Drug Class Table - Chapter 27 - Antilipemic Drugs completed PDF

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Chapter 27: Antilipemic Drugs Drug Class: HMG-CoA Reductase Inhibitors (Statins) How does this drug class work? Decrease rate of cholesterol production by competitively inhibiting HMG-CoA (the rate limiting step in cholesterol synthesis) Decreased cholesterol production -> increased LDL receptors in liver to recycle LDL Reasons they are used: Reduce plasma LDL cholesterol in hypercholesterolemia (type IIa and IIb hyperlipidemia) Medications Primary Use Prefix or Routes Side Effects Suffix Table 27-4 atorvastatin (Lipitor)

Lower total cholesterol, LDL cholesterol, triglyceride levels, raise HDL

-statin

-PO

Abdominal pain, rash, headache, elevations in liver enzymes, myopathy (can progress to rhabdomyolysis, often in combination with interacting drugs)

simvastatin (Zocor)

Lower total cholesterol, LDL cholesterol, triglyceride levels

-statin

-PO

Same as atorvastatin

raise HDL (less than atorvastatin)

Interactions Table 27-5, *Contraindications Oral anticoagulants, drugs metabolized by CYP3A4 (erythromycin, azole antifungals, verapamil, diltiazem, HIV and Hep C protease inhibitors, amiodarone, grapefruit juice), gemfibrozil see above, and itraconazole, ketoconazole, posaconazole, erythromycin, clarithromycin, HIV protease inhibitors, nefazodone, femfibrozil, cyclosporine, danazol

Lifespan Considerations

Chapter 27: Antilipemic Drugs (Page 2) Drug Class: Bile Acid Sequestrants (Bile acid-binding resins or ion-exchange resins) How does this drug class work? Bind bile, prevent resorption of bile acids from small intestine Creates a bile acid + resin complex that is excreted in the feces, when bile acids leave the body this way, the liver converts cholesterol to bile acids (reducing cholesterol in the liver and circulation), liver also increases the number of LDL receptors (decreasing LDL in circulation) Reasons they are used: Primary or adjunct drug for type II hyperlipidemia Pruiritis caused by partial biliary obstruction Medications Primary Use Prefix or Routes Side Effects Interactions, Lifespan Suffix Table 27-6 *Contraindications Considerations -PO (dry cholestyramine -Types IIa and IIb GI (constipation, nausea, *pts with complete hyperlipidemia powder, belching, bloating) biliary obstruction or -Pruiritis caused by partial must be PKU biliary obstruction diluted) -Constipation in patients with loose bowel movements

Drug Class: Niacin (Nicotinic Acid) How does this drug class work? Vitamin B3 Exact mechanism unknown – related to ability to inhibit lipolysis in adipose tissue, decrease triglyceride esterification in liver, increase activity of lipoprotein lipase Reasons they are used: Lowering lipid levels (Reduces metabolism or catabolism of cholesterol and triglycerides) Medications niacin

Primary Use Treats type IIa, IIb, III, IV, and V hyperlipidemia (lowers triglycerides, total serum cholesterol and LDL levels, increases HDL)

Prefix or Suffix

Routes -PO

Side Effects Table 27-7 flushing, pruritis, GI distress

Interactions, *Contraindications *pts with liver disease, peptic ulcer, active bleeding HMG-CoA reductase inhibitors increase risk of myopathy

Lifespan Considerations

Chapter 27: Antilipemic Drugs (Page 3) Drug Class: Fibric Acid Derivatives How does this drug class work? 1) Activate lipoprotein lipase, which breaks down cholesterol 2) Suppress release of free fatty acid from adipose tissue 3) Inhibit synthesis of triglycerides in liver 4) Increase secretion of cholesterol into bile *can also decrease platelet adhesiveness, increase plasma fibrinolysis Reasons they are used: Decrease triglyceride levels, increase HDL cholesterol levels Type II, IV, V hyperlipidemia (sometimes IIb) Routes Medications Primary Use Prefix or Suffix gemfibrozil Type IV and V hyperlipidemia PO (decreases synthesis of apolipoprotein B, lowers VLDL and triglyceride levels, increases HDL levels)

Side Effects Table 27-8 Abdominal discomfort, diarrhea, nausea, headache, blurred vision, increased risk for gallstones, prolonged prothrombin time

Interactions, *Contraindications warfarin, statins

Lifespan Considerations

Drug Class: Miscellaneous Antilipemic Drug – Cholesterol Absorption Inhibitor How does this drug class work? Selectively inhibits absorption of cholesterol and related sterols in small intestine -> reduces total cholesterol, LDL, apolipoprotein B, triglyceride levels, increase in HDL Reasons they are used:

Medications ezetimibe

Primary Use hyperlipidemia

Prefix or Suffix

Routes PO

Side Effects See Table 26-6

Interactions, *Contraindications *pts with active liver disease

Lifespan Considerations

Nursing – To be completed on your own as you discuss the relevant concept in NUR 221, NUR 305, NUR 311

Chapter 27: Antilipemic Drugs

CONCEPT:

What does the nurse need to assess before giving:

Special administration instructions:

What does the nurse need to monitor after giving:

Patient teaching:

How does the nurse know that the medication worked?...