NUR 354 Exam 3 (Modules 5-6)– Outline for Success
Module 5 – Chapter 23 & 27
Heart Failure and Lipids
Drugs for Lipids
Hyperlipidemia
High levels of lipids in blood—major risk factor for cardiovascular disease
Most patients asymptomatic until cardiovascular disease produces
symptoms.
Dyslipidemia
Abnormal levels of lipoproteins, excess or deficient
3 types of Lipids
•Triglycerides
•Phospholipids
•Steroids
HMG-CoA Reductase Inhibitors/Statins
•Interfere with the synthesis of cholesterol
•First drugs of choice to reduce blood-lipid levels
•Examples: atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor),
rosuvastatin (Crestor), simvastatin (Zocor)
•Monitor liver function tests
•Do not use with pregnancy or breastfeeding
•Watch for signs of GI upset
•Lowers bad cholesterol and increase the good
•Bad= Total cholesterol, Triglycerides, LDL
•Good= HDL
Atorvastatin (Lipitor)
MOA:
, inhibits HMG-CoA reductase
Use:
reduces serum-lipid levels
Side Effects:
headache, fatigue, muscle or joint pain, and heartburn, rarely
rhabdomyolysis (occurs when damaged muscle tissue releases its
proteins and electrolytes into the blood)
Admin Alerts:
Administer with food to decrease GI discomfort.
May be taken at any time of the day.
Pregnancy category X. Women should not breastfeed during therapy.
Herbal/Food:
Grapefruit juice inhibits the metabolism of statins, allowing them to reach
toxic levels. Red yeast rice contains small amounts of natural statins and
may increase the effects of atorvastatin. Because statins also decrease the
synthesis of coenzyme Q10 (CoQ10), patients may benefit from CoQ10
supplements.
Bile Acid Sequestrants
•Bind with bile acids to increase excretion of cholesterol in stool
•Used in combination with statins
•Examples: colesevelam (Welchol), colestipol (Colestid)
•Monitor for significant GI effects
•Obtain careful history for past GI disorders
Cholestyramine (Questran)
MOA:
bind with bile acids, increasing cholesterol excretion in stool
Use:
to lower serum-lipid levels
Cholestyramine is a powder that is mixed with fluid before being taken
once or twice daily.
It may take 30 days or longer to produce its maximum effect. Questran
binds with bile acids (containing cholesterol) in an insoluble complex
that is excreted in the feces. Cholesterol levels decline due to fecal loss.
Side Effects:
, Bloating/Gas
Constipation
Nausea
Can bind other drugs, increasing potential for drug–drug interactions
Admin Alerts:
Mix thoroughly with 60 to 180 m L of water, noncarbonated beverages,
highly liquid soups, or pulpy fruits (applesauce, crushed pineapple). Have
the patient drink it immediately to avoid potential irritation or
obstruction in the GI tract.
Give other drugs more than 2 hours before or 4 hours after the patient
takes cholestyramine.
Pregnancy category C.
Contradictions:
This drug is contraindicated in patients with total biliary obstruction and
in those with prior hypersensitivity to the drug.
Herbal/Food:
Taking cholestyramine with food may interfere with the absorption of the
following essential nutrients: beta-carotene, calcium, folic acid, iron,
magnesium, vitamin B12, vitamin D, vitamin E, vitamin K, and zinc.
Manifestations of nutrient depletion may include weakened immune
system, cardiovascular problems, and osteoporosis.
Niacin
•B-complex vitamin (B3)•Niacin (Niaspan)•Decreases VLDL levels•Has
numerous adverse effects: flushing, hot flashes, nausea, excess gas,
diarrhea; more serious effects like hepatotoxicity and gout possible•Mo
nitor patient’s liver function
•Monitor uric acid levels, if predisposed to gout•Monitor blood-sugar
levels, if diabetic
•Can take aspirin or ibuprofen 30 mins before and can be taken with
food
Fibric Acid Drugs
•Assess for complaints of GI distress before starting drug
, •Use with warfarin may potentiate anticoagulant effects:
–Monitor prothrombin time/international normalized ratio (PT/INR)
Gemfibrozil (Lopid)
Use:
treating severe hypertriglyceridemia
Side Effects:
GI distress; watch for bleeding with patients on anticoagulants
dyspepsia, diarrhea, nausea, and cramping
May increase the likelihood of gallstones and may occasionally affect liver
function.
Admin Alerts:
Administer with meals to decrease GI distress.
Pregnancy category B.
Contradictions:
contraindicated in patients with hepatic impairment, severe chronic
kidney disease (C K D), preexisting gallbladder disease, or those with prior
hypersensitivity to the drug.
Herbal/Food:
Fatty foods may decrease the efÏcacy of gemfibrozil.
Ezetimibe (Zetia)
Cholesterol Absorption Inhibitor
MOA/Use:
Inhibits absorption of cholesterol in small intestine, resulting in small
reduction in LDL
Side Effects:
Serious side effects uncommon; minor side effects nasopharyngitis,
myalgia, upper respiratory tract infection, arthralgia, and diarrhea
Can be administered with statins
Drugs for Heart Failure
Heart Failure
Module 5 – Chapter 23 & 27
Heart Failure and Lipids
Drugs for Lipids
Hyperlipidemia
High levels of lipids in blood—major risk factor for cardiovascular disease
Most patients asymptomatic until cardiovascular disease produces
symptoms.
