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Chapter 49 Dyslidemia
Coronary Heart Diseas
54
Nursing
Undergraduate 2
09/30/2010

Additional Nursing Flashcards

 


 

Cards

Term

 

HMG-CoA Reductase Inhibitors are commonly called?

Definition

 

Statins

Term

 

Which drugs are the most effective for lowering LDL and total cholesterol while raising HDL cholesterol and Triglycerides? 

Definition

 

Statins

Term

 

When should statins be taken and why?

Definition

 

Statins should be given in the evening because cholesterol synthesis normally increases in the evening

 

Term

 

Risk factors for CHD

Definition

  • ↑ LDL
  • ↑ TG
  • ↓ HDL
  • ↓ Activity
  • ↑ Age
  • Race (A.A)
  • diabetes (uncontrolled)
  • smoking
  • excess alcohol consumption
  • obesity
  • family HX
  • chronic untreated HTN

Term

 

Total Cholesterol goal

 

Definition

 

< 200

Term

 

Where is endogenous cholesterol produced?

Definition

 

Liver

Term

 

Name enzyme catalyzes the synthesizes of hepatic cholesterol.

Definition

 

HMG-CoA reductase

or hydroxymethylglutaryl coenzyme

Term

 

How do statins work?

Definition

 

Statins inhibit the HMG-CoA enzyme in the liver to prevent the production of cholesterol.

Term

 

What is the primary dietary concern where cholesterol production is concerned? 

Definition

 

Saturated fats- because the liver uses saturated fats to make cholesterol. When lowering cholesterol, it is paramount to reduce intake of saturated fats.

Term

 

What is the function of lipoproteins?

 

Definition

 

Lipoproteins solubilize lipids-cholesterol and triglycerides in the blood, as well as, transport them throughout the bloodstream.

Term

 

Name the two major classes of lipoproteins that are important in coronary artherosclerosis?

Definition

 


  1. low-density-lipoproteins (LDLs)
  2. high-density lipoprotein (HDLs)

 

Term

 

What is the goal level for LDLs?

 

Definition

 

<130

Term

 

What is the primary role of LDLs in the delivery of cholesterol?

Definition

 

LDLs are responsible for the delivery of cholesterol to nonhepatic tissues.

Term

 

The primary goal of cholesterol reducing drugs?

Definition

 

Reducing elevated LDL levels

Term

 

What is the function of HDL?

Definition

 

HDLs carry cholesterol from peripheral tissues back to the liver, thus promoting cholesterol removal, the prevention of atheroschlerosis and protects against CHD.

Term

How is atheroschlerosis formed? How are LDLs involved in 

Definition

Deposition of LDLs initiate and fuel development of atherogenosis 

  • transport of LDLs to from the arterial lumen in endothelial cells 
  • then into the space that underlies the arterial epithelium
  • once in the subendothelial space, components of LDLs undergo oxidation
  • Oxidized LDLs attract monocytes from the circulation into the subendothelial space, these monocytes are converted to macrophages
  • Oxidized LDLs are cytotoxic, and hence can directly damage the vascular endothelium
  • Oxidized LDLs are consumed by the macrophages and are referred to as FOAM CELLS. These large engorged macrophages lose their mobility, thereby keeping macrophages at the site of atherogenesis. Accumulation of foam cells beneath the arterial epithelium produces a fatty streak, which makes the surface of the wall lumpy
  • Continued accumulation of the foam cells can eventually cause rupture of the endothelium, thereby exposing the underlying tissue to the blood
  • Exposure to the blood results in platelet adhesion and formation of microthrombi.
  • As this process continues, muscle cells migrate to the site, synthesis of collagen increases, and their is continued rupturing and healing of endothelium
  • The end result is a mature atheroschlerosis lesion, characterized by a large lipid core and a tough fibrous cap. Less likely to cause infarction
  • In less mature lesion, the fibrous cap in not strong and as a result of arterial pressure and shear forces from moving blood can cause cap to rupture; if this occurs accumulation of platelets at he site rupture can cause thrombosis and a subsequent infarction
*it is important to know that atherogenesis is considered primarily a chronic inflammatory process.

Term
If an assessment indicates a risk of CHD, what measures should be taken?
Definition

CHD Risk
  • lifestyle changes- diet and exercise
If CHD risk is especially high
  • LDL lowering drugs

Term
How often should cholesterol levels be screened?
Definition

 

A fasting blood draw should be done every 5 year over the age of 20 for total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides

Term
What is the goal level of HDLs?
Definition

 

=/>50

Term
What are some of the teaching points for clients with  CHD risk factors?
Definition

 

  • Lifestyle changes- diet & exercise
  • Control intake of saturated and trans fats
  • ↑ fruits and vegetables
  • ↑ aerobic exercise

 

 

Term

 

Name the biomarker that indicates an ongoing inflammatory process such as increased CV risk

Definition

 

C-reactive protein (CRP)

Term

How does smoking impact blood cholesterol levels?

