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.