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bile acid sequestrant
Management of primary hypercholesterolemia. TX of pruritus associated with elevated levels of bile acids
Binds with bile acids in the intestine, allowing excretion in feces instead of reabsorption, causing cholesterol to be oxidized in the liver and serum cholesterol levels to fall. -Clear out the cholesterol
Cholestyramine Adverse reactions
IRash, headache, anxiety, vertigo, dizziness, constipation due to fecal impaction, exacerbation of hemorrhoids, cramps, flatulence, nausea, increased bleeding tendencies, vitamin A and D deficiencies, muscle and joint pain.
Not absorbed systemically
Excreted in the feces
Cholestyramine nursing interventions
obtain a diet history, assess for constipation and presence of BS, Monitor lipids, Monitor LFT, electrolytes and PT. Perform a Physical exam.
Bile acid sequestrants are contraindicated in the presence of allergy to any bile acid sequestrant to prevent hypersensitivity reactions. These drugs are also contraindicated with complete biliary obstruction, which would prevent bile from being secreted into the intestine; abnormal intestinal function, which could be aggravated by the presence of these drugs; and pregnancy or lactation because the potential decrease in the absorption of fat and fat-soluble vitamins could have a detrimental effect on the fetus or neonate
Cholestyramine drug to drug interactions
Malabsorption of fat-soluble vitamins occurs when they are combined with these drugs. These drugs decrease or delay the absorption of thiazide diuretics, digoxin, warfarin, thyroid hormones, and corticosteroids. Consequently, any of these drugs should be taken 1 hour before or 4 to 6 hours after the bile acid sequestrant
HMG-CoA Reductase Inhibitors
Adjunct to diet in the treatment of elevated levels of cholesterol, triglycerides, and LDL; to increase HDL cholesterol in patients with primary hypercholesterolemia; treatment of boys and postmenarchal girls aged 10 to 17 years with familial hypercholesterolemia and two or more risk factors for CAD; prevention of CAD in adults without clinically evident heart disease but with multiple risk factors to reduce the risk for CV events.
Inhibits HMG-CoA, causing a decrease in serum cholesterol levels, LDLs, and triglycerides and an increase in HDL levels.
metabolized in the liver and cells and excreted in the bile.
Atorvastatin adverse effects
Headache, flatulence, abdominal pain, cramps, constipation, rhabdomyolysis with acute renal failure
Atorvastatin Nursing considerations
Assess for contraindications and cautions:
Perform Physical exam for baseline include weight
Assess LOC, CNS functions, VS
Inspect the abdomen for distention and auscultate bowel sounds
Assess for constipation
Monitor the results of laboratory tests, including renal and liver function tests
Atorvastatin drug to drug interactions
risk for rhabdomyolysis increases if any of these drugs is combined with erythromycin, cyclosporine, gemfibrozil, niacin, or antifungal drugs; such combinations should be avoided.
Increased serum levels and resultant toxicity can occur if these drugs are combined with digoxin or warfarin
Increased estrogen levels can occur if these drugs are taken with oral contraceptives
Serum levels and the risk of toxicity increase if these drugs are combined with grapefruit juice
Liver disease, myopathy, renal failure, uncontrolled seizures, pregnancy, hypersensitivity, ETOH, rhabdomyolysis
Cholesterol Absorption Inhibitors
Adjunct to diet and exercise to lower serum cholesterol levels; in combination with atorvastatin or simvastatin for the treatment of homozygous familial hypercholesterolemia; with diet for the treatment of homozygous sitosterolemia to lower sitosterol and campesterol levels.
It is metabolized in the liver and the small intestine.
Excretion is through the feces and urine
Avoid use in active liver disease and renal failure
avoid hypersensitivity reactions. If it is used in combination with a statin, it should not be used during pregnancy or lactation, use cautiously with elderly
Ezetimibe Drug-Drug Interactions
The risk of elevated serum levels of ezetimibe increases if it is given with cholestyramine, fenofibrate, gemfibrozil, or antacids. The risk for toxicity also increases if ezetimibe is combined with cyclosporine.
ezetimibe is combined with any fibrate, the risk of cholelithiasis increase. Warfarin levels increase in a patient who is also taking ezetimibe.
