1. Chapter 18 Drugs Used to Lower Lipids

2. hyperlipidemia: excess lipids in the blood
lipids are fats
hyperlipidemia: excess lipids in the blood
main lipids in the blood are:
cholesterol
triglycerides
cholesterol: waxy, fat-like substance found in all body cells
body produces the cholesterol it needs
it’s also found in foods from animal sources
body converts extra dietary cholesterol into fat

3. build up is called atherosclerosis
triglycerides: fatty compounds that come from animal and vegetable fats
source of energy
stored in body’s fatty tissues
if too many lipids in blood, fat can build up on walls or arteries and arterioles throughout the body
build up is called atherosclerosis
it causes a hardening of the arteries
blocks blood flow
when build-up/blockage occurs in the heart’s arteries it causes coronary artery disease (CAD)
CAD can lead to angina or MI
CAD is leading cause of death in U.S. in men and women

5. blood is a liquid, lipids are fatty and they do not mix well
to travel in bloodstream fats are carried in blood by lipo- proteins
lipo-proteins are made up of fat and proteins
Low-density lipo-protein (LDL) cholesterol:
bad cholesterol
leads to build up of plaque in arteries
higher the LDL level higher risk of CAD
High-density lipo-protein (HDL) cholesterol:
good cholesterol
carries cholesterol from other body parts to the liver and liver removes it from the body
the higher the HDL level the lower the risk of CAD

7. dyslipidemia: abnormality of one or more of the blood fats (lipids)
causes:
hereditary: high blood cholesterol can run in families
diet high in fat, cholesterol, carbs, calories and alcohol
weight gain and being over weight
lack of regular exercise
age and gender

8. Bile Acid-Binding Resins:
Drugs Used to Lower Lipids:
Bile Acid-Binding Resins:
- bile is a yellow-green liver secretion, stored in gallbladder
- bile is released into the duodenum to prepare fats for digestion
bile acid is produced when cholesterol is metabolized
resins are sold or semi-solid substances
bile acid-binding resins interrupt the normal circulation of bile acids between the liver and intestines
more bile acids are excreted in feces
liver produces bile acids from cholesterol
because there are fewer bile acids, liver takes more LDL cholesterol from the blood to replace them, thus LDL levels in the blood decrease

9. Assisting With the Nursing Process for bile-acid binding resins:
Drugs Used to Lower Lipids cont…
Assisting With the Nursing Process for
bile-acid binding resins:
ASSESSMENT: ask persons about abdominal pain, nausea and flatus
PLANNING: oral dose forms:
cholestyramine(Questran):
4g powder packets
210/378g cans
colestipol (Colestid):
1g tablets
5g granule packets
100 and 500g containers
colesevelam(Welchol)
625mg tablets
IMPLEMENTATION: see pg. 237 for adult dosages and preparation
EVALUATION: report and record:
-constipation, abdominal pain, bloating, fullness, nausea, flatulence. Mix drug with non-carbonated drink, no gulping air with swallowing, increase liquid intake, fiber

10. Niacin: niacin (nicotinic acid) is vitamin B
Drugs Used to Lower Lipids cont…
Niacin:
niacin (nicotinic acid) is vitamin B
limits the livers ability to produce LDL cholesterol
can be used with bile-acid producing resins or statins to lower cholesterol and triglyceride levels
causes vaso-dilation and increases blood flow

11. Assisting With the Nursing Process
Drugs Used to Lower Lipids cont…
Assisting With the Nursing Process
Niacin:
ASSESSMENT: measure BP and heart rate, ask person about abdominal pain, nausea and flatus
PLANNING: oral dose forms:
-50, 100, 250, 500mg tablets
-125, 250, 400, 500mg time-release capsules
-250, 500, 750, 1000mg time release tablets
IMPLEMENTATION: initial dose is 100mg 3x/day,
dose is increased by 300mg weekly until therapeutic level is reached. Give food with this drug.
EVALUATION: report and record:
-flushing, itching, rash, tingling, headache: common at start
-nausea, gas, abdominal discomfort, pain: give all doses with food
-dizziness, faintness, hypotension: provide for safety
-fatigue, anorexia, nausea, malaise, jaundice: may signal liver toxicity
-muscle aches, soreness, weakness: signal there may be changes is t the muscle tissue

