Chapter 22 Hyperlipidemia 1. What lifestyle measures will help control cholesterol levels?

Monitor levels regularly; Maintain or lose weight; Exercise; Reduce dietary fat; Increase soluble fiber; Eliminate tobacco. 2. How do statins work to reduce cholesterol? Statins inhibit a critical enzyme, HMG-CoA reductase, in the synthesis of cholesterol, which results in less cholesterol biosynthesis. The liver makes less cholesterol and then responds by making more LDL receptors on the surface of liver cells. The greater number of LDL receptors results in increased removal of LDL from the blood. Blood levels of both LDL and cholesterol are reduced. What time of day should MOST statins be administered? In the evening, because cholesterol biosynthesis in the body is higher at night. 3. What serious side effect should be reported to health care provider (HCP) ASAP? Myopathy and rhabdomyolysis. (Muscle fibers do not function and breakdown of muscle fibers) 4. What education is required for a client using statins? Goals of the therapy, the reasons for obtaining baseline data (vital signs, underlying cardiac and hepatic disorders) Keep all scheduled lab visits for LFTs. Do not take other prescription drugs and OTC medications, herbal remedies, or vitamins and minmerals without notifying your HCP, because some antibiotics and immunosuppressants can increase the risk of sever myopathy. Avoid alcohol; Practice reliable contraception and notify HCP if pregnancy is planned or suspected. Immediately report unexplained muscle pain, tenderness, or weakness, especially if accompanied by malaise or fever; Take the drug with the evening meal to prevent GI disturbances. 5. How do bile acid resins (sequestrants) reduce cholesterol? Bile acid resins (sequestrants) bind bile acids (which contain a high concentration of cholesterol), increasing the excretion of cholesterol in the stool. Because resins are large, they are not absorbed from the small intestine and are eliminated in the feces. Once again, the liver responds to the loss of cholesterol by making more LD receptors, which removes even more cholesterol from the blood. 6. Why arent bile acid sequestrants considered first line therapy? Because they tend to cause more frequent side effects than statins. What side effects are associated with bile acid sequestrants? They are not absorbed into the systemic circulation, so side effects are limited to the GI tract. (bloating, abdominal pain, nausea, vomiting, diarrhea, steatorrhea and constipation) They can also bind other drugs such as digoxin and warfarin, increasing the potential for drug-drug interactions. 7. Why shouldnt persons having GI motility issues use bile acid sequestrants? Because they cause constipation and add to the GI motility issues make them worse.

8. When should bile acid sequestrants be administered? Medications, vitamins and minerals should be administered more than 1 hour before or 4 hours after the client takes a bile acid sequestrant to prevent decrased absorption of the medicines. 9. Why should vitamin supplements be given with bile acid sequestrants? Take vitamin suppliments to replace folic acid, fat-soluble vitamins, and vitamin K, because bile acid resins decrease the absorption of vitamins and minterals and can lead to hypokalemia. 10. How does nicotinic acid reduce cholesterol levels? Nicotinic acid or Niasin decreases VLDL levels, and because LDL is synthesized from VLDL, the client experiences a reduction in LDL levels. It also reduces triglycerides and increases HDL levels. 11. What side effect occurs in almost every client using niacin? Flushing and hot flashes. What therapy can reduce this effect? Take one aspirin tablet 30 minutes prior to niacin administration can reduce uncomfortable flushing. 12. How do fibric acid agents work? Fibric acid agents inhibit the synthesis of triglycerides but have little effect on LDLs. Combining a fibric acid agent with a statin results in greater decreases of triglyceride levels than using either drug alone. 13. How do cholesterol absorption inhibitors differ from bile acid sequestrants? Cholesterol absorption inhibitors (ezetimibe Vytorin) block the absorption of cholesterol by cells in the jejunum of the small intestine. Bile acid sequestrants bind bile acids that contain a high concentration of cholesterol and are excreted. 14. Which antilipemic drug class is most likely to cause gallstones? Fibric acid agents. Note: all lipid agents are likely to cause GI effects; all have the potential of causing hepatic disorders