Works in the brush border of the small intestine to inhibit the absorption of cholesterol.
metabolized in the liver and small intestine and excreted in the feces and urine.
Ezetimibe Adverse Effects:
Adverse Effects: Headache, dizziness, abdominal pain, diarrhea, URI, back pain, myalgia, arthralgia.
Ezetimibe Nursing Considerations
Assess for contraindications or cautions: any known allergies.
Physical Assessment: before & during therapy for effectiveness or adverse effects.
Monitor orientation and reflexes to detect changes in CNS function, such as dizziness, that could require safety measures.
Monitor respirations and auscultate lungs.
Inspect the abdomen for distention and auscultate bowel sounds.
Assess bowel elimination patterns
labs: lipids, lfts, toxic effects
Both medications are contraindicated for people with history of serious hypersensitivity reactions.
Evolocumab drug to drug interactions
These medications may be administered with other hyperlipidemia medications. There are no dosage adjustments necessary for mild to moderate renal or liver dysfunction. The medications have not been studied with severe renal or hepatic impairment.
Adjunct to diet and maximally tolerated statin therapy for treatment of adults with heterozygous familial hypercholesterolemia (HeFH) or clinical atherosclerotic cardiovascular disease (CVD), who require additional lowering of LDL and indicated with other LDL-lowering therapies such as statin in patients with homozygous familial hypercholesterolemia (HoFH) who require additional therapy.
Bind to free PCSK9 to allow for the liver to decrease the blood LDL levels.
11 to 17 days; eliminated via binding to PCSK9 and via lytic process of the protein.
Evolocumab Adverse Effects
Hypersensitivity effects (rash, urticaria), upper respiratory tract infection, nasopharyngitis, influenza, injection site reactions.
Evolocumab nursing considerations
Assess for contraindications or cautions: any known allergies or hypersensitivity
Perform a physical assessment to establish a baseline before beginning therapy and during therapy to determine its effectiveness and evaluate for any adverse effects.
Monitor for any infection due to some increased risk of infection with the medications.
Monitor the results of laboratory tests, including serum cholesterol and lipid levels to evaluate the effectiveness of drug therapy and liver function studies to monitor for toxic effects.
(Tricor and others) is a peroxisome proliferator receptor alpha activator. It increases lipolysis and elimination of triglycerides by activating the receptor in the liver. The decrease in triglycerides changes the composition of LDL cholesterol, which makes it more easily eliminated.
Gemfibrozil (Lopid) inhibits peripheral breakdown of lipids, reduces production of triglycerides and LDLs, and increases HDL concentrations. It is associated with GI and muscle discomfort. This drug should not be combined with statins. risk of rhabdomyolysis
(Trilipix) is also a peroxisome proliferator-activated receptor alpha agonist. This drug works to activate a specific hepatic receptor that results in increased breakdown of lipids, elimination of triglyceride-rich particles from the plasma, and reduction in the production of an enzyme that naturally inhibits lipid breakdown. The result is seen as a decrease in triglyceride levels, changes in LDL production that makes them more easily broken down in the body, and an increase in HDL levels.
Vitamin B3 (Niacin)
or nicotinic acid, inhibits the release of free fatty acids from adipose tissue, increases the rate of triglyceride removal from plasma, and generally reduces LDL and triglyceride levels and increases HDL levels.
is associated with intense cutaneous flushing, nausea, and abdominal pain
Omega-3-acid ethyl esters
(Lovaza) are a combination of omega-3 fatty acids and an activator that inhibits liver enzyme systems to decrease the synthesis of triglycerides, a risk factor in metabolic syndrome, lowering serum triglyceride levels.
Mipomersen (Kynamro) and
treatment of homozygous familial hypercholesterolemia. Approved as adjuncts to diet, exercise, and other lipid-lowering therapies. Both have black box warnings regarding the potential for serious hepatotoxicity
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