 

Definition

 

Smoking raises LDL levels and and lowers HDL levels

Term
Why is exercise important in reducing risk of CHD?
Definition
aerobic exercise can decrease LDL and increase HDL, as well as reduce BP, decrease insulin resistance, and improve overall CV performance
Term

Therapeutic Lifestyle Change are?

 

Definition
The TLC diet, which includes diet, weight control, and exercise. 
Term
What are the two objectives of diet change?
Definition

 

  1. reducing LDL cholesterol
  2. establishing and maintaining a healthy weight by: 
  • reducing intake of cholesterol, saturated fats and trans fats
  • increasing soluble fiber and plant stanols and sterols (cholesterol-reducing margarine)

 

Term
When should drugs be employed to reduce cholesterol?
Definition

 

When Therapeutic Lifestyle Changes (TLCs) have failed to reduce LDL levels and if the patient's risk justify it 

Term
What should be a dietary teaching point if drugs are prescribed?
Definition
It is essential that dietary modifications continue as drug therapy may not be adequate alone
Term
Name the 4 drug families that are used to lower LDL cholesterol
Definition

 

  1. HMG-CoA reductase inhibitors (Statins)
  2. Niconic Acid (Niacin)
  3. Bile Acid Sequestrants (Colesevelam)
  4. Fibrin Acid (Fibrates)

 

Term

A group of metabolic abnormalities associated with an increased risk of CHD and type 2 diabetes. Abnormalities such as

 

  • ↑ blood glucose
  • ↑ TG
  • ↑ apoliprotein B
  • ↓ HDL
  • small LDL particles
  • a prothrombotic state
  • proinflammatory state
  • HTN

 

Definition
Term

 

 

How is metabolic syndrome diagnosed?

Definition

When three or more of the following are present:

 

  • Abdominal obesity- waist circumference 40 in or more for men and 35 inches or more for most women
  • High TG levels- 150 mg/dl or higher or undergoing drug therapy for high TGs
  • Low HDL cholesterol- below 40 mg/dl for men and 50 mg/dl for women
  • Hyperglycemia- fasting BG 110 mg.dl or higher
  • High BP 130/85 mm Hg or higher

 

Term

 

Which is the most effective drug for lowering LDLs and why?

Definition

 

HMG-CoA reductase inhibitors (Statins) are the most effective drug because they are

 

  • most effective for ↓ LDLs, ↓ total cholesterol, ↓ TGs, and ↑HDLs
  • cause fewer adverse effects
  • better tolerated
  • more likely to improve clinical outcomes ↓ risk of heart failure and sudden death (morbidity and mortality)

 

Term

 

What is the primary mechanism by which HMG-CoA reductase (Statins) inhibitors work?

Definition

 

The primary mechanism is through the inhibition of HMG-CoA, the rate-limiting enzyme in cholesterol synthesis, causes hepatocyte to synthesize more LDL receptors on the hepatocytes. The increase in LDL receptors allows the the removal of more LDLs from the blood.

 

Term

 

What are Statins therapeutic uses?

Definition

 

  • Hypercholesterolemia
  • Prevention MI, angina, stroke
  • Post MI therapy, if patient was not on Statins pre MI
  • Diabetes

 

Term

 

Pharmacokinetic of Statins 

Definition

 

  • administered orally
  • 30-90% absorbed
  • most absorbed in the first pass through the liver, where it acts
  • excreted in bile
  • rosuvastatin(Crestor) reached abnormally high levels in Asians. At therapuetic doses, it is twice those in whites, therefore dosage should be reduced in Asians.

 

Term

 

Adverse Effects of Statins

Definition

Statins are generally well tolerated and side effects are rare and if occur are usually mild and transient

 

Mild effects

  • headaches
  • rash
  • GI disruption (dyspepsia, cramps, flatulence, constipation, abdominal pain)
Severe effects- extremely rare
  • Myopathy (muscle cell break down and result in kidney failure). indicated by muscle pain and moderate elevation of CK creatine kinase
  • Liver failure-  check liver enzymes prior to use to get a baseline

 

Term

 

 

Contraindications for Statins

Definition

 

  • pregnancy - risk category X
  • not to be combined w/ other lipid lowering drugs (except bile acid sequestrants) as increase in the incidence of and severity of the serious statin-related side effects
  • with drugs that inhibit CYP3A4
  • grapefruit juice, as little as 8 oz can inhibit effectiveness

 

Term

 

 

Statin dosing considerations

Definition
  • taken once daily in evening with meal or at bedtime due to endogenous cholesterol synthesis occurring at night
Term

 

Which LDL Reducing Drug also lowers TGs and increases levels of HDL levels better than any other drug?

