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

2. Hyperlipidemia Fats in the blood Chylomicrons
VLDL = very low-density lipoproteins
LDL = low-density lipoproteins
HDL = high-density lipoproteins
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3. Agents Used to Treat Hyperlipidemia
Drugs used to lower lipid levels
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4. 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.
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5. Classification of Hyperlipidemics
Fibric acid derivatives
HMG-CoA reductase inhibitors (HMGs or statins)
Niacin (nicotinic acid)
Bile acid sequestrants
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6. 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
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7. 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.
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8. 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
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9. 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
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10. Bile Acid Sequestrants: Therapeutic Uses
Treatment of hyperlipidemia
Decrease the triglyceride levels
Increase HDL by as much as 25%
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11. Side Effects of Hyperlipidemics
Abdominal discomfort
Diarrhea or constipation
Nausea
Headache
Increased risk of gallstones
Prolonged prothrombin time
Liver studies: dysfunctional changes, elevated enzymes
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12. Hyperlipidemics All hyperlipidemic agents
Take several weeks to show effectiveness
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13. 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.
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14. 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)
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