1. differentiate the mechanism of action, indication for use, common adverse effects and nursing implications for Nicotinic acid.

Indication for use: used to treat hyperlipidemia. It reduces the levels of triglycerides and LDL cholesterol levels and raises levels of HDL cholesterol.

Mechanism of action: Inhibits lipolysis in adipose to decrease esterification of triglyceride in the liver and to increase lipoprotein lipase activity.

Adverse effects: flushing of the skin, gastrointestinal distress, abdominal pain, diarrhea, nausea, and vomiting.

Nursing implications: Assess for niacin deficiency, obtain a diet history, serum glucose, uric acid, and hepatic function test.

2. Describe the therapeutic effects, indications for use, common adverse effects and nursing implications associated with Nitrates.

Indication for use: used to treat angina, hypertension, congestive heart failure to create controlled hypotension.

Therapeutic effect: relaxes smooth muscle and dilates vascular beds.

Adverse effect: headache followed by hypotencsion.

3. Relate the interaction of core drug knowledge to core patient variables for drugs that effect lipid levels.

Determine health history of diseases and serum cholesterol and lipid levels before therapy. Obtain blood work periodically that monitors complete lipid profile. Therapy is effective when the total cholesterol is below 200mg/dl, LDL is lower than 100mg/dl, and HDL is above 40mg/dl.

Three main drugs are used to treat angina.

            -Beta blockers prevent adrenergic receptors from being stimulated, it slows heart rate, depresses AV conduction, decreases cardiac output, reduces systolic and diastolic blood pressure, which decreases oxygen demand thereby decreasing angina.

            -Calcium channel blockers inhibit calcium from moving across cell membranes. It causes decreased contraction, depression of impulse formation, and slows conduction velocity, thereby decreasing oxygen needs of heart. Usually used when patient can’t tolerate beta blockers.

            -Nitrates dilate vascular smooth muscle and both venous and arterial vessels. Venous dilation decreases returning flow, and arterial dilation reduces systemic vascular resistance and arterial pressure.

5. Describe nursing interventions to maximize therapeutic effects and minimize adverse effects for drugs that affect lipid levels, including necessary laboratory evaluation and interpretation.

Maximize- Lovastatin is most effective when administered in the evening (when most cholesterol synthesis occurs).

chest pain that results from ischemia when heart needs more oxygen than is being produced.

- new form of angina. Patients have chest pain but no apparent coronary blockage.

(also known as variant angina) caused by sudden coronary artery spasms that induce ischemia in the heart muscle.

caused by severely decreased coronary blood flow. Pain occurs when resting, even when at sleep and can wake you up.

8. Differentiate the mechanism of action, indication for use, common adverse effects and nursing implications for Fibric acid derivatives.

Mechanism of action – works to lower triglyceride levels and increase HDL levels. It can lower or raise LDL levels.

Adverse effects – has increase risk of myopathies with combination of statins.

            Fenofibrate- is contraindicated in hepatic dysfunction, can cause pancreatitus, cholelithiasis, myopathy, myositis.

            Gemfibrozil- has increase risk of hepatic malignancy and cholelithiasis, and muscle inflammation.

            Clofibrate- can cause hepatic tumors, cholelithiasis, and peptic ulcers.

Indication for use – used to treat primary hypercholesterolemia and combined hyperlipidemia, and secondary prevention of coronary events.

Mechanism of action- it inhibits HMG-CoA reductase which catalyzes cholesterol biosynthesis and increases HDL and decreases LDL, total cholesterol VLDL.

Adverse effects- elevated liver enzymes and myopathies, muscle ache, joint ache, chabdomyolysis.

Nursing implications- before therapy monitor liver function, evaluate patient for muscle soreness, avoid physical activity, monitor older adult who receives polypharmacy.

Identify core patient variables relevant to drugs that affect lipid levels.

Before starting drug therapy, patients should be treated with nonpharmacologic methods of controlling cholesterol and lipids, including dieting. Determine whether the patient is pregnant because lovastatin is in pregnancy category x drug. Check for drug interaction with older adults.

10. Determine and utilize key points for patient and family education for drugs used to treat angina, including measures to be taken if meds do not alleviate symptoms.

drugs to treat angina

beta blockers

calcium channel blockers

nitrates 

prevent adrenergic receptors from being stimulated, it slows heart rate, depresses AV conduction, decreases cardiac output, reduces systolic and diastolic blood pressure, which decreases oxygen demand thereby decreasing angina.

inhibit calcium from moving across cell membranes. It causes decreased contraction, depression of impulse formation, and slows conduction velocity, thereby decreasing oxygen needs of heart. Usually used when patient can’t tolerate beta blockers.

dilate vascular smooth muscle and both venous and arterial vessels. Venous dilation decreases returning flow, and arterial dilation reduces systemic vascular resistance and arterial pressure.

Statins

Fibric acid derivatives

Nicotinic acid