Antihyperlipidemics - Miscellaneous: Nursing pharmacology

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-LO3Now, 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. Niacin is contraindicated in clients with active hepatic disease or peptic ulcer disease, as well as in those with arterial hemorrhage.

Caution should be taken during pregnancy and breastfeeding, as well as in clients with cardiovascular disease, diabetes, or gout.

Additional precautions should be taken in clients with hepatic or renal impairment, as well as in those who consume large amounts of alcohol.Next, we have PCSK9 inhibitors, like alirocumab and evolocumab, which are monoclonal antibodies administered via subcutaneous injection.

Once administered, these medications target the PCSK9 protein that’s normally secreted by liver cells and binds to LDL receptors on the cell’s surface, causing them to be uptaken and broken down intracellularly.

PCSK9 inhibitors bind to these proteins to prevent LDL receptor breakdown. This mechanism increases the overall quantity of LDL receptors on liver cells and thus causes a large decrease in LDL in the bloodstream, which is sometimes referred to as “bad” cholesterol, while providing a slight increase in HDL, which is sometimes referred to as “good” cholesterol.

For that reason, these medications are used to treat familial hypercholesterolemia and atherosclerotic disease.Side effects include local injection site reactions, and hypersensitivity reactions.

Some clients may also present with flu-like symptoms, cough, diarrhea, and hepatic side effects like increased blood transaminases, as well as muscle spasms and myalgia.

There are no major contraindications, but they should be used cautiously during pregnancy and breastfeeding.Finally, there’s omega-3 fatty acids like icosapent and fish oil, which are taken orally.

Once absorbed into the bloodstream, these medications act by decreasing lipogenesis in the liver, which ultimately reduces the production of VLDLs.

In addition, omega-3 fatty acids also increase the activity of lipoprotein lipase, which subtracts triglycerides from VLDLs, decreasing its levels in the blood.

So, overall, these medications help decrease VLDL levels.Common side effects of omega-3 fatty acids include abdominal pain, constipation, or diarrhea, as well as myalgia and arthralgia, and gout.

Some clients may also present with more serious side effects, such as hemorrhage, especially in those who take anticoagulant or antiplatelet medications; as well as cardiovascular side effects like arrhythmias or peripheral edema.

Omega-3 fatty acids have no major contraindications, but they should be used with caution in clients who are allergic to fish or shellfish, as well as in clients with coagulopathy or hepatic impairment.

Precautions should also be taken during pregnancy and breastfeeding.Now, when caring for a client who has severe hyperlipidemia and is prescribed an antihyperlipidemic like icosapent, start your assessment by asking them if they are allergic to fish or shellfish, and if they’re currently taking anticoagulant or antiplatelet medications or any other omega-3 fatty acid supplement.

Then, assess their vital signs and review their most recent laboratory test results, including a lipid panel, liver function tests, and coagulation studies.Moving on to client education, explain to your client that their medication will help decrease their VLDL levels, and instruct them to take their medication twice daily with food.

Also, reinforce the importance of adhering to the recommended lifestyle modifications, including regular physical activity, and a diet low in fat and high in fiber from whole grains, fruits, and vegetables.Next, teach your client about some side effects they may experience during therapy.

Let them know that constipation can be prevented by increasing their fluid intake along with continuing their recommended diet and exercise regimen.

Also, let your client know that they may also experience muscle aches, and prompt them to contact their healthcare provider if they persist.

Lastly, advise them to immediately contact their healthcare provider if they notice a fast heartbeat or palpitations; or signs of unusual bleeding like bruising without a known cause, cuts that continue to bleed after 5 minutes of pressure, or bleeding nose or gums.

Finally, while your client is being treated with an antihyperlipidemic, be sure to monitor them closely for side effects, as well as for the desired therapeutic effect of lowered lipid levels.

All right, as a quick recap… Antihyperlipidemic are medications used to treat clients with increased blood lipid levels, and to decrease the risk of cardiovascular events.

Some types of antihyperlipidemic medications include niacin, PCSK9 inhibitors, and omega-3 fatty acids. All these medications work to decrease blood lipid levels by blocking the production or release of free fatty acids, triglycerides, and cholesterol at various stages throughout the body.

Important side effects include ‘niacin flush,’ myalgias, and gastrointestinal upset. When caring for a client taking an antihyperlipidemic, nursing considerations include performing a baseline assessment, monitoring for side effects, and evaluating the therapeutic effect.

Client teaching focuses on recommended lifestyle modifications, recognition of potential side effects, and knowing when to contact