Antihyperlipidemics - Miscellaneous: Nursing pharmacology

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Notes

Notes

ANTIHYPERLIPIDEMICS: MISCELLANEOUS
DRUG NAME
niacin
(Niaspan, Niacor)
alirocumab (Praluent); evolocumab (Repatha)
icosapent (Vascepa);
 fish oil (Lovaza)
CLASS
Vitamin B3
PCSK9 inhibitors
Omega-3 fatty acids
MECHANISM of ACTION
  • Inhibits lipoprotein lipase → decrease release of free fatty acids from adipose tissue → decrease triglyceride production by the liver
  • Bind to PCSK9 → prevent LDL-receptor degradation → decrease LDL levels in blood
  • Decrease lipogenesis in the liver → reduces hepatic VLDL synthesis and secretion → decrease VLDL levels in blood
  • Increase lipoprotein lipase activity → enhance TG clearance from circulating VLDL particles → decrease VLDL levels

INDICATIONS
Hypertriglyceridemia
Familial hypercholesterolemia,
atherosclerotic disease
Severe hypertriglyceridemia
ROUTE(S) of ADMINISTRATION
PO
SubQ
PO
SIDE EFFECTS
  • ”Niacin flush”
  • Headaches
  • Dizziness
  • Insomnia
  • Paresthesia
  • Abdominal pain
  • Nausea
  • Vomiting
  • Diarrhea
  • Flatulence
  • Hyperglycemia
  • Hyperuricemia
  • Hepatitis
  • Increased blood transaminases

  • Local injection site reactions
  • Hypersensitivity reactions
  • Flu-like symptoms
  • Cough
  • Diarrhea
  • Increased blood transaminases
  • Muscle spasms
  • Myalgia

  • Abdominal pain
  • Constipation
  • Diarrhea
  • Myalgia
  • Arthralgia
  • Gout
  • Hemorrhage
  • Arrhythmias
  • Peripheral edema

CONTRA-INDICATIONS and CAUTIONS
  • Pregnancy
  • Breastfeeding
  • Cardiovascular disease
  • Diabetes
  • Gout
  • Hepatic or renal impairment
  • Excessive alcohol consumption

  • Pregnancy
  • Breastfeeding
  • Pregnancy
  • Breastfeeding
  • Allergy to fish or shellfish
  • Coagulopathy
  • Hepatic impairment

NURSING CONSIDERATIONS
Assessment and monitoring
Assessment
  • Vital signs
  • Allergy to fish or shellfish
  • Medications: anticoagulants, antiplatelets, other omega-3 fatty acid supplements
  • Laboratory test results: lipid panel, liver function tests, coagulation studies

Monitoring
  • Side effects
  • Therapeutic effect: lowered lipid levels

Client education
  • Purpose of medication: decrease VLDL levels
  • Take twice daily with food
  • Lifestyle modifications: regular physical activity, low fat, high fiber diet
  • Side effects
    • Constipation: increase fluid intake; continue their recommended diet and exercise regimen
    • Report: persistent muscle aches, irregular heart beat, unusual bleeding

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 decrease the risk of cardiovascular events. Antihyperlipidemics include different classes of medications, including niacin, also known as vitamin B3 or nicotinic acid; PCSK9 inhibitors, like alirocumab and evolocumab; and omega-3 fatty acids, like icosapent and fish oil.

Let’s start with niacin, which is taken orally. Once administered, it works by inhibiting the enzyme lipoprotein lipase in adipose tissue, which decreases the release of free fatty acids into the bloodstream. As a result, there’s less fatty acids available for the liver to produce triglycerides. For that reason, niacin is primarily used to treat hypertriglyceridemia. LO1-LO3

Now, a common side effect is “niacin flush,” which leads to a red, flushed face, and pruritus. Clients may also experience headaches, dizziness, insomnia, and paresthesia or a sensation of pins and needles, as well as gastrointestinal side effects, including abdominal pain, nausea, vomiting, diarrhea, or flatulence. Other side effects include hyperglycemia, hyperuricemia, and hepatitis with increased blood transaminases.

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