Definition

 

Nicotinic Acid (Niacin)

Term

 

What does nicotinic acid (Niacin) reduce and how does it work?

Definition

Nicotinic acid (Niacin) reduces risk of major coronary events and may also reduce total mortality by reducing production of LDLs by reducing production of VLDLs (LDLs are a by-product of VLDLs)

Term

 

Name adverse effects of nicotinic acid

Definition

  • intense skin flushing of the face, neck and ears - this reaction diminishes in several weeks and can be attenuated by aspirin
  • irritation of GI tract (gastric upset, nausea, vomiting, diarrhea)
  • Severe liver damage can occur (most likely with Slo-Niacin
  • hyperglycemia
  • gouty arthritis

Term

 

Name the LDL reducer that is used primarily as adjunct to statins

Definition


Bile-Acid Sequestrants


Term

 

Name the Bile-Acid Sequestrant that is the drug of choice 

Definition

 

Colesevelam (Welchol)

Term

 

What is the mechanism in Colesevelam?

Definition

 

Colesevelam:
  • lowers LDLs by increasing LDL receptors on hepatocytes
  • bile acids secreted in the intestine are normally reabsorbed and reused. Bile-Acid sequestrants prevent reabsorption
  • bile acids are made from cholesterol, liver cells must have an increase in cholesterol supply in order to increase bile acid production. The required cholesterol is provided from LDLs
  • To avail themselves more LDL cholesterol , liver cell increase their # of LDL receptors, thereby increasing their capacity for LDL uptake
  • The result is an increase in LDL uptake from plasma, which decreases circulation LDL levels 

 

 

Term

 

What is the main response on colesevelam on plasma lipoproteins?

Definition

 

The main response to bile-acid sequestrants is a reduction in LDL cholesterol

Term

 

Pharmacokinetics of bile-acid sequestrants

 

Definition

 

  • biologically inert
  • insoluble in water and cannot be absorbed in GI tract and cannot be attacked by digestive enzymes
  • following oral administration, they pass through the intestines and are excreted in feces

 

Term
What is the therapeutic use for colesevelam?
Definition

  • adjunct therapy to diet and exercise for reducing LDL cholesterol in patients with primary hypercholesterolemia 
  • often used with a statin

Term
Adverse effects of bile-acid sequestrants
Definition

  • constipation
  • bloating
  • indigestion
  • nausea

Term

 

Drug interaction of bile acid sequestrants and other drugs

Definition

  • can form insoluble complexes with drugs that undergo binding- cannot be absorbed and then are not available for systemic effect. Drugs such as:  thiazide diuretics, digoxin, warfarin, and some antibiotics
  • know drugs that interact should be given 1 hour before sequestrant or 4 hours after

Term

 

Which drug is most effective for lowering TG levels, raising HDLs, but having no effect on LDLs

Definition

 

Fibric Acid Derivatives (Fibrates)

 

Term

 

What is the main Fibric Acid Derivative and what is it primarily used for?

Definition

 

Gemfibrozil (Lopid)

used to reduce high levels of TGs in patients who have not responded to weight loss and diet modiication

 

Term

 

Adverse effects of gemfibrozil

Definition

gemfibrozil is generally well tolerated however, the most common reactions are

  • rash
  • Gi upset (nausea, abdominal pain, diarrhea)
  • increases risk of gallstones
  • Myopathy
  • Liver injury

 

Term

 

Drug interaction with gemfibrozil

Definition

  • gemfibrozil displaces warfarin from plasma albumin, thereby increasing anticoagulant effects- warfarin may need to be reduces
  • in combination with a statin increases risk of statin-induces myopathy- use great caution, if at all

Term

 

Dosing of gemfibrozil (Lopid)

Definition

  • available in 600 mg tablets
  • adult dosage is 600 mg twice a day
  • given 30 minutes before morning and evening meals 

Term

 

What do lipoproteins consist of?

Definition

 

Lipoproteins consist of a hydrophobic core, a hydrophilic shell, plus at least one apolipoprtein, which serves as a recognition site for receptors on cells 

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