Drugs

Therapy for
Dyslipidemi
a
Chapter 10

NUR 426
 Course Objectives

• Recognize the correlation of dyslipidemia in atherosclerotic

cardiovascular disease

• Identify the prototype drug from each drug class used to treat
dyslipidemia

• Describe the classes of dyslipidemia drugs and understand their

action, use, major adverse effects and nursing implications

• Create educational strategies for patients on dyslipidemic drugs

 Overview of Dyslipidemia-Etiology

• Blood lipids include-cholesterol, phospholipids, triglycerides

• Cholesterol: waxy, fat-like substance in body cells
• Phospholipids: fat molecule that have a hydrophilic and
hydrophobic pole
• Triglycerides: Type of fat, used for energy or stored

• Derived from diet

• Synthesized by liver and intestine

• Found in body cells, perform essential functions

• Transported in plasma by lipoproteins

N.B Cholesterol is not treated in pregnancy and the drugs are
contraindicate
Pathophysiology of Dyslipidemia
Abnormal Lipid levels A.K.A. “Dyslipidemia”

• Associated with atherosclerosis

• Many pathophysiologic effects
• MI and ischemia
• CVA
• Peripheral arterial occlusive disease
• CAD
• Ischemic HD has high rate of morbidity and mortality

Primary

• Genetic, familial
• Secondary
• Dietary habits, other diseases
• DM, alcoholism, hypothyroidism
• Obesity, obstructive liver disease

Metabolic Syndrome-Group of Cardiovascular risk factors

• Central adiposity (increased waist circumference)

• Elevated triglycerides,
• Reduced HDL
• Elevated BP
• Elevated Blood Glucose
Management
• Lifestyle Changes
• Diet/weight reduction if overweight
• Exercise
• Smoking cessation
• Postmenopausal hormone
replacement therapy
• Drug Therapy
• Alter the production, absorption,
metabolism or removal of lipids and
lipoproteins (Life style modification)
• Based on type & severity of
dyslipidemia
 Clinical Manifestations: Lipid Profile

• Total cholesterol
• HDL cholesterol
• LDL cholesterol
• Triglycerides
 Plasma Cholesterol and Triglyceride
Levels in Adults and Children
Updated according to the CDC 2024
Adults Children

Total Cholesterol (mg/dL) Desirable =150 mg/dL Desirable = < 170 mg/dL

LDL Cholesterol (mg/dL) Desirable = 100 mg/dL Desirable = < 100 mg/dL

HDL Cholesterol (mg/dL) Desirable = 40 mg/dL Desirable = > 45 mg/dL

(men)
50 mg/dL (women)
Triglycerides (mg/dL) Desirable = <150 mg/dL Desirable = < 100 (<9yrs)
< 130 (10+yrs)
Drugs used to treat
Dyslipidemia
 HMG-COA Reductase Inhibitors(Statins)

1. Atorvastatin (Lipitor)
Prototype
2. Rosuvastatin (Crestor)
 HMG-CoA Reductase Inhibitors (Statins)
Prototype: Atorvastatin (Lipitor)

• Pharmacokinetics:
• First pass in liver – result-low levels of
available drug for circulation
• Increase in effectiveness when taken at night
• Crosses placenta barrier, in breast milk –avoid
pregnancy
• Excreted in feces and urine
• Nursing Implications:
• Awareness of many drug
• Action:
interactions
• Statins inhibit HMC-CoA reductase (required
for hepatic synthesis of cholesterol • Given in the evening – bulk of
cholesterol synthesis at night
• Use:
• Assess therapeutic effect
• Hypercholesterolemia & reduction of cardiovascular
events • Assess for adverse effects
• Most powerful drug to reduce LDL with minimal • Childbearing age woman should
effects on HDL and Triglycerides be on birth control
• Adverse Side Effects: • Monitoring Liver Function –
• Nausea, constipation, diarrhea, abdominal cramps or required before starting statin
pain headache, shin rash • Low fat diet
• Myopathies – injure muscle result in muscle ache, pain, • Increase aerobic exercise
inure muscle tissue weakness • Many drug and herb interactions-
• Contraindications: NO GRAPEFRUIT JUICE
• Pregnancy category X, lactation, hypersensitivity
Other drugs in the class of
Statins:
Rosuvastatin (Crestor)

