’d) Adverse effects Mild, transient GI disturbances Rash Headache Myopathy (muscle pain), possibly leading to the serious condition rhabdomyolysis Elevations in liver enzymes or liver disease Bile Acid Sequestrants : Bile Acid Sequestrants cholestyramine (Questran) colestipol hydrochloride (Colestid) colesevelam (tablet form) Also called bile acid–binding resins and ion-exchange resins Bile Acid Sequestrants (cont’d) : Bile Acid Sequestrants (cont’d) Mechanism of action Prevent resorption of bile acids from small intestine Bile acids are necessary for absorption of cholesterol Bile Acid Sequestrants (cont’d) : Bile Acid Sequestrants (cont’d) Indications Type II hyperlipoproteinemia Relief of pruritus associated with partial biliary obstruction (cholestyramine) May be used along with statins Bile Acid Sequestrants (cont’d) : Bile Acid Sequestrants (cont’d) Adverse effects Constipation Heartburn, nausea, belching, bloating These adverse effects tend to disappear over time Niacin (Nicotinic Acid) : Niacin (Nicotinic Acid) Vitamin B3 Lipid-lowering properties require much higher doses than when used as a vitamin Effective, inexpensive, often used in combination with other lipid-lowering drugs Niacin (Nicotinic Acid) (cont’d) : Niacin (Nicotinic Acid) (cont’d) Mechanism of action Thought to increase activity of lipase, which breaks down lipids Reduces the metabolism or catabolism of cholesterol and triglycerides Niacin (Nicotinic Acid) (cont’d) : Niacin (Nicotinic Acid) (cont’d) Indications Effective in lowering triglyceride, total serum cholesterol, and LDL levels Increases HDL levels Effective in the treatment of types IIa, IIb, III, IV, and V hyperlipidemias Niacin (Nicotinic Acid) (cont’d) : Niacin (Nicotinic Acid) (cont’d) Adverse effects Flushing (due to histamine release) Pruritus GI distress Fibric Acid Derivatives : Fibric Acid Derivatives Also known as fibrates gemfibrozil (Lopid) fenofibrate (Tricor) Fibric Acid Derivatives (cont’d) : Fibric Acid Derivatives (cont’d) Mechanism of action Believed to work by activating lipase, which breaks down cholesterol Also suppress release of free fatty acid from the adipose tissue, inhibit synthesis of triglycerides in the liver, and increase the secretion of cholesterol in the bile Fibric Acid Derivatives (cont’d) : Fibric Acid Derivatives (cont’d) Indications Treatment of types III, IV, and V hyperlipidemias Drug Effects Decrease the triglyceride levels Increase HDL by as much as 25% Fibric Acid Derivatives (cont’d) : Fibric Acid Derivatives (cont’d) Adverse effects Abdominal discomfort, diarrhea, nausea Blurred vision, headache Increased risk of gallstones Prolonged prothrombin time Liver studies may show increased function Cholesterol Absorption Inhibitor : Cholesterol Absorption Inhibitor ezetimibe (Zetia) Inhibits absorption of cholesterol and related sterols from the small intestine Results in reduced total cholesterol, LDL, triglylceride levels Also increases HDL levels Works well when taken with a statin drug Nursing Implications : Nursing Implications Before beginning therapy, obtain a thorough health and medication history Assess dietary patterns, exercise level, weight, height, VS, tobacco and alcohol use, family history Assess for contraindications, conditions that require cautious use, and drug interactions Nursing Implications (cont’d) : Nursing Implications (cont’d) Contraindications include biliary obstruction, liver dysfunction, active liver disease Obtain baseline liver function studies Patients on long-term therapy may need supplemental fat-soluble vitamins (A, D, K) Take with meals to decrease GI upset Nursing Implications (cont’d) : Nursing Implications (cont’d) Patient must be counseled concerning diet and nutrition on an ongoing basis Instruct on proper procedure for taking the medications Powder forms must be taken with a liquid, mixed thoroughly but not stirred, and NEVER taken dry Nursing Implications (cont’d) : Nursing Implications (cont’d) Other medications should be taken 1 hour before or 4 to 6 hours after meals to avoid interference with absorption Clofibrate often causes constipation; instruct patients to increase fiber and fluid intake to offset this effect Nursing Implications (cont’d) : Nursing Implications (cont’d) To minimize adverse effects of niacin, start on low initial dose and gradually increase it, and take with meals Small doses of aspirin or NSAIDs may be taken 30 minutes before niacin to minimize cutaneous flushing Inform patients that these drugs may take several weeks to show effectiveness Nursing Implications (cont’d) : Nursing Implications (cont’d) Instruct patients to report persistent GI upset, constipation, abnormal or unusual bleeding, and yellow discoloration of the skin Monitor for adverse effects, including increased liver enzyme studies Monitor for therapeutic effects Reduced cholesterol and triglyceride levels You do not have the permission to view this presentation. 