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HYPERLIPIDEMIA (RISK FACTORS (Hypertension, Smoking (reduces HDL-C levels)…

- - - - Diet changes: low fat, low cholesterol
        
        Step 1: 30% of total calories per day should come from fats; less than 10% should come from saturated fats; increase fiber
        
        Step 2: 30% of total calories per day should come from fats; less than 7% should come from saturated fats; increase fiber
    - - Exercise: 30 minutes a day X 5 times a week
        
        Increases HDL levels
        
        helpful for collateral circulation
    - - If they cant quit encourage to reduce. (patches, lozenges, Albutrin, gum)
- - - - STATINS [HMG COA reductase inhibitors]
        
        side effects: GI symptoms-nausea, vomiting, constipation, diarrhea, abdominal pain
        
        appear to increase risk of diabetes
        
        reduce LDL, & Triglycerides; have no impact on HDL
        
        most not approved with children
        
        works on specific enzyme in the liver so less cholesterol is made
        
        not safe during pregnancy
        
        cant have with grapefruit or grapefruit juice
        
        serious side effects-TOXIC TO LIVER (hepatotoxicity): Look for JAUNDICE (eyes, skin) Labs: look at ALT, AST & bilirubin
        
        serious side effects: MYOPATHY-muscle pain; {do full musculoskeletal assessment} Stop the med; see if the pain improves
        
        Lipitor, Lescol, Mevacor, Zocar
    - - decrease production of cholesterol
      - increase HDL, decrease VDL, most effective in lowering triglycerides
      - gemfibrozil(Lopid), fenofibrate(Tricor) chlofibrate (Atromid-S)
      - check AST, ALT, bilirubin levels
      - safe for pregnancy
      - side effects: GI symptoms-nausea, vomiting, constipation, diarrhea, abdominal pain
      - Gallbladder disease should not use these
    - - attach to cholesterol in the intestine so they cant be absorbed & excreted in the feces
      - lower LDL, raise HDL
      - Used with STATINS
        
        cholestyramine (Questran) colestipol (Colestid) colesevelam (Welchol)
      - all in powder form and need to mixed with 6 oz of liquid (water or juice)
      - effect other meds; should not be taken within 2 hours of other meds
      - can be used in pregnancy
      - side effects: GI symptoms-nausea, vomiting, constipation, diarrhea, abdominal pain
      - changes characteristics of stool-more fat in feces will make it float
- - - - Greater than 240 high risk for adverse cardiovascular events (heart attack, stroke)
      - 201-239 borderline risk for adverse cardiovascular events
- - - - Bruits-turbulent, swooshing sound- auscultating pulses common in carotids, abdominal aortas
      - Problems with perfusion
        
        Intermittent claudication: pain in calf that worsens from standing/walking throughout the day. It improves with rest and in the morning.
      - Strong are easily palpated, weak are hard to palpate, absent are critical. Don't document absent if you cant feel it, doppler the pulse first[ X mark indicates where it can be found];
      - DONT CHECK CAROTID PULSES AT THE SAME TIME ;
      - Bounding pulse are visibly seen
    - - SKIN COLOR & TEMP
        
        Normal for ethnicity
    - - CAPILLARY REFILL
        
        Less than 3 seconds as soon as you let go; check under below finger nail for those with painted nails
    - - look for differences in MAPS (mean arterial pressures) to see if one side is getting more pressure
      - document site because pressures are different
      - check in both extremities
- - - - NIACIN (Vitamin B3)
        
        increased uric acid in blood (causes Gout)
        
        increased blood sugars
        
        can cause hepatotoxicity
        
        if they have itchy skin use antihistamine (diphenhydramine)
        
        recommend to take with meals or 325 mg of aspirin if safe
        
        side effects are dose dependent-the higher the dose the greater the side effect: Flushed skin
        
        water soluble; excreted out of the urine if there is too much (urine will be BRIGHT YELLOW)
        
        lowers LDL & triglycerides