Pharmacokinetics:
• First pass in liver
• Can be taken anytime during the day
• Category X--avoid pregnancy
• Excreted in feces
Action:
• Statins inhibit HMC-CoA reductase (required for
hepatic synthesis of cholesterol)
Use:
• Hypercholesterolemia & reduction of
cardiovascular events
Adverse Effects/Contraindications: same as Atorvastatin
• Nausea, constipation, diarrhea, abdominal cramps or pain
headache, shin rash
• Myopathies – injure muscle result in muscle ache, pain,
inure muscle tissue weakness
 Bile Acid Sequestrates
Prototype: Cholestyramine (Prevalite,
Questran)
Pharmacokinetics:
• Ability to reduce LDL-no effect on HDL or triglycerides.
• is an add-on with statins or niacin.
• Not absorbed when taken orally-excreted in feces
Action: Nursing Implications:
• Binds with bile acids (high levels of cholesterol) in intestinal
lumen - excreted in feces-preventing recirculation to liver. • Decrease absorption of
• Loss of bile acids causes more bile acids to be made by many oral meds-(dig, folic
cholesterol. acid, glipizide, propranolol,
• Liver used cholesterol to make more bile - hepatic in cellular
level falls, increasing absorption of cholesterol (LDL) tetracyclines, thiazides,
• Prevent reabsorption of bile salt thyroid hormones, fat
Use: soluble vitamins, warfarin)
• Reduce LDL cholesterol • May need to change dose
• Little or no effect on HDL cholesterol
if bile acid Sequestrants
Adverse/Side Effects:
• Abdominal fullness
are added or withdrawn
• Flatulence • May prevent absorption
• Diarrhea, of fat=soluble vit
• Constipation (A,D,E, and K)-take 1 hr
Contraindications: before or 4-6 after
• Biliary Obstruction-because bile is not excreted into intestine
• Caution with use of vit K-drug binds to vit K
eating. Mix with water
or other fluids
 Fibrates: Pharmacokinetics, Action, Use
Prototype: Fenofibrate (TriCor)

Pharmacokinetics:
• Administered orally
• Protein bound
• Peak 6-8 hrs
• Metabolized in liver
• Excreted by urine
Action:
• Increase the oxidation of fatty acids in liver and muscle
tissue
• Decrease hepatic production of triglycerides, decrease
VLDL cholesterol, and increase HDL cholesterol
Use: Nursing Implications
• Most effective drugs for reducing serum • Increase risk of bleeding
triglyceride values
(hypoprothrombinemia effect)
Adverse/Side Effects: • Give with food – increase
• GI discomfort
• Diarrhea
absorption
• Increase cholesterol concentration in biliary tract –
formation of Gallstones
Contraindications:
• Hypersensitivity
• Hepatic or renal impairment
• Pre-existing gallbladder disease
 Cholesterol Absorption Inhibitors:
Prototype: Ezetimibe (Zetia)
Pharmacokinetics:
• Works in the small intestine
• Inhibits absorption of dietary cholesterol & decreases
intestinal cholesterol to liver
• Reduces hepatic cholesterol stores, increased clearance
from blood
• Protein bound
• Metabolized in small intestine and liver
• Excreted in feces Nursing Implications:
• Diet education – low
Action:
• Blocks biliary and dietary cholesterol absorption at the
cholesterol
brush border of the intestine (sm. Intestine) • Patient to report side effects
Use:
• Some Medication
• Used with dietary management for tx of primary interactions-check with
dyslipidemia. pharmacy
Adverse Effects:
• Same time each day. At night
• Headache, diarrhea hypersensitivity (rash), nausea if patient is on a statin
• 2 hour before or 4 hours
Contraindications:
after Bile Sequestrants to
• Pregnancy and lactation
prevent altered absorption
• In patients with statins that have active hepatic disease
Your turn
Educational Strategies for Patients on
Dyslipidemic Drugs:
Educate your patient on the following drugs: cover the two
of the following
• Generic Name/Trade Name
• Drug Class
• Use
• Adverse Effects/Contraindications
• Nursing Interventions
• In simple language
• Atorvastatin
• Rosuvastatin
• Cholestyramine
• Fenofibrate
• Ezetimibe
 Question

Is the following statement

True or False?

• Metabolic syndrome is a
group of cardiovascular risk
factors linked with diabetes
mellitus.
 Question
•A 48-year-old man visits his health care
provider for his annual checkup. He is otherwise
in good health, but assessment findings reveal
the new onset of a slight increase in blood
pressure and a total serum cholesterol of 240
mg/dL. What can the nurse anticipate as the
preferred treatment for this patient?

• A. a low-lipid diet and an exercise program

• B. a low-lipid diet and a cholesterol synthesis
inhibitor
• C. an exercise program and a fibrate
• D. a low-lipid diet, an exercise program, and
niacin
Matching

A. Works in the brush border of the

____ HMG-COA Reductase small intestine preventing
absorption of dietary cholesterol
Inhibitors(Statins)
____ Bile Acid Sequestrants B. Blocks the HMG-CoA enzyme

____ Fibrates C. increasing absorption of cholesterol

for the liver to increase bile production,
____ Cholesterol Absorption resulting in decreasing serum levels of
Inhibitor cholesterol

D. decrease hepatic production of

triglycerides
Review Time 
• What is the desirable total cholesterol level for
adults
• What is the desirable LDL level for adults
• What is the desirable HDL level for adults
• What is the desirable Triglyceride level for adults
• What is the most powerful drug used to reduce
LDL, with minimal effect on HDL and triglycerides
• What drug reduces LDL with little to no effect on
HDL
• What is the most effective drug to use to
decrease triglyceride levels
• What drug works in the small intestine to reduce
absorption of cholesterol and decrease intestinal
cholesterol to liver
The End!