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Hypolipidemic drugs for Bsc nursing
This document discusses hypolipidemic drugs used to treat high cholesterol and triglyceride levels. It describes the different classes of drugs, including statins, bile acid sequestrants, niacin, fibrates, ezetimibe, and omega-3 fatty acids. For each class, it covers the mechanism of action, examples of drugs, indications, effects on lipid levels, adverse effects and interactions. Nursing implications for administration and monitoring of these drugs are also reviewed.
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Introduction to hypolipidemic drugs by Dr. Resu Neha Reddy, MD Pharmacology student.
Explanation of lipoproteins as combinations of triglycerides or cholesterol and apolipoproteins.
Details about different lipoproteins: VLDL (produced by the liver), LDL, and HDL (good cholesterol).
Discusses the risk of coronary heart disease related to cholesterol levels and various positive/negative risk factors.
Introduction to antilipemic drugs alongside lifestyle modifications such as diet and exercise.
Overview of various hypolipidemic drugs, focusing on HMG-CoA reductase inhibitors (statins), their actions, and indications.
Details on the adverse effects and drug interactions associated with statins.
Mechanism of action, indications, and side effects of bile acid sequestrants.
Introduction to Niacin’s use, mechanism of action, indications, and adverse effects.
Mechanism of action, indications, effects, and adverse effects of fibrates.
Discusses Ezetimibe's role in inhibiting cholesterol absorption and its clinical effectiveness.
Information on garlic and omega-3 fatty acids as herbal products used to reduce cholesterol.
Critical nursing considerations, contraindications for therapy, patient counseling, and monitoring.
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Hypolipidemic drugs for Bsc nursing
- 1. HYPOLIPIDEMIC DRUGS Dr. Resu NehaReddy 2nd year Post Graduate MD Pharmacology Osmania Medical College
- 3. Triglycerides and Cholesterol •Lipoprotein is the combination of triglyceride or cholesterol with apolipoprotein
- 5. Lipoproteins • Very-low-density lipoprotein(VLDL) • Produced by the liver • Transports endogenous lipids to the cells • Low-density lipoprotein (LDL) • High-density lipoprotein (HDL) • Responsible for “recycling” of cholesterol • Also known as “good cholesterol”
- 7. Cholesterol and CoronaryHeart Disease (CHD) • The risk of CHD in patients with cholesterol levels of 300 mg/dL is three to four times greater than that in patients with levels less than 200 mg/dL.
- 8. Coronary Heart Disease PositiveRisk Factors • Age Male 45 years or older Female 55 years or older Family history of premature CHD • Current cigarette smoker
- 9. Coronary Heart Disease PositiveRisk Factors (cont’d) • Hypertension BP 140/90 or higher, or on antihypertensive medication • Low HDL levels: less than 40 mg/dL • Diabetes mellitus
- 10. Coronary Heart Disease Negative(Beneficial) Risk Factor • High HDL (“good” cholesterol): 60 mg/dL or higher
- 11. Hyperlipidemias and TreatmentGuidelines • Antilipemic drugs Drugs used to lower lipid levels Used as an adjunct to diet therapy • Drug choice based on the specific lipid profile of the patient
- 12. Treatment Guidelines (cont’d) •All reasonable non-drug means of controlling blood cholesterol levels (e.g., diet, exercise) should be tried for at least 6 months and found to fail before drug therapy is considered
- 17. Hypolipidemic drugs • HMG-CoAreductase inhibitors (HMGs, or statins) • Bile acid sequestrants • B vitamin niacin (vitamin B3, nicotinic acid) • Fibric acid derivatives (fibrates) • Cholesterol absorption inhibitor (Zetia) • Combination drugs (Vytorin)
- 22. HMG-CoA Reductase Inhibitors:Mechanism of Action • Inhibit HMG-CoA reductase, which is used by the liver to produce cholesterol • Lower the rate of cholesterol production
- 23. HMG-CoA Reductase Inhibitors(HMGs, or statins) • Most potent LDL reducers • lovastatin (Mevacor) • pravastatin (Pravachol) • simvastatin (Zocor) • atorvastatin (Lipitor) • fluvastatin (Lescol) • rosuvastatin (Crestor) • pitavastatin (Livalo)
- 24. HMG-CoA Reductase Inhibitors:Indications • First-line drug therapy for hypercholesterolemia • Treatment of types IIa and IIb hyperlipidemias • Reduces LDL levels by 30% to 40% • Increases HDL levels by 2% to 15% • Reduces triglycerides by 10% to 30%
- 25. HMG-CoA Reductase Inhibitors:Adverse Effects • Mild, transient GI disturbances • Rash • Headache • Myopathy (muscle pain), possibly leading to the serious condition rhabdomyolysis • Elevations in liver enzymes or liver disease
- 26. HMG-CoA Reductase Inhibitors:Interactions • Oral anticoagulants • Drugs metabolized by CYP3A4 • erythromycin • Azole antifungals • verapamil • diltiazem • HIV protease inhibitors • Amiodarone • Grapefruit juice
- 27. Classroom Response Question Apatient with a new prescription for a HMG-CoA (statin) drug is instructed to take the medication with the evening meal or at bedtime. The patient asks why it must be taken at this time of day. The reason is: A. The medication is better absorbed at this time. B. This timeframe correlates better with the natural diurnal rhythm of cholesterol production. C. There will be fewer adverse effects if taken at night instead of with the morning meal. D. This timing reduces the incidence of myopathy.
