Chapter 46 Antihyperlipidemics and Peripheral
Description: Chapter 46 Antihyperlipidemics and Peripheral Vasodilators Copyright 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc. Lipoproteins Major categories High-density lipoprotein (HDL) (good) Removes
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slide1. Chapter 46 Antihyperlipidemics and Peripheral Vasodilators Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide2. Lipoproteins Major categories
High-density lipoprotein (HDL) (“good”)
Removes cholesterol from blood
Transports cholesterol to liver for elimination
Low-density lipoprotein (LDL) (“bad”)
Contains higher percent of cholesterol
Very low-density lipoprotein (VLDL)
Contains mostly triglycerides, less cholesterol
Chylomicrons
Contain mostly triglycerides
Transport fatty acids and cholesterol to liver Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide3. Apolipoproteins Apolipoproteins are within the lipoprotein shell and contain apolipoprotein (apo) A-1, apoB, and apoE.
Major component of apoA1 is HDL.
The major component of apoB is LDL.
Two forms: apoB-100 and apoB-48
Contains higher percent of cholesterol
ApoB-100 has a VLDL as well as LDL
Better indicator of risk for coronary artery disease (CAD) than LDL alone Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide4. Nonpharmacologic Methods for Cholesterol Reduction Reduce saturated fats in diet.
Reduce total fat intake to 30% or less of caloric intake.
Reduce cholesterol intake to 300 mg/day or less.
Exercise as possible.
Stop smoking. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide5. Antihyperlipidemics Types of antilipidemics
Bile-acid sequestrants
Fibrates (fibric acid)
Nicotinic acid
Cholesterol absorption inhibitor
Hepatic 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide6. Antihyperlipidemics (Cont.) Bile-acid sequestrants
Cholestyramine (Questran), colestipol (Colestid), colesevelam HCl
Reduce LDL cholesterol (LDL-C) levels by binding with bile acids in the intestine
Side effects–constipation, flatulence, and cramping Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide7. Antihyperlipidemics (Cont.) Fibrates
Gemfibrozil (Lopid)
Do not take with anticoagulants.
Nicotinic acid (Niacin, vitamin B2)
Numerous side effects
Large doses are required.
As few as 20% of patients can initially tolerate niacin.
With proper counseling, careful drug titration, and concomitant use of aspirin, this number can be increased to as high as 60% to 70%. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide8. Antihyperlipidemics (Cont.) Cholesterol absorption inhibitor
Ezetimibe (Zetia)
Acts on the cells in the small intestine to inhibit cholesterol absorption
It must be combined with a statin for optimum effect. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide9. Statins HMG CoA reductase inhibitors
Action: inhibit the enzyme HMG CoA reductase in cholesterol biosynthesis
Examples:
Atorvastatin calcium (Lipitor)
Fluvastatin (Lescol)
Lovastatin (Mevacor)
Pravastatin sodium (Pravachol)
Rosuvastatin calcium (Crestor)
Simvastatin (Zocor) Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide10. Statins (Cont.) Side effects and adverse effects
Liver impairment
Rhabdomyolysis (skeletal muscle disorder)
Cataracts
Nursing interventions
Monitor liver enzymes.
Report unexplained muscle tenderness or weakness, fever, and malaise.
Teach patient importance of compliance with health care regimen. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide11. Laboratory Tests Homocysteine
4 to 17 mmol/L (fasting)
High levels linked to cardiovascular disease, stroke, and the possibility of Alzheimer’s disease
May also promote blood clotting
Three vitamins that can lower serum homocysteine levels:
Vitamin B6 (pyridoxine)
Vitamin B12 (cyanocobalamin)
Folic acid Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide12. Laboratory Tests (Cont.) High sensitivity C-reactive protein (hsCRP)
Reference value: <0.175 mg/L; low risk: <1 mg/L; moderate risk: 1-3 mg/L; high risk: >3 mg/L
Used to detect an inflammatory process caused by the buildup of atherosclerotic plaque in the arterial system, particularly the coronary arteries Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide13. Nursing Process: Statins Assessment
Nursing diagnoses
Planning
Nursing interventions
Patient teaching
Cultural considerations
Evaluation Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide14. Peripheral Vasodilators Peripheral arterial (vascular) disease (PAD, PVD)
Arteriosclerosis
Hyperlipidemia
Treatment
Peripheral vasodilators to improve blood flow Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide15. Peripheral Vasodilators (Cont.) Classifications
Alpha-adrenergic antagonists
Direct-acting peripheral vasodilators
Hemorrheologic
Others
Antiplatelets
Selected antihypertensives Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide16. Peripheral Vasodilators (Cont.) Drugs that promote vasodilation
Papaverine (Para-Time): Direct-acting peripheral vasodilator
Prazosin (Minipress): Alpha blocker
Nifedipine (Procardia): Calcium channel blocker
Side effects: Lightheadedness, dizziness, orthostatic hypotension, tachycardia, palpitation, flush, and GI distress Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide17. Antiplatelet Drug Cilostazol (Pletal)
Direct-acting vasodilator and antiplatelet drug
Treats intermittent claudication
Side effects: Nausea, vomiting, dizziness, syncope, blood in eye, headache, abdominal pain, abnormal stools, peripheral edema Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide18. Hemorrheologic Agent Pentoxifylline (Trental)
Improves microcirculation and tissue perfusion
Decreases blood viscosity
Improves flexibility of erythrocytes
Inhibits aggregation of platelets and red blood cells
Decreases blood viscosity Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide19. Nursing Process: Vasodilators Assessment
Nursing diagnoses
Planning
Nursing interventions
Patient teaching
Cultural considerations
Evaluation Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide20. Practice Question #1 A patient’s serum lipids are cholesterol 197 mg/dL, low-density lipoprotein (LDL) 110 mg/dL, and high-density lipoprotein (HDL) 35 mg/dL. The nurse knows what about these values?