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Chapter 28 - antilipemic drugs playing with voice over hreyes Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 365 Category: Education License: All Rights Reserved Like it (0) Dislike it (0) Added: August 30, 2010 This Presentation is Public Favorites: 0 Presentation Description No description available. Comments Posting comment... Premium member Presentation Transcript CHAPTER 28Antilipemic Drugs : CHAPTER 28Antilipemic Drugs Antilipemics : Antilipemics Drugs used to lower lipid levels Triglycerides and Cholesterol : Triglycerides and Cholesterol Two primary forms of lipids in the blood Water-insoluble fats that must be bound to apolipoproteins, specialized lipid-carrying proteins Lipoprotein is the combination of triglyceride or cholesterol with apolipoprotein Lipoproteins : Lipoproteins Very-low-density lipoprotein (VLDL) Produced by the liver Transports endogenous lipids to the cells Low-density lipoprotein (LDL) High-density lipoprotein (HDL) Responsible for “recycling” of cholesterol Also known as “good cholesterol” Coronary Heart Disease : Coronary Heart Disease The risk of CHD in patients with cholesterol levels of 300 mg/dL is three to four times greater than that in patients with levels less than 200 mg/dL Coronary Heart DiseasePositive Risk Factors : Coronary Heart DiseasePositive Risk Factors Age Male 45 years or older Female 55 years or older, or women with premature menopause not on estrogen replacement therapy Family history: history of premature CHD Current cigarette smoker Coronary Heart DiseasePositive Risk Factors (cont’d) : Coronary Heart DiseasePositive Risk Factors (cont’d) Hypertension BP 140/90 or higher, or on antihypertensive medication Low HDL levels: less than 35 mg/dL Diabetes mellitus Coronary Heart DiseaseNegative (Beneficial) Risk Factor : Coronary Heart DiseaseNegative (Beneficial) Risk Factor High HDL (“good” cholesterol): 60 mg/dL or higher Treatment Guidelines : Treatment Guidelines Antilipemic drugs are used as an adjunct to diet therapy Drug choice based on the specific lipid profile of the patient Treatment Guidelines (cont’d) : Treatment Guidelines (cont’d) All reasonable non-drug means of controlling blood cholesterol levels (e.g., diet, exercise) should be tried for at least 6 months and found to fail before drug therapy is considered Antilipemics : Antilipemics HMG-CoA reductase inhibitors (HMGs, or statins) Bile acid sequestrants Niacin (nicotinic acid) Fibric acid derivatives Cholesterol absorption inhibitor Combination drugs Antilipemics: HMG-CoA Reductase Inhibitors (HMGs, or statins) : Antilipemics: HMG-CoA Reductase Inhibitors (HMGs, or statins) Most potent LDL reducers lovastatin (Mevacor) pravastatin (Pravachol) simvastatin (Zocor) atorvastatin (Lipitor) fluvastatin (Lescol) HMG-CoA Reductase Inhibitors (cont’d) : HMG-CoA Reductase Inhibitors (cont’d) Mechanism of action Inhibit HMG-CoA reductase, which is used by the liver to produce cholesterol Lower the rate of cholesterol production HMG-CoA Reductase Inhibitors (cont’d) : HMG-CoA Reductase Inhibitors (cont’d) Indications First-line drug therapy for hypercholesterolemia Treatment of types IIa and IIb hyperlipidemias Reduce LDL levels by 30% to 40% Increase HDL levels by 2% to 15% Reduce triglycerides by 10% to 30% HMG-CoA Reductase Inhibitors (cont’d) : HMG-CoA Reductase Inhibitors (cont’d) Adverse effects Mild, transient GI disturbances Rash Headache Myopathy (muscle pain), possibly leading to the serious condition rhabdomyolysis Elevations in liver enzymes or liver disease Bile Acid Sequestrants : Bile Acid Sequestrants cholestyramine (Questran) colestipol hydrochloride (Colestid) colesevelam (tablet form) Also called bile acid–binding resins and ion-exchange resins Bile Acid Sequestrants (cont’d) : Bile Acid Sequestrants (cont’d) Mechanism of action