Agents Used in the Treatment of Hyperlipidemia Chapter 21 Agents Used in the Treatment of Hyperlipidemia

Hyperlipidemia Fats in the blood Chylomicrons VLDL = very low-density lipoproteins LDL = low-density lipoproteins HDL = high-density lipoproteins Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Agents Used to Treat Hyperlipidemia Drugs used to lower lipid levels Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Hyperlipidemics Prevent heart disease According to Ignatavicius and Workman, Medical-Surgical Nursing: Critical Thinking for Collaborative Care, 2005, the risk for coronary heart disease is three times greater if the cholesterol level is at or above 260 mg/dL compared to a person with a level of 200 mg/dL or lower. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Classification of Hyperlipidemics Fibric acid derivatives HMG-CoA reductase inhibitors (HMGs or statins) Niacin (nicotinic acid) Bile acid sequestrants Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Fibric Acid Derivatives Reduce the synthesis of triglycerides in the liver Decrease VLDL and LDL Increase HDL Side effects Nausea, flatulence, bloating, diarrhea, and liver changes Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

HMG-CoA Reductase Inhibitors Inhibit HMG-CoA reductase Enzyme used by the liver to produce cholesterol Lowers the rate of cholesterol production Side effects Liver changes GI upset, constipation, or diarrhea Atorvastatin is very effective. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Vitamin B3 Niacin Requires higher doses than when used as a vitamin Decreases triglycerides Increases HDL Effective and inexpensive Often used in combination with other lipid-lowering agents Side effect Hypotension from vasodilation Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Bile Acid Sequestrants Bile acids are necessary for absorption of cholesterol Mechanism of action Combine with bile acids Form insoluble complex Result Prevent resorption of bile acids from small intestine Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Bile Acid Sequestrants: Therapeutic Uses Treatment of hyperlipidemia Decrease the triglyceride levels Increase HDL by as much as 25% Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Side Effects of Hyperlipidemics Abdominal discomfort Diarrhea or constipation Nausea Headache Increased risk of gallstones Prolonged prothrombin time Liver studies: dysfunctional changes, elevated enzymes Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Hyperlipidemics All hyperlipidemic agents Take several weeks to show effectiveness Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Nursing Implications Contraindications Long-term therapy Biliary obstruction and active liver disease Liver function studies Long-term therapy Requires supplemental fat-soluble vitamins (A, D, E, and K) Take with meals to decrease GI upset. (continues) Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.

Nursing Implications Obtain a thorough health and medication history (continued) Nursing Implications Obtain a thorough health and medication history Assess dietary patterns, exercise level, height and weight, vital signs, and family history (genetics, and tobacco and alcohol use) Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.