Serum lipids are within desirable values.
Cholesterol is within desirable value, but LDL and HDL are not.
Cholesterol is not within desirable value, though LDL and HDL are.
Cholesterol, LDL, and HDL are not within desirable values. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide21. Practice Question #2 A nurse who is administering atorvastatin calcium (Lipitor) realizes the importance of monitoring for which serious adverse reaction?
Pharyngitis
Rash/pruritus
Rhabdomyolysis
Agranulocytosis Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide22. Practice Question #3 A patient is scheduled to receive gemfibrozil (Lopid). It is most important for the nurse to assess for concurrent use of which medication?
Acetaminophen (Tylenol)
Ibuprofen (Motrin)
Warfarin ( Coumadin)
Folic acid Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide23. Practice Question #4 A patient is receiving medication therapy for peripheral vascular disease. Which medication does the nurse identify as an antiplatelet drug?
Cilostazol (Pletal)
Papaverine (Para-Time)
Prazosin (Minipress)
Nifedipine (Procardia) Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide24. Practice Question #5 Which herb is most often associated with the treatment of intermittent claudication?
Ginseng
Valerian
St. Johns wort
Ginkgo biloba Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide2. Lipoproteins Major categories
High-density lipoprotein (HDL) (“good”)
Removes cholesterol from blood
Transports cholesterol to liver for elimination
Low-density lipoprotein (LDL) (“bad”)
Contains higher percent of cholesterol
Very low-density lipoprotein (VLDL)
Contains mostly triglycerides, less cholesterol
Chylomicrons
Contain mostly triglycerides
Transport fatty acids and cholesterol to liver Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide3. Apolipoproteins Apolipoproteins are within the lipoprotein shell and contain apolipoprotein (apo) A-1, apoB, and apoE.
Major component of apoA1 is HDL.
The major component of apoB is LDL.
Two forms: apoB-100 and apoB-48
Contains higher percent of cholesterol
ApoB-100 has a VLDL as well as LDL
Better indicator of risk for coronary artery disease (CAD) than LDL alone Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide4. Nonpharmacologic Methods for Cholesterol Reduction Reduce saturated fats in diet.
Reduce total fat intake to 30% or less of caloric intake.
Reduce cholesterol intake to 300 mg/day or less.
Exercise as possible.
Stop smoking. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide5. Antihyperlipidemics Types of antilipidemics
Bile-acid sequestrants
Fibrates (fibric acid)
Nicotinic acid
Cholesterol absorption inhibitor
Hepatic 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide6. Antihyperlipidemics (Cont.) Bile-acid sequestrants
Cholestyramine (Questran), colestipol (Colestid), colesevelam HCl
Reduce LDL cholesterol (LDL-C) levels by binding with bile acids in the intestine
Side effects–constipation, flatulence, and cramping Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide7. Antihyperlipidemics (Cont.) Fibrates
Gemfibrozil (Lopid)
Do not take with anticoagulants.
Nicotinic acid (Niacin, vitamin B2)
Numerous side effects
Large doses are required.
As few as 20% of patients can initially tolerate niacin.