- 29. Bile Acid Sequestrants:Mechanism of Action • Prevent resorption of bile acids from small intestine • Bile acids are necessary for absorption of cholesterol
- 30. Bile Acid Sequestrants •cholestyramine (Questran) • colestipol (Colestid) • colesevelam (Welchol) • Also called bile acid–binding resins and ion-exchange resins
- 31. Bile Acid Sequestrants:Indications • Type II hyperlipoproteinemia • Relief of pruritus associated with partial biliary obstruction (cholestyramine) • May be used along with statins
- 32. Bile Acid Sequestrants: AdverseEffects • Constipation • Heartburn, nausea, belching, bloating These adverse effects tend to disappear over time
- 35. Niacin (Nicotinic Acid) •Vitamin B3 • Lipid-lowering properties require much higher doses than when used as a vitamin • Effective, inexpensive, often used in combination with other lipid-lowering drugs
- 36. Niacin: Mechanism ofAction • Thought to increase activity of lipase, which breaks down lipids • Reduces the metabolism or catabolism of cholesterol and triglycerides
- 37. Niacin: Indications • Effectivein lowering triglyceride, total serum cholesterol, and LDL levels • Increases HDL levels • Effective in the treatment of types IIa, IIb, III, IV, and V hyperlipidemias
- 38. Niacin: Adverse Effects •Flushing (caused by histamine release) • Pruritus • GI distress
- 39. Classroom Response Question Apatient will be taking niacin as part of antilipemic therapy. The best way to avoid problems with flushing or pruritus would be to: A. take the medication at bedtime. B. take the medication with a small dose of a steroid. C. take the medication with a full glass of water on an empty stomach. D. start with a low initial dose, and then increase it gradually.
- 42. Fibric Acid Derivatives:Mechanism of Action • Believed to work by activating lipase, which breaks down cholesterol • Also suppress the release of free fatty acid from adipose tissue, inhibit synthesis of triglycerides in the liver, and increase secretion of cholesterol in the bile
- 43. Fibric Acid Derivatives •Also known as fibrates • gemfibrozil (Lopid) • fenofibrate (Tricor)
- 44. Fibric Acid Derivatives:Indications • Treatment of types III, IV, and V hyperlipidemias • The fibric acid derivatives gemfibrozil and fenofibrate decrease the triglyceride level and increase the HDL cholesterol level by as much as 25%
- 45. Fibric Acid Derivatives: DrugEffects • Decrease the triglyceride levels • Increase HDL by as much as 25%
- 46. Fibric Acid Derivatives: AdverseEffects • Abdominal discomfort, diarrhea, nausea • Blurred vision, headache • Increased risk of gallstones • Prolonged prothrombin time • Liver studies may show increased function
- 47. Fibric Acid Derivatives: Interactions •Oral anticoagulants • Statins • Risk for myositis, myalgias, and rhabdomyolysis is increased • Laboratory test reactions • Decreased hemoglobin level, hematocrit value, and white blood cell count • Increased activated clotting time, lactate dehydrogenase level, and bilirubin level
- 50. Cholesterol Absorption Inhibitor •Ezetimibe (Zetia) • Inhibits absorption of cholesterol and related sterols from the small intestine • Results in reduced total cholesterol, LDL, and triglyceride levels • Also increases HDL levels • Often combined with a statin drug • Clinical usefulness has been questioned; new trials underway Currently recommended only when patients have not responded to other therapy
- 51. Herbal Product: Garlic •Used as an antispasmodic, antihypertensive, antiplatelet, lipid reducer • Adverse effects: dermatitis, vomiting, diarrhea, flatulence, antiplatelet activity • Possible interactions with warfarin, diazepam • May enhance bleeding when taken with NSAIDs
- 52. Classroom Response Question Apatient wants to take garlic tablets to improve his cholesterol levels. Which condition would be a contraindication? A. Hypertension B. Bowel obstruction C. Sinus infection D. Scheduled surgery
- 53.
- 54. Herbal Product: Omega-3 FattyAcids • Fish oil products • Used to reduce cholesterol • May cause rash, belching, allergic reactions • Potential interactions with anticoagulant drugs
- 56. Nursing Implications • Beforebeginning therapy, obtain a thorough health and medication history • Assess dietary patterns, exercise level, weight, height, vital signs, tobacco and alcohol use, family history • Assess for contraindications, conditions that require cautious use, and drug interactions
- 57. Nursing Implications (cont’d) •Contraindications include biliary obstruction, liver dysfunction, active liver disease • Obtain baseline liver function studies • Patients on long-term therapy may need supplemental fat-soluble vitamins (A, D, K) • Take with meals to decrease GI upset
- 58. Nursing Implications (cont’d) •Counsel patient concerning diet and nutrition on an ongoing basis • Instruct patient on proper procedure for taking the medications
- 59. Nursing Implications (cont’d) •Other medications should be taken 1 hour before or 4 to 6 hours after meals to avoid interference with absorption • To minimize adverse effects of niacin, start on low initial dose and gradually increase it, and take with meals
- 60. Classroom Response Question Beforeadministering niacin, it is most important for the nurse to assess the patient for A. allergy to erythromycin. B. gout. C. coronary artery disease. D. hypothyroidism.
- 61. Nursing Implications (cont’d) •Small doses of aspirin or NSAIDs may be taken 30 minutes before niacin to minimize cutaneous flushing • Inform patients that these drugs may take several weeks to show effectiveness
- 62. Nursing Implications (cont’d) •Instruct patients to report persistent GI upset, constipation, abnormal or unusual bleeding, and yellow discoloration of the skin • Monitor for adverse effects, including increased liver enzyme studies • Monitor for therapeutic effects • Reduced cholesterol and triglyceride levels
- 63.