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ANTILIPEMIC DRUGS (Function (Used for patients with elavated blood lipids…

- - - - Mechanisim of Action
        Inhibits hydroxmethylglutary_COA(HMG CoA)reductase,the enzyme that catalyes the early step in cholesterol snthesis.
      - Indication
        Adjunct to diet therapy to reduce elevated total cholesterol(Tc).
        2.Low density lipoprotein (LDC),apo-protein B,
        and trigyceride and increase high density lipo-protein.
        3.In primary hypercholesterolemia and mixed dyslipidemia reduce elevated TC,ldl,apoB in children 10-16yrs with heterozygous familia hypercholesterolemia sterolemia.
        4.reduce need for revascularization procedures in patients with coronary artery disease CAD slow progression of atheroslerosis in patients with CAd
      - Contra_indications
        1.active hepatic disease
        2.breast feeding
        3.pregnancy
        4.unexplained increased serum transaminase
        CAUTION
        Hepac impairment
        Concurrent use with colchine
        Gemfibrozic
        Fabric acid derivatives or niacin.
        Those at risk for rhabdomyolysis
        Heavy alcohol consumption
        Elderly
      - Route
        PO:adults ,Elderly, patients requiring 25%or less decrease in LDL
      - Side effects (frequent)8%-5%
        Backpain,myalgia,arthralgia,diarrhea ,abdominal cramping,rhinitis
        (Occasionally)5%-2%
        Nausea, vomiting,insomia constipation,flatulence,rash,pruritus,fatigue,cough, dizziness.
- - - - Mechanism of action
        Binds with bile acids in intestine,forming insoluble
        Complex.
        Binding results in partial removal of bile acids from enter hepatic circulation.
        THERAPEUTIC Effect
        Removes LDL cholsterol from plasma.
      - Indications
        Adjunct to dietary therapy to decrease elevated serum cholesterol levels in patients with primary hypercholesterolemia.
        Relief of pruritus associated with elevated levels of bile acids.
      - Contra-indications:
        Complete biliary obstruction,hypersensitivity to cholestyramine,tartrazine(frequently seen in aspirin hypersensitivity)
        Cautions: GI dysfunction especially constipation.
        Recent abdominal surgery.
      - Side effects
        FREQUENT: constipation (may lead to fecal impaction)
        Nausea
        Vomiting
        Abdominal pain
        Indigestion.
        OCCASIONAL: diarrhea,belching, bloating,headache,dizziness.
      - Route of administration
        PO:give other drugs at least 1hr before or 4-6hrs following chooestyramine.
        Do not give in dry form mix with 3-6 water,milk fruit juice,soup.
        Place powder on surface for 1-2 min,then mix thoroughly.
        Excessive foaming with carbolated beverages..
        Use extra large glass .
        Stir slowly.
        Administer with meals
      - Nursing consideration
        BASELINE ASSESSMENT
        Question for history of hypersensitivity to chooestyramine,tartrazine,aspirin.
        Obtain baseline serum cholesterol,trigylcerides ,electrolytes,hepatic enzyme levels.
- - - - Used to reduce high triglyceride levels &to a lesser extent high LDL levels
    - - Mechanism of action
        1.inhibits lipolysis of fat in adipose tissue.
        2.decreases hepatic uptake of free fatty acids(reduces hepatic trigyceride production).
        3.inhibits snthesis of VLDL carrier apolipoprotein B.
        THERAPEUTIC Effect:Lowers serum cholesterol,trygycerides
      - Indications
        Treatment of hypertryglyceridemia in types IV and V hyperlipidemia for pts who are at greater risk for pancreatitis and those who have not responded to dietary intervention.
        Reduce risk of coronary heart disease development in pts without symptoms who have decreased HDL,increased LDL,increased triglycerides
      - Contra -indications
        Hepatic dysfunction
        Pre existing gallbladder disease
        Severe renal dysfunction
        CAUTIONS :
        Concurrent use with statins ,mild to moderate renal impairment.
        Anticoagulant therapy.
      - Side effects
        Frequent 20%: dyspepsia
        Occasional 10%-2%:abdominal pain, diarrhea,nausea, vomiting, fatigue.
        RARE less than 2%: constipation,rash, pruritus, altered taste.
      - Route of administration
        PO
        Give 30 min before morning and evening meals.
      - Nursing consideration
        Base line assessment
        Obtain diet history, especially fat/alcohol consumption.
        Assess baseline lab results
        Serum glucose
        Triglyceride
        Cholesterol
        Hepatic function tests
        CBC