12. Assisting With the Nursing Process
Drugs Used to Lower Lipids cont…
Statins:
statins are strongest anti-lipemic drugs available
block the enzyme the liver needs to produce cholesterol, this reduces the amount of cholesterol in the liver
forces the liver to remove cholesterol from the blood
goal is to remove cholesterol from the blood
statins also reduce inflammation and blood clotting, help reduce strokes and MI’s
Assisting With the Nursing Process
ASSESSMENT: ask person about abdominal pain, nausea, flatus
PLANNING: see table 18-1 (pg. 238) for “Oral Dose forms”
IMPLEMENTATION: see table 18-1 (pg. 238) for “Daily adult dose” and “maximum daily dose, do NOT give drug w/ grapefruit juice EVALUATION: report and record:
fatigue, anorexia, nausea, malaise, jaundice: may indicate liver problems
muscle aches, soreness, weakness: may signal changes in muscle tissues

13. Assisting With the Nursing Process
Drugs Used to Lower Lipids cont…
Fibric Acids
-lower triglyceride and LDL levels
-raise HDL levels
-used for those who haven’t responded to weight loss, diet therapy or other anti- lipemic drugs
- 2 common drugs: gemfibrozil (Lopid) and fenofibrate (Tricor)
Assisting With the Nursing Process
Fibric Acids:
ASSESSMENT: ask person about abdominal pain, nausea and flatus
PLANNING: oral dose forms: gemfibrozil(Lopid) 600mg tablets
fenofibrate (Tricor) 48 and 145mg tablets
IMPLEMENTATION: Lopid:1200mg/day, in 2 doses, given 30mins before meals,
Tricor: initial dose is increased every 4-8 weeks up to 145mg daily, give with meal
EVALUATION: report and record:
-nausea, diarrhea, flatulence, bloating, abdominal distress: these are common, lower dose taken between meals may reduce these effects
-fatigue, anorexia, nausea, malaise, jaundice: liver or gallbladder troubles
-muscle aches, soreness, weakness: signal changes in muscle tissue

14. Assisting With the Nursing Process
Drugs Used to Lower Lipids cont…
Other anti-lipemic drugs:
ezetimibe (Zetia):
-small intestine absorbs dietary cholesterol and releases it into the blood
-cholesterol absorption inhibitors block the absorption, thus they lower cholesterol levels
Assisting With the Nursing Process
Zetia:
ASSESSMENT: ask person about abdominal pain, nausea, flatus
PLANNING: oral dose form is 10mg tablets
IMPLEMENTATION: usual dose is 10mg/day, can be taken with or without food
EVALUATION: report and record: abdominal pain, diarrhea: generally mild

15. Assisting With the Nursing Process
Drugs Used to Lower Lipids cont…
Other anti-lipemic drugs:
Omacor:
-contains fatty acids, commonly called fish oils
-reduces synthesis of triglycerides in liver
-lowers triglyceride levels with small increases in HDL
Assisting With the Nursing Process
ASSESSMENT: ask person about abdominal pain, nausea, flatus
PLANNING: oral dose form is 1g capsule
IMPLEMENTATION: usual dose is 4g once/day or 2g twice a day
EVALUATION: see following slide….

16. side effects from Omacor (p. 239, box 18-1)
Report the following at once:
Other side effects:
arm, back or jaw pain
loss of appetite sleep problems
belching taste: change in
chest pain/discomfort
bloating tiredness
chest tightness or heaviness
chills weakness
breathing: difficult, labored, or shortness of breath
cough vomiting
diarrhea
heartbeat: fast or irregular
fever
nausea
discomfort
sweating
headache
hoarseness
wheezing
joint pain
pain: lower back, side
muscles: aches and pains
urination: difficult or painful
rash
runny nose
shivering