Transcript Ch. 18-Drugs used to Lower Lipidsx

Chapter 18
Drugs Used to
Lower Lipids
lipids are fats
 hyperlipidemia: excess lipids in the blood
 main lipids in the blood are:

 cholesterol
 triglycerides
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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

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
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blood is a liquid, lipids are fatty and they do not mix well
to travel in bloodstream fats are carried in blood by lipoproteins
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
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
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
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
Drugs Used to Lower Lipids cont…
Niacin:
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niacin (nicotinic acid) is vitamin B
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limits the livers ability to produce LDL cholesterol
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can be used with bile-acid producing resins or statins to
lower cholesterol and triglyceride levels
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causes vaso-dilation and increases blood flow
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
Drugs Used to Lower Lipids cont…
Statins:
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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
- Statins:
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
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 antilipemic 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
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
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
Omacor:
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….
side effects from Omacor (p. 239, box 18-1)
Report the following at once:
- arm, back or jaw pain
- chest pain/discomfort
- chest tightness or heaviness
- breathing: difficult, labored, or
shortness of breath
- heartbeat: fast or irregular
- nausea
- sweating
- wheezing
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Other side effects:
- loss of appetite
-sleep problems
- belching
-taste: change in
- bloating
-tiredness
- chills
-weakness
- cough
-vomiting
- diarrhea
- fever
- discomfort
- headache
- hoarseness
- joint pain
- pain: lower back, side
- muscles: aches and pains
- urination: difficult or painful
- rash
- runny nose
- shivering
- sweating