With proper counseling, careful drug titration, and concomitant use of aspirin, this number can be increased to as high as 60% to 70%. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide8. Antihyperlipidemics (Cont.) Cholesterol absorption inhibitor
Ezetimibe (Zetia)
Acts on the cells in the small intestine to inhibit cholesterol absorption
It must be combined with a statin for optimum effect. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide9. Statins HMG CoA reductase inhibitors
Action: inhibit the enzyme HMG CoA reductase in cholesterol biosynthesis
Examples:
Atorvastatin calcium (Lipitor)
Fluvastatin (Lescol)
Lovastatin (Mevacor)
Pravastatin sodium (Pravachol)
Rosuvastatin calcium (Crestor)
Simvastatin (Zocor) Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide10. Statins (Cont.) Side effects and adverse effects
Liver impairment
Rhabdomyolysis (skeletal muscle disorder)
Cataracts
Nursing interventions
Monitor liver enzymes.
Report unexplained muscle tenderness or weakness, fever, and malaise.
Teach patient importance of compliance with health care regimen. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide11. Laboratory Tests Homocysteine
4 to 17 mmol/L (fasting)
High levels linked to cardiovascular disease, stroke, and the possibility of Alzheimer’s disease
May also promote blood clotting
Three vitamins that can lower serum homocysteine levels:
Vitamin B6 (pyridoxine)
Vitamin B12 (cyanocobalamin)
Folic acid Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide12. Laboratory Tests (Cont.) High sensitivity C-reactive protein (hsCRP)
Reference value: <0.175 mg/L; low risk: <1 mg/L; moderate risk: 1-3 mg/L; high risk: >3 mg/L
Used to detect an inflammatory process caused by the buildup of atherosclerotic plaque in the arterial system, particularly the coronary arteries Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide13. Nursing Process: Statins Assessment
Nursing diagnoses
Planning
Nursing interventions
Patient teaching
Cultural considerations
Evaluation Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide14. Peripheral Vasodilators Peripheral arterial (vascular) disease (PAD, PVD)
Arteriosclerosis
Hyperlipidemia
Treatment
Peripheral vasodilators to improve blood flow Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide15. Peripheral Vasodilators (Cont.) Classifications
Alpha-adrenergic antagonists
Direct-acting peripheral vasodilators
Hemorrheologic
Others
Antiplatelets
Selected antihypertensives Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide16. Peripheral Vasodilators (Cont.) Drugs that promote vasodilation
Papaverine (Para-Time): Direct-acting peripheral vasodilator
Prazosin (Minipress): Alpha blocker
Nifedipine (Procardia): Calcium channel blocker
Side effects: Lightheadedness, dizziness, orthostatic hypotension, tachycardia, palpitation, flush, and GI distress Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide17. Antiplatelet Drug Cilostazol (Pletal)
Direct-acting vasodilator and antiplatelet drug
Treats intermittent claudication
Side effects: Nausea, vomiting, dizziness, syncope, blood in eye, headache, abdominal pain, abnormal stools, peripheral edema Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide18. Hemorrheologic Agent Pentoxifylline (Trental)
Improves microcirculation and tissue perfusion
Decreases blood viscosity
Improves flexibility of erythrocytes
Inhibits aggregation of platelets and red blood cells
Decreases blood viscosity Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide19. Nursing Process: Vasodilators Assessment
Nursing diagnoses
Planning
Nursing interventions
Patient teaching
Cultural considerations
Evaluation Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide20. Practice Question #1 A patient’s serum lipids are cholesterol 197 mg/dL, low-density lipoprotein (LDL) 110 mg/dL, and high-density lipoprotein (HDL) 35 mg/dL. The nurse knows what about these values?
Serum lipids are within desirable values.
Cholesterol is within desirable value, but LDL and HDL are not.
Cholesterol is not within desirable value, though LDL and HDL are.
Cholesterol, LDL, and HDL are not within desirable values. Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide21. Practice Question #2 A nurse who is administering atorvastatin calcium (Lipitor) realizes the importance of monitoring for which serious adverse reaction?
Pharyngitis
Rash/pruritus
Rhabdomyolysis
Agranulocytosis Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide22. Practice Question #3 A patient is scheduled to receive gemfibrozil (Lopid). It is most important for the nurse to assess for concurrent use of which medication?
Acetaminophen (Tylenol)
Ibuprofen (Motrin)
Warfarin ( Coumadin)
Folic acid Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide23. Practice Question #4 A patient is receiving medication therapy for peripheral vascular disease. Which medication does the nurse identify as an antiplatelet drug?
Cilostazol (Pletal)
Papaverine (Para-Time)
Prazosin (Minipress)
Nifedipine (Procardia) Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>
slide24. Practice Question #5 Which herb is most often associated with the treatment of intermittent claudication?
Ginseng
Valerian
St. Johns wort
Ginkgo biloba Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.<br>