NR 565 Advanced
Pharmacology – Chronic
Coronary Disease
Medications:
Comprehensive Study and
Clinical Review
Statins (HMG-CoA Reductase Inhibitors): Example: lovastatin (Mevacor)
Example, Primary Function, Unique Features Primary Function: Statins are a class of lipid-lowering
medications primarily used to reduce cholesterol levels in the
blood, particularly low-density lipoprotein (LDL) cholesterol,
which is often referred to as "bad" cholesterol.
Unique Features: These drugs are referred to as “statins”
because the generic name ends in -statin.
Statins (HMG-CoA Reductase Inhibitors): Statins inhibit the enzyme HMG-CoA reductase in the liver.
MOA This enzyme is crucial for the synthesis of cholesterol. By
inhibiting this enzyme, statins effectively reduce the
production of cholesterol, leading to decreased levels of LDL
cholesterol in the body.
Statins (HMG-CoA Reductase Inhibitors): - Hypercholesterolemia: Statins are the most effective drug
Indications and Therapeutic Uses for decreasing LDL cholesterol.
- Stroke and MI prevention
- Post MI
,Statins (HMG-CoA Reductase Inhibitors): - Hepatotoxicity
Side Effects and Adverse Reactions - Myopathy & Rhabdomyolysis: severe breakdown of
muscle tissue that can lead to kidney damage.
Statins (HMG-CoA Reductase Inhibitors): Precautions
Precautions and Contraindications - Perform liver function tests prior to initiating treatment
and then when clinically indicated.
- Caution in clients with a history of liver disease or
heavy alcohol use.
- Statins should be used cautiously in elderly clients due
to increased risk of muscle-related side effects.
- Consider the use of certain statins in clients of Asian
descent (particularly rosuvastatin) as toxicity can occur
from altered
metabolism.
Contraindications
- Absolute contraindication in pregnancy due to the risk of
congenital defects.
Statins (HMG-CoA Reductase Inhibitors): - other lipid-lowering medications (including fibrates)
Drug Interactions - CYP3A4 inhibitors: grapefruit juice, macrolide antibiotics,
azole antifungals, amiodarone
Statins (HMG-CoA Reductase Inhibitors): - Dose adjustment may be necessary in hepatic impairment.
Dosing - Check drug dosing guidelines for individualized dosing.
- Statins are typically administered once daily. The timing
of the dose may vary, but evening administration is common
for certain statins due to the body's natural rhythm of
cholesterol production.
- Dosage is adjusted based on the client's LDL
levels, tolerance, and response to the
medication.
- Monitor CK, LFTs, and cholesterol levels.
Statins (HMG-CoA Reductase Inhibitors): Administration
Administration and Client Teaching - Oral administration.
- Typically administered at night since most cholesterol
synthesis occurs at night and these drugs inhibit that process.
Client Teaching
- Advise pregnant clients or those planning pregnancy to
discuss medication alternatives with their healthcare provider.
- Avoid grapefruit juice.
- Inform about potential side effects and the importance of
reporting muscle pain or weakness.
- Discuss the necessity of routine blood tests to monitor
liver function and cholesterol levels.
- Highlight the importance of maintaining a healthy diet
and exercise regimen alongside medication
, Statins (HMG-CoA Reductase Inhibitors): Liver Function Tests (LFTs)
Labs to Monitor Monitor liver function tests (LFTs) prior to treatment and to
monitor for hepatotoxicity.
Creatine Kinase (CK)
Assess creatine kinase (CK) levels if symptoms of myopathy
or muscle pain occur.
Lipid Profiles
Regularly monitor lipid profiles to assess effectiveness.
Basic Metabolic Panel (BMP)
Assess kidney function if myopathy and rhabdomyolysis is
suspected.
Fibric Acid Derivatives (Fibrates): Example, Example: gemfibrozil (Lopid)
Primary Function, Unique Features Primary Function: Fibric acid derivatives, commonly known as
fibrates, are a class of medications primarily used to lower
lipid levels, specifically triglycerides, and to a lesser extent,
increase high-density lipoprotein (HDL) cholesterol.
Unique Features: The principle indication for fibrates is
hypertriglyceridemia and treatment is reserved for clients who
have not responded to weight control and diet modifications.
Fibric Acid Derivatives (Fibrates): MOA Fibrates activate peroxisome proliferator-activated receptors
(PPARs), specifically PPAR-alpha. This activation leads to an
increase in the oxidation of fatty acids in the liver and muscle
tissue. They decrease the production of triglycerides and
VLDL (very low-density lipoprotein) while increasing HDL
cholesterol.
Fibric Acid Derivatives (Fibrates): Indications Hypertriglyceridemia: Primarily prescribed for the treatment
and Therapeutic Uses of high triglyceride levels (hypertriglyceridemia).
Fibric Acid Derivatives (Fibrates): Side - Gallstones
Effects and Adverse Reactions - Hepatotoxicity
- Myopathy and Rhabdomyolysis: severe breakdown of
muscle tissue that can lead to kidney damage
Fibric Acid Derivatives (Fibrates): Precautions
Precautions and Contraindications - Use with caution in clients with a history of gallbladder
disease.
- Should be used with extreme caution or avoided in
combination with statins due to increased risk of myopathy
and rhabdomyolysis and hepatotoxicity.
Contraindications
- Contraindicated in clients with severe liver disease.
- Not recommended in clients with severe renal impairment.
