agents used to treat hyperlipidemia. hyperlipidemia 2 atherosclerosis – accumulation of fatty...

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  • Slide 1
  • Agents Used to Treat Hyperlipidemia
  • Slide 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
  • Slide 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
  • Slide 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
  • Slide 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)
  • Slide 6
  • Total cholesterol (U.S. and some other countries) Total cholesterol* (Canada and most of Europe) Below 200 mg/dL Below 5.2 mmol/L Desirable 200-239 mg/dL 5.2-6.2 mmol/L Borderline high 240 mg/dL and above Above 6.2 mmol/L High 6
  • Slide 7
  • LDL cholesterol (U.S. and some other countries) LDL cholesterol* (Canada and most of Europe) Below 70 mg/dL Below 1.8 mmol/L Ideal for people at very high risk of heart disease Below 100 mg/dL Below 2.6 mmol/L Ideal for people at risk of heart disease 100-129 mg/dL 2.6-3.3 mmol/L Near ideal 130-159 mg/dL 3.4-4.1 mmol/L Borderline high 160-189 mg/dL 4.1-4.9 mmol/L High 190 mg/dL and above Above 4.9 mmol/L Very high 7
  • Slide 8
  • HDL cholesterol (U.S. and some other countries) HDL cholesterol* (Canada and most of Europe) Below 40 mg/dL (men) Below 50 mg/dL (women) Below 1 mmol/L (men) Below 1.3 mmol/L (women) Poor 40-49 mg/dL (men) 50-59 mg/dL (women) 1-1.3 mmol/L (men) 1.3-1.5 mmol/L (women) Better 60 mg/dL and above 1.6 mmol/L and above Best 8
  • Slide 9
  • Triglyceride s (U.S. and some other countries) Triglyceride s* (Canada and most of Europe) Below 150 mg/dL Below 1.7 mmol/L Desirable 150-199 mg/dL 1.7-2.2 mmol/L Borderline high 200-499 mg/dL 2.3-5.6 mmol/L High 500 mg/dL and above Above 5.6 mmol/L and above Very high 9
  • Slide 10
  • Classification of antihyperlipidemics 10 Fibrinic acid derivatives Gemfibrozil (Lopid), fenofibrate (Tricor) HMG-CoA reductase inhibitors (HMGs or statins) Atorvastatin (Lipitor), ezetimibe (Zetia), lovastatin (Mevacor), rosuvastatin (Crestor), simvastatin (Zocor)
  • Slide 11
  • Classification of antihyperlipidemics Niacin (nicotinic acid) Vitamin B3 1-2 grams 3x/day Bile acid sequestrants may bind other PO drugs; dont give within 1 hour after or 4 hours before other drugs cholestyramine colestipol Hcl 11
  • Slide 12
  • Fibrinic Acid Derivatives 12 Reduce the synthesis of triglycerides in the liver Decrease VLDL and LDL Increase HDL Side effects Nausea, flatulence, bloating, diarrhea, and liver changes
  • Slide 13
  • HMG-CoA Reductase Inhibitors 13 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
  • Slide 14
  • Vitamin B 3 Niacin 14 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
  • Slide 15
  • Bile Acid Sequestrants 15 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
  • Slide 16
  • Bile Acid Sequestrants: Therapeutic Uses Treatment of hyperlipidemia Decrease the triglyceride levels Increase HDL by as much as 25% 16
  • Slide 17
  • Side Effects of antihyperlipidemics 17 Abdominal discomfort Diarrhea or constipation Nausea Headache Increased risk of gallstones Prolonged prothrombin time Liver studies: dysfunctional changes, elevated enzymes
  • Slide 18
  • Antihyperlipidemics Antihyper-lipidemic agents generally take several weeks to show effectiveness 18
  • Slide 19
  • Nursing Implications 19 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.
  • Slide 20
  • Nursing Implications 20 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