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Antihyperlipidemics - Fibrates: Nursing Pharmacology

Notes

Notes

ANTIHYPERLIPIDEMICS: FIBRATES
DRUG NAME
gemfibrozil (Lopid); fenofibrate (Tricor)
CLASS
Fibrates
MECHANISM OF ACTION
Activate PPARα → increase lipolysis → decrease triglyceride levels
INDICATIONS
  • Hypertriglyceridemia
  • Hypercholesterolemia
  • Mixed dyslipidemia
ROUTE(S) OF ADMINISTRATION
  • PO
SIDE EFFECTS
  • GI: dyspepsia, abdominal pain, nausea, vomiting, diarrhea, cholelithiasis, pancreatitis
  • Skin: rash, urticaria, pruritus
  • CNS: fatigue, dizziness, headache
  • Muscular: rhabdomyolysis (increased risk when combined with colchicine and statins)
  • Gemfibrozil: pancytopenia, eosinophilia
CONTRAINDICATIONS AND CAUTIONS
  • Severe renal and hepatic disease
  • Gallbladder disease
  • Pregnancy and breastfeeding
  • Gemfibrozil: don’t combine with dasabuvir, repaglinide, or simvastatin
  • Fenofibrate: elderly clients, pancreatitis, diabetes mellitus
NURSING CONSIDERATIONS
Assessment and monitoring
Assessment
  • Vital signs, cardiovascular status
  • Laboratory test results: CBC, renal and hepatic function, lipid panel

Monitor
  • Side effects, periodic lipid profile
  • Therapeutic response: decreased triglycerides, increased HDLs

Client education
  • Purpose of medication: lower their triglycerides and increase HDL levels
  • Take gemfibrozil twice each day, 30 minutes before breakfast and dinner
  • Take fenofibrate once daily with food
  • Increase their fluid intake while taking their medication
  • Lifestyle modifications to reduce the risk of cardiovascular events
  • Can take up to three months to determine efficacy
  • Side effects: upset stomach, diarrhea
  • Immediately report
    • Symptoms of rhabdomyolysis; e.g., unexplained muscle pain, weakness; brown urine
    • Symptoms of gallstone development; e.g., pain in upper abdomen, between shoulder blades, or right shoulder; nausea and vomiting
Transcript

Antihyperlipidemics are medications used to treat clients with dyslipidemia, which refers to increased blood levels of lipids, such as cholesterol and triglycerides. In addition, they’re indicated to treat clients with coronary artery disease and prevent myocardial infarction. Antihyperlipidemics include different classes of medications, among which some of the most commonly used are fibrates.

Now, fibrates include gemfibrozil and fenofibrate, which are administered orally. Once absorbed into the bloodstream, fibrates work by activating an intranuclear receptor called PPARα, or peroxisome proliferator-activated receptor alpha, a major regulator of lipid metabolism.

When activated by fibrates, PPARα causes adipose tissue cells to produce more lipoprotein lipase, increasing lipolysis and lowering triglyceride levels.

Fibrates also increase the synthesis of HDL, which is sometimes referred to as “good” cholesterol; however, they aren’t very effective at decreasing the levels of low-density lipoproteins or LDL, which is sometimes referred to as “bad” cholesterol.

Therefore, they can be combined with other antihyperlipidemics, such as statins, to treat clients with mixed dyslipidemia, where both triglyceride and cholesterol levels are elevated.

Okay, the most common side effects of fibrates include gastrointestinal disturbances like dyspepsia and diarrhea. In addition, fibrates decrease the conversion of cholesterol into bile acid, which promotes the formation of gallstones, potentially leading to serious side effects like cholelithiasis and pancreatitis.

Clients taking fibrates may also develop a skin rash, urticaria, and pruritus. Fibrates can also cause rhabdomyolysis, and the risk increases when combined with medications like certain statins or colchicine.

Fatigue, dizziness and headache are also common, especially with fenofibrate. Finally, clients taking gemfibrozil may develop pancytopenia and eosinophilia.

Now, fibrates are contraindicated in clients with severe renal and hepatic disease, gallbladder disease, and should be avoided during pregnancy and breastfeeding.

Gemfibrozil shouldn’t be combined with certain medications like dasabuvir, repaglinide, simvastatin, or warfarin, since it can increase the risk of toxicity. Finally, fenofibrate should be used with caution in elderly clients, as well as in those with pancreatitis or diabetes mellitus.

All right, if your client with dyslipidemia is prescribed an antihyperlipidemic like gemfibrozil, start by performing a baseline assessment, including vital signs and cardiovascular status.

Sources
  1. "Focus on Nursing Pharmacology" LWW (2019)
  2. "Pharmacology" Elsevier Health Sciences (2014)
  3. "Mosby's 2021 Nursing Drug Reference" Mosby (2020)
  4. "Saunders Comprehensive Review for the NCLEX-RN Examination" Saunders (2016)