Fibric Acid Derivatives (Fibrates): Drug - Statins
Interactions - Warfarin
Pharmacology – Chronic
Coronary Disease
Medications:
Comprehensive Study and
Clinical Review
Statins (HMG-CoA Reductase Inhibitors): Example: lovastatin (Mevacor)
Example, Primary Function, Unique Features Primary Function: Statins are a class of lipid-lowering
medications primarily used to reduce cholesterol levels in the
blood, particularly low-density lipoprotein (LDL) cholesterol,
which is often referred to as "bad" cholesterol.
Unique Features: These drugs are referred to as “statins”
because the generic name ends in -statin.
Statins (HMG-CoA Reductase Inhibitors): Statins inhibit the enzyme HMG-CoA reductase in the liver.
MOA This enzyme is crucial for the synthesis of cholesterol. By
inhibiting this enzyme, statins effectively reduce the
production of cholesterol, leading to decreased levels of LDL
cholesterol in the body.
Statins (HMG-CoA Reductase Inhibitors): - Hypercholesterolemia: Statins are the most effective drug
Indications and Therapeutic Uses for decreasing LDL cholesterol.
- Stroke and MI prevention
- Post MI
,Statins (HMG-CoA Reductase Inhibitors): - Hepatotoxicity
Side Effects and Adverse Reactions - Myopathy & Rhabdomyolysis: severe breakdown of
muscle tissue that can lead to kidney damage.
Statins (HMG-CoA Reductase Inhibitors): Precautions
Precautions and Contraindications - Perform liver function tests prior to initiating treatment
and then when clinically indicated.
- Caution in clients with a history of liver disease or
heavy alcohol use.
- Statins should be used cautiously in elderly clients due
to increased risk of muscle-related side effects.
- Consider the use of certain statins in clients of Asian
descent (particularly rosuvastatin) as toxicity can occur
from altered
metabolism.
Contraindications
- Absolute contraindication in pregnancy due to the risk of
congenital defects.
Statins (HMG-CoA Reductase Inhibitors): - other lipid-lowering medications (including fibrates)
Drug Interactions - CYP3A4 inhibitors: grapefruit juice, macrolide antibiotics,
azole antifungals, amiodarone
Statins (HMG-CoA Reductase Inhibitors): - Dose adjustment may be necessary in hepatic impairment.
Dosing - Check drug dosing guidelines for individualized dosing.
- Statins are typically administered once daily. The timing
of the dose may vary, but evening administration is common
for certain statins due to the body's natural rhythm of
cholesterol production.
- Dosage is adjusted based on the client's LDL
levels, tolerance, and response to the
medication.
- Monitor CK, LFTs, and cholesterol levels.
Statins (HMG-CoA Reductase Inhibitors): Administration
Administration and Client Teaching - Oral administration.
- Typically administered at night since most cholesterol
synthesis occurs at night and these drugs inhibit that process.
Client Teaching
- Advise pregnant clients or those planning pregnancy to
discuss medication alternatives with their healthcare provider.
- Avoid grapefruit juice.
- Inform about potential side effects and the importance of
reporting muscle pain or weakness.
- Discuss the necessity of routine blood tests to monitor
liver function and cholesterol levels.
- Highlight the importance of maintaining a healthy diet
and exercise regimen alongside medication
, Statins (HMG-CoA Reductase Inhibitors): Liver Function Tests (LFTs)
Labs to Monitor Monitor liver function tests (LFTs) prior to treatment and to
monitor for hepatotoxicity.
Creatine Kinase (CK)
Assess creatine kinase (CK) levels if symptoms of myopathy
or muscle pain occur.
Lipid Profiles
Regularly monitor lipid profiles to assess effectiveness.
Basic Metabolic Panel (BMP)
Assess kidney function if myopathy and rhabdomyolysis is
suspected.
Fibric Acid Derivatives (Fibrates): Example, Example: gemfibrozil (Lopid)
Primary Function, Unique Features Primary Function: Fibric acid derivatives, commonly known as
fibrates, are a class of medications primarily used to lower
lipid levels, specifically triglycerides, and to a lesser extent,
increase high-density lipoprotein (HDL) cholesterol.
Unique Features: The principle indication for fibrates is
hypertriglyceridemia and treatment is reserved for clients who
have not responded to weight control and diet modifications.
Fibric Acid Derivatives (Fibrates): MOA Fibrates activate peroxisome proliferator-activated receptors
(PPARs), specifically PPAR-alpha. This activation leads to an
increase in the oxidation of fatty acids in the liver and muscle
tissue. They decrease the production of triglycerides and
VLDL (very low-density lipoprotein) while increasing HDL
cholesterol.
Fibric Acid Derivatives (Fibrates): Indications Hypertriglyceridemia: Primarily prescribed for the treatment
and Therapeutic Uses of high triglyceride levels (hypertriglyceridemia).
Fibric Acid Derivatives (Fibrates): Side - Gallstones
Effects and Adverse Reactions - Hepatotoxicity
- Myopathy and Rhabdomyolysis: severe breakdown of
muscle tissue that can lead to kidney damage
Fibric Acid Derivatives (Fibrates): Precautions
Precautions and Contraindications - Use with caution in clients with a history of gallbladder
disease.
- Should be used with extreme caution or avoided in
combination with statins due to increased risk of myopathy
and rhabdomyolysis and hepatotoxicity.
Contraindications
- Contraindicated in clients with severe liver disease.
- Not recommended in clients with severe renal impairment.
Fibric Acid Derivatives (Fibrates): Drug - Statins
Interactions - Warfarin
