Chapter 19

Agents Used to Treat Hyperlipidemia

Hyperlipidemia

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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 albuminForms chemical compound called lipoproteins

Hyperlipidemia

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Fats in the bloodChylomicronsVLDL = very low-density lipoproteins

LDL = low-density lipoproteinsHDL = high-density lipoproteinsTarget >40mg/dL male/>50mg/dL women

Lipoproteins

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VLDL and LDL plays a role in developing arthrosclerosis

First line of defense is dietary management

Drug therapy may be indicatedDoes not reverse existing arthrosclerosisLong-term therapyStandards established to reduce rate of CAD

Antihyperlipidemics

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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)

Classification of antihyperlipidemics

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Fibrinic acid derivatives Gemfibrozil (Lopid), fenofibrate (Tricor)

HMG-CoA reductase inhibitors (HMGs or statins) Atorvastatin (Lipitor), ezetimibe (Zetia), lovastatin (Mevacor), rosuvastatin (Crestor), simvastatin (Zocor)

Classification of antihyperlipidemics

Niacin (nicotinic acid) Vitamin B31-2 grams 3x/day

Bile acid sequestrants – may bind other PO drugs; don’t give within 1 hour after or 4 hours before other drugscholestyraminecolestipol Hcl

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Fibrinic Acid Derivatives

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Reduce the synthesis of triglycerides in the liverDecrease VLDL and LDLIncrease HDL

Side effectsNausea, flatulence, bloating, diarrhea, and liver changes

HMG-CoA Reductase Inhibitors

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Inhibit HMG-CoA reductaseEnzyme used by the liver to produce cholesterol

Lowers the rate of cholesterol production

Side effectsLiver changesGI upset, constipation, or diarrhea

Atorvastatin is very effective

Vitamin B3 Niacin

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Requires higher doses than when used as a vitaminDecreases triglyceridesIncreases HDLEffective and inexpensiveOften used in combination with other lipid-lowering agents

Side effectHypotension from vasodilation

Bile Acid Sequestrants

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Bile acids are necessary for absorption of cholesterol

Mechanism of actionCombine with bile acidsForm insoluble complexResult

Prevent resorption of bile acids from small intestine

Bile Acid Sequestrants: Therapeutic Uses

Treatment of hyperlipidemiaDecrease the triglyceride levels

Increase HDL by as much as 25%

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Side Effects of antihyperlipidemics

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Abdominal discomfortDiarrhea or constipationNauseaHeadacheIncreased risk of gallstonesProlonged prothrombin timeLiver studies: dysfunctional changes,

elevated enzymes

Antihyperlipidemics

Antihyper-lipidemic agents generally take several weeks to show effectiveness

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Nursing Implications

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ContraindicationsBiliary obstruction and active liver diseaseLiver function studies

Long-term therapyRequires supplemental fat-soluble vitamins (A, D, E, and K)

Take with meals to decrease GI upset.

Nursing Implications

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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