1. Chapter 19 Agents Used to Treat Hyperlipidemia

2. Hyperlipidemia 2 Atherosclerosis – accumulation of fatty substances on the inner wall of large and medium sized arteries Can lead to CAD, cerebral vascular disease, peripheral vascular disease or renal disease and failure Lipids bind to albumin Forms chemical compound called lipoproteins

3. Hyperlipidemia 3 Fats in the blood Chylomicrons VLDL = very low-density lipoproteins LDL = low-density lipoproteins HDL = high-density lipoproteins Target >40mg/dL male/>50mg/dL women

4. Lipoproteins 4 VLDL and LDL plays a role in developing arthrosclerosis First line of defense is dietary management Drug therapy may be indicated Does not reverse existing arthrosclerosis Long-term therapy Standards established to reduce rate of CAD

5. Antihyperlipidemics 5 Help prevent heart disease 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 (Ignatavicius and Workman, Medical-Surgical Nursing: Critical Thinking for Collaborative Care, 2005)

6. Classification of antihyperlipidemics 6 Fibrinic acid derivatives Gemfibrozil (Lopid), fenofibrate (Tricor) HMG-CoA reductase inhibitors (HMGs or statins) Atorvastatin (Lipitor), ezetimibe (Zetia), lovastatin (Mevacor), rosuvastatin (Crestor), simvastatin (Zocor)

7. Classification of antihyperlipidemics Niacin (nicotinic acid) Vitamin B3 1-2 grams 3x/day Bile acid sequestrants – may bind other PO drugs; don’t give within 1 hour after or 4 hours before other drugs cholestyramine colestipol Hcl 7

8. Fibrinic Acid Derivatives 8 Reduce the synthesis of triglycerides in the liver Decrease VLDL and LDL Increase HDL Side effects Nausea, flatulence, bloating, diarrhea, and liver changes

9. HMG-CoA Reductase Inhibitors 9 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

10. Vitamin B 3 Niacin 10 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

11. Bile Acid Sequestrants 11 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

12. Bile Acid Sequestrants: Therapeutic Uses Treatment of hyperlipidemia Decrease the triglyceride levels Increase HDL by as much as 25% 12

13. Side Effects of antihyperlipidemics 13 Abdominal discomfort Diarrhea or constipation Nausea Headache Increased risk of gallstones Prolonged prothrombin time Liver studies: dysfunctional changes, elevated enzymes

14. Antihyperlipidemics Antihyper-lipidemic agents generally take several weeks to show effectiveness 14

15. Nursing Implications 15 Contraindications 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.

16. Nursing Implications 16 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) Teach patients that dietary modifications are important when treating elevated serum lipids