Prevent resorption of bile acids from small intestine Bile acids are necessary for absorption of cholesterol Bile Acid Sequestrants (cont’d) : Bile Acid Sequestrants (cont’d) Indications Type II hyperlipoproteinemia Relief of pruritus associated with partial biliary obstruction (cholestyramine) May be used along with statins Bile Acid Sequestrants (cont’d) : Bile Acid Sequestrants (cont’d) Adverse effects Constipation Heartburn, nausea, belching, bloating These adverse effects tend to disappear over time Niacin (Nicotinic Acid) : Niacin (Nicotinic Acid) Vitamin B3 Lipid-lowering properties require much higher doses than when used as a vitamin Effective, inexpensive, often used in combination with other lipid-lowering drugs Niacin (Nicotinic Acid) (cont’d) : Niacin (Nicotinic Acid) (cont’d) Mechanism of action Thought to increase activity of lipase, which breaks down lipids Reduces the metabolism or catabolism of cholesterol and triglycerides Niacin (Nicotinic Acid) (cont’d) : Niacin (Nicotinic Acid) (cont’d) Indications Effective in lowering triglyceride, total serum cholesterol, and LDL levels Increases HDL levels Effective in the treatment of types IIa, IIb, III, IV, and V hyperlipidemias Niacin (Nicotinic Acid) (cont’d) : Niacin (Nicotinic Acid) (cont’d) Adverse effects Flushing (due to histamine release) Pruritus GI distress Fibric Acid Derivatives : Fibric Acid Derivatives Also known as fibrates gemfibrozil (Lopid) fenofibrate (Tricor) Fibric Acid Derivatives (cont’d) : Fibric Acid Derivatives (cont’d) Mechanism of action Believed to work by activating lipase, which breaks down cholesterol Also suppress release of free fatty acid from the adipose tissue, inhibit synthesis of triglycerides in the liver, and increase the secretion of cholesterol in the bile Fibric Acid Derivatives (cont’d) : Fibric Acid Derivatives (cont’d) Indications Treatment of types III, IV, and V hyperlipidemias Drug Effects Decrease the triglyceride levels Increase HDL by as much as 25% Fibric Acid Derivatives (cont’d) : Fibric Acid Derivatives (cont’d) Adverse effects Abdominal discomfort, diarrhea, nausea Blurred vision, headache Increased risk of gallstones Prolonged prothrombin time Liver studies may show increased function Cholesterol Absorption Inhibitor : Cholesterol Absorption Inhibitor ezetimibe (Zetia) Inhibits absorption of cholesterol and related sterols from the small intestine Results in reduced total cholesterol, LDL, triglylceride levels Also increases HDL levels Works well when taken with a statin drug Nursing Implications : Nursing Implications Before beginning therapy, obtain a thorough health and medication history Assess dietary patterns, exercise level, weight, height, VS, tobacco and alcohol use, family history Assess for contraindications, conditions that require cautious use, and drug interactions Nursing Implications (cont’d) : Nursing Implications (cont’d) Contraindications include biliary obstruction, liver dysfunction, active liver disease Obtain baseline liver function studies Patients on long-term therapy may need supplemental fat-soluble vitamins (A, D, K) Take with meals to decrease GI upset Nursing Implications (cont’d) : Nursing Implications (cont’d) Patient must be counseled concerning diet and nutrition on an ongoing basis Instruct on proper procedure for taking the medications Powder forms must be taken with a liquid, mixed thoroughly but not stirred, and NEVER taken dry Nursing Implications (cont’d) : Nursing Implications (cont’d) Other medications should be taken 1 hour before or 4 to 6 hours after meals to avoid interference with absorption Clofibrate often causes constipation; instruct patients to increase fiber and fluid intake to offset this effect Nursing Implications (cont’d) : Nursing Implications (cont’d) To minimize adverse effects of niacin, start on low initial dose and gradually increase it, and take with meals Small doses of aspirin or NSAIDs may be taken 30 minutes before niacin to minimize cutaneous flushing Inform patients that these drugs may take several weeks to show effectiveness Nursing Implications (cont’d) : Nursing Implications (cont’d) Instruct patients to report persistent GI upset, constipation, abnormal or unusual bleeding, and yellow discoloration of the skin Monitor for adverse effects, including increased liver enzyme studies Monitor for therapeutic effects Reduced cholesterol and triglyceride levels