1. Chapter 21 Agents Used in the Treatment of Hyperlipidemia

2. Hyperlipidemia p514 Hyperlipidemia: High levels of fatty substances (lipids) circulating in the blood Contributes to development of atherosclerosis Untreated: – Stroke – Heart attack – Hypertension

3. Hyperlipidemia p515 Fats in the blood – VLDL = very low density lipoproteins – LDL = low density lipoproteins – HDL = high density lipoproteins - 3 - 3

4. 2004 standards of National Cholesterol Education Program Total cholesterol should be less than 200mg/dl Goal for total cholesterol is 170-180mg/dl

5. Anti-hyperlipidemics Lower serum cholesterol levels Risk for coronary artery 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.

6. HMG-CoA Reductase Inhibitors p515 HMG-CoA reductase – Enzyme used by the liver to produce cholesterol HMG-CoA reductase inhibitors (statins) – inhibit the HMG-CoA reductase enzyme Side effects – Liver changes, expect liver function labs – GI upset – Photosensitivity – Myopathy – Rhabdomyolysis (can lead to renal failure) Pregnancy category X

7. HMG-CoA reductase inhibitors cont atorvastatin (Lipitor) simvastatin (Zocor) pravastatin (Pravachol) rosuvastatin (Crestor)

8. Vitamin B 3, Niacin, nicotinic acid p 517 Requires higher doses than when used as a vitamin supplement – Decreases triglycerides – Increases HDL – Effective and inexpensive Side effects – Hypotension from vasodilation – Pruritis – Flushing – GI irritation

9. Exchange resins p517 Bile is made from cholesterol After bile emulsifies fat, some bile is reabsorbed to be used again Mechanism of action of bile acid sequestrants – Combine with bile acids Form insoluble complex excreted in stool Result: Prevents reabsorption of bile from small intestine – When bile is bound and not reusable, more cholesterol is used to make new bile, and serum cholesterol levels decrease. – Examples: cholestyramine (Questran)

10. Exchange resins p517 Side effects: – Constipation – abdominal discomfort – N&V – diarrhea – Exchange resins will bind other drugs that are orally ingested. They must not be administered 1 hour after or 4 hours before any other orally administered drug. – Produce a deficit of fat soluble vitamins (A,D, E, K) These drugs are available as a dry powder or granules and must be mixed with liquid prior to administration

11. Nursing considerations p519 Assessment: – Xanthoma: yellow nodule or papule containing cholesterol – Assess for exercise patterns, diet, smoking, alcohol intake, family history of hyperlipidemia. Encourage weight loss to lower blood lipid level

12. Safe nursing practice p522 Good summaries: – Box 21-1 pg 522 – Home care client teaching pg 523