Dyslipidemia
Abnormal levels of lipoproteins, excess or deficient
3 types of Lipids
•Triglycerides
•Phospholipids
•Steroids
HMG-CoA Reductase Inhibitors/Statins
•Interfere with the synthesis of cholesterol
•First drugs of choice to reduce blood-lipid levels
•Examples: atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor),
rosuvastatin (Crestor), simvastatin (Zocor)
•Monitor liver function tests
•Do not use with pregnancy or breastfeeding
•Watch for signs of GI upset
•Lowers bad cholesterol and increase the good
•Bad= Total cholesterol, Triglycerides, LDL
•Good= HDL
Atorvastatin (Lipitor)
MOA:
, inhibits HMG-CoA reductase
Use:
reduces serum-lipid levels
Side Effects:
headache, fatigue, muscle or joint pain, and heartburn, rarely
rhabdomyolysis (occurs when damaged muscle tissue releases its
proteins and electrolytes into the blood)
Admin Alerts:
Administer with food to decrease GI discomfort.
May be taken at any time of the day.
Pregnancy category X. Women should not breastfeed during therapy.
Herbal/Food:
Grapefruit juice inhibits the metabolism of statins, allowing them to reach
toxic levels. Red yeast rice contains small amounts of natural statins and
may increase the effects of atorvastatin. Because statins also decrease the
synthesis of coenzyme Q10 (CoQ10), patients may benefit from CoQ10
supplements.
Bile Acid Sequestrants
•Bind with bile acids to increase excretion of cholesterol in stool
•Used in combination with statins
•Examples: colesevelam (Welchol), colestipol (Colestid)
•Monitor for significant GI effects
•Obtain careful history for past GI disorders
Cholestyramine (Questran)
MOA:
bind with bile acids, increasing cholesterol excretion in stool
Use:
to lower serum-lipid levels
Cholestyramine is a powder that is mixed with fluid before being taken
once or twice daily.
It may take 30 days or longer to produce its maximum effect. Questran
binds with bile acids (containing cholesterol) in an insoluble complex
that is excreted in the feces. Cholesterol levels decline due to fecal loss.
Side Effects:
, Bloating/Gas
Constipation
Nausea
Can bind other drugs, increasing potential for drug–drug interactions
Admin Alerts:
Mix thoroughly with 60 to 180 m L of water, noncarbonated beverages,
highly liquid soups, or pulpy fruits (applesauce, crushed pineapple). Have
the patient drink it immediately to avoid potential irritation or
obstruction in the GI tract.
Give other drugs more than 2 hours before or 4 hours after the patient
takes cholestyramine.
Pregnancy category C.
Contradictions:
This drug is contraindicated in patients with total biliary obstruction and
in those with prior hypersensitivity to the drug.
Herbal/Food:
Taking cholestyramine with food may interfere with the absorption of the
following essential nutrients: beta-carotene, calcium, folic acid, iron,
magnesium, vitamin B12, vitamin D, vitamin E, vitamin K, and zinc.
Manifestations of nutrient depletion may include weakened immune
system, cardiovascular problems, and osteoporosis.
Niacin
•B-complex vitamin (B3)•Niacin (Niaspan)•Decreases VLDL levels•Has
numerous adverse effects: flushing, hot flashes, nausea, excess gas,
diarrhea; more serious effects like hepatotoxicity and gout possible•Mo
nitor patient’s liver function
•Monitor uric acid levels, if predisposed to gout•Monitor blood-sugar
levels, if diabetic
•Can take aspirin or ibuprofen 30 mins before and can be taken with
food
Fibric Acid Drugs
•Assess for complaints of GI distress before starting drug
, •Use with warfarin may potentiate anticoagulant effects:
–Monitor prothrombin time/international normalized ratio (PT/INR)
Gemfibrozil (Lopid)
Use:
treating severe hypertriglyceridemia
Side Effects:
GI distress; watch for bleeding with patients on anticoagulants
dyspepsia, diarrhea, nausea, and cramping
May increase the likelihood of gallstones and may occasionally affect liver
function.
Admin Alerts:
Administer with meals to decrease GI distress.
Pregnancy category B.
Contradictions:
contraindicated in patients with hepatic impairment, severe chronic
kidney disease (C K D), preexisting gallbladder disease, or those with prior
hypersensitivity to the drug.
Herbal/Food:
Fatty foods may decrease the efÏcacy of gemfibrozil.
Ezetimibe (Zetia)
Cholesterol Absorption Inhibitor
MOA/Use:
Inhibits absorption of cholesterol in small intestine, resulting in small
reduction in LDL
Side Effects:
Serious side effects uncommon; minor side effects nasopharyngitis,
myalgia, upper respiratory tract infection, arthralgia, and diarrhea
Can be administered with statins
Drugs for Heart Failure
Heart Failure
