Monday, April 30, 2012

ANTILIPEMIC MEDICATIONS



BILE SEQUESTERING DRUGS

·         Combines with bile acids to form an insoluble compound excreted in the stool
·         Indication:
o    Patient s unable to lower their LDL level through diet alone or with statin therapy.
·         Contraindication:
o    Should not be used as the only therapy in patients with elevated triglycerides (may raise triglyceride levels)

Example:
cholestyramine (Questran®)
colesevelam (Welchol®)
colestipol (Colestid®)

Side Effects:

·         Constipation
·         Peptic ulcer

Nursing Considerations:

ü  Cholestyramine-mix thoroughly in juice or water before administration
ü  Monitor patient for side effects.
ü  Provide patient teaching. Medication should be followed by sufficient fluid intake.
ü  May bind with thiazides, digoxin, warfarin and some antibiotics.

FIBRIC ACID DERIVATIVES

·         Lower triglycerides and raise HDL (good cholesterol)
·         Indication:
o    To reduce the risk of heart attack in patients with coronary artery disease who have low LDL, low HDL, high triglycerides
·         Contraindication:
o    Severe hepatic and renal disease, gallbladder disease, primary biliary cirrhosis, hypersensitivity

Example:
fenofibrate (Tricor®)
gemfibrozil (Lopid®)

Side Effects:

Gemfibrozil:

·         Upset stomach, nausea and vomiting
·         Abdominal pain
·         Increased risk for gallstones
·         Can interact with anticoagulants causing bleeding

Fenofibrate:

·         Rash
·         Stomach upset
·         Risk for gallstones
·         Hepatitis
·         Myositis
Nursing Considerations:

ü  Monitor patients liver function tests and WBC counts.
ü  Check triglycerides and cholesterol levels to assess for drug effectiveness.
ü  Notify physician for biliary colic. Give analgesic if necessary.
ü  Provide patient teaching:
o    Inform the patient about prescribed drug and side effects.
o    Instruct the patient with DM to monitor blood glucose levels regularly when using gemfibrozil.

HYDROXYMETHYLGLUTARYL-COENZYME A (HMG-CoA) REDUCTASE INHIBITORS (Statins)

·         Lower lipid levels by interfering with cholesterol synthesis. (↓LDL,↑HDL)
·         Indication:
o    To treat hypercholesterolemia and prevent cardiovascular events
·         Contraindication:
o    Do not administer with anticoagulants and gemfibrozil
o    Administer with caution in patients taking immunosuppressive drugs

Example:
atorvastatin (Lipitor®)
lovastatin (Mevacor®)
pravastattin (Pravachol®)
rosuvastatin (Crestor®)
simvastatin (Zocor®)
fluvastatin (Lescol®)

Side Effects:

·         Abdominal pain
·         Constipation
·         Dyspepsia
·         Diarrhea
·         Flatulence
·         Nausea and vomiting
·         Alopecia
·         Pruritus
·         Hepatotoxicity
·         Rhabdomyolysis

Nursing Considerations:

ü  Advise patient to begin or continue lifestyle changes (dietary management, weight control, exercise)
ü  Monitor liver function test results.
ü  Monitor cholesterol levels.
ü  Administer lovastatin with evening meal to enhance absorption.
ü  Administer pravastatin at bedtime (for geriatric patient, one with primary hypercholesterolemia, renal or hepatic dysfunction).
ü  Instruct patient to notify immediately for any signs of inexplained muscles aches.

CHOLESTEROL ABSORPTION INHIBITORS

·         Inhibit absorption of cholesterol and phytosterols at the small intestines
·         Indication:
o    To treat primary cholesterolemia
·         Contraindications:
o    Patients with liver disease or liver enzyme elevations
o    Hypersensitivity to drug components

Example:
ezetimibe (Zetia®)
Side Effects:

·         Abdominal pain
·         Diarrhea
·         Arthralgia
·         Cough
·         Back pain, myalgia
·         Dizziness
·         Chest pain
·         Fatigue
·         Upper respiratory tract infection
·         Headache


Nursing Considerations:

ü  Place patient on a diet for lowering cholesterol before therapy starts and urge patient to continue it during therapy.
ü  Assess liver function tests before therapy starts and periodically thereafter if given with HMG-CoA reductase inhibitor.

NICOTINIC ACID

·         Water- soluble vitamin that decreases triglyceride and apolipoprotein B-100 levels and increases HDL levels
·         Indication:
o    Used as adjunct to lower triglyceride levels in patients with type IV or V hyperlipidemia who are at risk for pancreatitis
·         Contraindication:
o    Patients with liver dysfunction, active peptic ulcer disease, or arterial bleeding

Example:
nicotinic acid (Niacor®)

Side Effects:

·         Flushing
·         Hepatotoxicity
·         Vasodilation
·         Hyperuricemia
·         Gastrointestinal disturbances


Nursing Considerations:

ü  May tahe ASA 30 minutes before to decrease flushing
ü  Monitor patient’s liver function tests.
ü  Assess lipid, triglyceride, cholesterol level.
ü  Monitor for possible drug induced adverse reactions.
ü  Assess patient’s nutrition status periodically.

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