Where does the freshest most oxygenated blood go
CA (cardiac aortia)
what are some modifiable risk factors for cardiac disease
sodium intake;
DM;
smoking;
obesity;
alcohol;
cholesterol;
HTN;
sedentary life style
What are some nonmodifiable risk factors
family history;
advancing age & atherosclerosis;
sex;
race
What are the ranges for normal total cholesterol levels
< 200
What are the ranges for borderline high total cholesterol level
200 - 239 (single medication)
What is the range for high total cholesterol levels
240 or above (2 or more medications)
High density lipoprotein (HDL) cholesterol
contains larger amounts of protein and smaller amounts of lipid;
often referred to as " good cholesterol," is a small but very important lipoprotein.
What is the optimal HDL level
40 - 60
Low density lipoprotein (LDL) cholesterol
contains less protein and larger amounts of lipid;
" bad cholesterol,
What is the optimal LDL level
< 100
What is the optimal triglyceride level
< 150
What are the 5 types of Dyslipidemia Medications
HMG-CoA reductase Inhibitors (Statins);
Bile Acid Sequesterants (Cholestyramine);
Fibrates (Gemfibrozil);
Niacin;
Cholesterol Absorption Inhibitor (Ezetimibe)
What is the first line of treatment in dyslipedemia
Statins
which drugs are the considered the most effective drugs in reducint he major types of dyslipedemia
STATINS�HMG-CoA Reduce Inhibitors
What are the action of STATINS�HMG-CoA Reduce Inhibitors
inhibit the production of an enzyme necessary for hepaticc synthesis of cholesterol and are effective in decreasing LDL w/in 2 weeks---they reach maximal effect in 4-6 weeks
What is the main STATINS�HMG-CoA Reduce Inhibitors
Atorvastatin (lipitor)
STATINS�HMG-CoA Reduce Inhibitors reduce LDL but they increase
HDL
What are some uses for Statins
Statins are preferred for single drug therapy to lower cholesterol;
To lower both cholesterol and triglycerides, combination therapy is indicated;
Statins are more effective if taken at night
Why are statins more effective if taken at night
Metabolization takes place and night;
stop process
What are some common side effects of Statins
GI symptoms are the most common adverse effect, primarily constipation;
Liver dysfunction is possible;
muscle tissue damage characterized by muscle ache---rare myostis and progression to rabdomyolitis
What is rabdomyolitis
breakdown of muscles
A nursing consideration of statins is grapefruit juice this is because
will cause increased risk of toxicity
There is a rare occurance of hepatotoxicity in statins therefore what test is used before & after therapy is started
LFT (Liver Function Test)
What is the nursing consideration for Statins in regards to the sun
Increased sensitivity to sunlight, NO sunbathing, USE of sunscreen
What are some drugs that increase the effects of statins and related drugs
anti-fungals,
cyclosporine,
erythromycin
What are some drugs that decrase the effects of the statins and related drugs
antacids,
riphampin and
bile acid sequestrants
What is the action of Bile Acid Sequestrants
Bind bile acids to the intestinal lumen thus causing bile acids to be excreted in feces
Bile Acid Sequestrants
Cholestyramine (questran)
What are bile acid Sequestrants (Cholestyramine) used for
to reduce LDL in folks already taking statins
A side effect of bile acid sequestrants is constipation, what would you increase because of this
fiber intake
Watch taking othe drugs as they my prevent asborbtion
side effect of Bile acid Sequestrants
How are bile acid sequestrants administered in regards to other drugs
Take other meds 1hour before or 4-6hours after taking these
What is a nursing consideration for bile acid sequestrants
This is a powder and must be mixed with H2O, or apple juice. Don't take dry
What is the action of fibrates
Mimic endogenous fatty acids and decrease the oxidation of hepatic fatty acids thereby decreasing hepatic production of trigycerides
What drug is the most effective drugs for lowering triglycerides
Fibrates (Gemfibrozil);
main indicator is a level of < 500
(optimmal is < 150)
What are some side effects of Fibrates
Cause diarrhea;
may increase cholesterol in the biliary tract therefore
watch for gallstones
Fibrates
Gemfibrozil
What is the action of niacin
Decrease cholesterol and trigycerides but high doses are required for dyslipidemmic effect
flushing, pruritIs, GI tract irritation are side effects of what drug (vitamin)
Niacin
A nursing consideration of Niacin is to decrease flushing, how is done
give 1 ASA (325mg) 30-60 min before ; take around your daily aspirin