Chapter 18 Drugs Used to Lower Lipids

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

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

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

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

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

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

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

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

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

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

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

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….

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