Pharm (Dyslipidemia & coagulation)

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