Antihyperlipidemics - Fibrates: Nursing pharmacology

Anti-hyperlipidemics 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. Anti-hyperlipidemics 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 PPAR alpha, or paroxosome proliferator activated receptor alpha, a major regulator of lipid metabolism.

PPAR alpha 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 anti-hyperlipidemics, such as statins, to treat clients with mixed dyslipidemia, where both triglyceride and cholesterol levels are elevated.

OK, 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 puritis.

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 Dastavivir, repaglinide, simvastatin, or warfarin, since it can increase the risk of toxicity.

Finally, fenofibrates 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 anti-hyperlipidemic like gemfibrozil, start by performing a baseline assessment, including vital signs and cardiovascular status.

Then review their laboratory test results, including CBC, renal and hepatic function, as well as a lipid panel, which includes total cholesterol, triglycerides, HDL, LDL, and VLDL levels.

Next, explain to your client how the medication will help lower their triglycerides and increase HDL levels. Instruct your client to take it twice each day, 30 minutes before breakfast and dinner, and advise them to increase their fluid intake while taking their medication.

In addition, encourage lifestyle modifications that can reduce the risk of cardiovascular events, including smoking cessation, weight control, physical activity as tolerated, as well as a diet high in complex carbohydrates and fiber, and low in fat and cholesterol.

Lastly, let your client know it can take up to 3 months to determine if the medication is effective. Then let your client know about common side effects that they may experience, including an upset stomach and diarrhea.

And be sure to stress the importance of immediately reporting symptoms of rhabdomyolysis, such as unexplained muscle pain or weakness or brown urine, as well as symptoms of gallstone development, such as pain felt in the upper abdomen, between the shoulder blades or the right shoulder, along with nausea and vomiting.

Finally, during the course of treatment, be sure to monitor your client for side effects and obtain periodic lipid profile tests to evaluate for the desired therapeutic effect of decreased triglycerides and increased HDL levels.

All right, as a quick recap, anti-hyperlipidemics are medications used to treat dyslipidemia, which refers to increased blood levels of lipids and include gemfibrozil and fenofibrate.

Fibrates work by activating an intranuclear receptor called PPAR alpha, or peroxome proliferator activated receptor alpha, which increases lipolysis and helps to lower triglyceride levels.

In addition, fibrates also increase the synthesis of HDL. Common side effects of fibrates include gastrointestinal disturbances like dyspepsia and diarrhea, as well as rhabdomyolysis and gallstone formation.

When caring for a client taking a fibrate, nursing considerations include conducting a baseline assessment, monitoring for side effects, and evaluating the desired therapeutic effects of the medication.

Finally, client teaching is focused on self-administration and learning to recognize and report side effects.