Drugs for Midterm 2

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Chapters 32, 38, 39, 41
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Laboratory Standard for Serum Cholesterol

Less than 200 mg/dL


Laboratory Standard for Low-Density Lipoprotein (LDL)

Less than 100 mg/dL


Laboratory Standard for Low-Density Lipoprotein (LDL) for person with previous MI.

Less than 75 mg/dL, or as low as possible.


Laboratory Standard for High-Density Lipoprotein (HDL)

Moderate Risk: at least 35-45 mg/dL

Desirable: greater than 60 mg/dL


Lipid-Lowering Drugs' MoA: Statins

Interferes with HMG-CoA reductase, the critical enzyme in the biosynthesis of cholesterol.


Lipid-Lowering Drugs' MoA: Ezetimibe

Blocks absorption of cholesterol in the small intestine.


Lipid-Lowering Drugs' MoA: Bile Acid Resins

Binds bile acids, thus increasing the excretion of cholesterol in the stool.


Lipid-Lowering Drugs' MoA: Niacin

Decreases both VLDL and LDL levels.


Prototype: Atrovastatin (Lipitor) - Basic info.

  • T classification: Anti-hyperlipidemic
  • P classification: HMG-CoA reductase inhibitor
  • MoA:
    • Inhibits HMG-CoA reductase
    • Liver makes less cholesterol, making instead more LDL receptors to remove it from the bloodstream.

Prototype: Atrovastatin (Lipitor) - Precautions & S/E

  • Precautions: Hepatic impairment
  • D2D interactions:
    • increases digoxin levels
    • increases levels of oral contraceptives
    • increases Erythomycin levels
    • increases risk of rhabdomyolysis
    • grapefruit inhibits metabolism of statins
  • S/E: intestinal cramping, diarrhea, or constipation

Prototype: Atrovastatin (Lipitor) - Nx Responsibilities & Pt. Teaching

  • Nx Responsibilities:
    • Obtain lipid value baseline
    • Monitor LDL levels q3months initially and then q6months
      • At initiation of therapy or dosage change: assess lipid lab test w/in 2-4 wks
  • Pt. Teaching:
    • Take drug in the evening w/a meal.
    • Avoid grapefruit products.

Prototype: Cholestyramine (Questran) - Basic info.

  • T classification: Anti-hyperlipidemic
  • P classification: Bile Acid sequestrant
  • MoA:
    • Goes into GI tract and binds to dietary cholesterol.
    • Binds cholesterol to bile acids, forming an insoluble complex that's excreted in feces.
    • Increases LDL receptors on hepatocytes, decreasing LDL levels.

Prototype: Cholestyramine (Questran) - Precautions & S/E

  • Contraindications:
    • Serum triglycerides greater than 400 mg/dL
    • Complete biliary obstruction
  • D2D interactions:
    • decreases effects of digoxin, penicillins, iron supplements, thyroid hormones, and thiazide diuretics
    • increases effects of warfarin
  • S/E:
    • Constipation, bloating, nausea, other GI related problems
  • Severe S/E:
    • Obstruction of GI tract
      • due to too much insoluble complex (cholesterol), plugging it up

Prototype: Cholestyramine (Questran) - Nx Responsibilities & Pt. Teaching

  • Nx Responsibilities:
    • Consult prescriber if supplemental vitamins A & D, folic acid for long-term care
  • Pt. Teaching:
    • Increase intake of oral fluids and fiber

Prototype: Niacin (Nicotinic Acid )

  • aka, B-complex vitamin (B3)
  • used to increase HDL levels
  • produces more s/e than statins
  • instruct pt. not to self-medicate
  • S/E: flushing sensation
    • instruct pt. to take an aspirin 30-45 prior to medication to reduce flushing

Prototype: Gemfibrozil (Lopid ) - Basic Info.

  • T classification: Anti-hyperlipidemic
  • P classification: Fibric acid agent (Fibrate)
  • MoA:
    • Unknown
    • Inhibits the breakdown of stored fat
  • Indication: Hypertriglyceridemia

Prototype: Gemfibrozil (Lopid ) - Precautions & S/E

  • Contraindications:
    • Gallbladder disease, serious liver impairment
  • D2D interactions:
    • increased risk of myositis and rhabdomyolysis with some statins
    • bleeding w/anticoagulants
    • enhanced hypoglycemic effects w/anti-diabetic agents
  • S/E:
    • Abdominal cramping, diarrhea, nausea, dyspepsia (indigestion), headache, dizziness, peripheral neuropathy, decreased libido

Prototype: Gemfibrozil (Lopid ) - Nx Responsibilities & Pt. Teaching

  • Nx Responsibilities:
    • Consult prescriber if inadequate response after 3 months
  • Pt. Teaching:
    • Low-cholesterol diet
    • Monitor blood glucose levels if diabetic

Prototype: Ezetimibe (Zetia)

  • only drug in the new class of cholesterol absorption inhibitors
  • MoA:
    • blocks absorption of cholesterol in intestinal lumen
    • forms thin coating inside intestine to prevent absorption
      • note: doesn't work well, expensive and must administer statin concurrently
    • body responds by making more cholesterol receptors

MoA of Beta-Adrenergic Antagonists to treat Angina

  • Prevents episodes
  • lowers HR & contractility
  • lowers CO & workload

MoA of Ca2+ Channel Blockers to treat Angina

  • Taken if B-blockers aren't well tolerated
  • dilates arterial smooth muscle
  • lowers BP & workload

MoA of Organic Nitrates to treat Angina

  • Terminates episode
  • Dilates veins, reducing amount of blood returning to heart = reduces preload
  • Dilates the coronary arteries, bringing more blood to myocardium = increases blood flow

Long-Acting Organic Nitrates

  • Prevents angina attacks
  • Topical paste

Short-Acting Organic Nitrates

  • Stops angina attacks
  • Emergency-use = sublingual tablets

Common S/E of Organic Nitrates

  • Hypotension (overdose)
  • Headache (bc blood vessels dilate, pressing on nerves)