Chapter 21
Agents Used in the
Treatment of
Hyperlipidemia
Hyperlipidemia

Fats in the blood




Chylomicrons
VLDL = very low-density lipoproteins
LDL = low-density lipoproteins
HDL = high-density lipoproteins
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Agents Used to Treat
Hyperlipidemia

Drugs used to lower lipid levels
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Hyperlipidemics


Prevent heart disease
According to Ignatavicius and Workman,
Medical-Surgical Nursing: Critical
Thinking for Collaborative Care, 2005,
the risk for coronary heart disease is
three times greater if the cholesterol level
is at or above 260 mg/dL compared to a
person with a level of 200 mg/dL or
lower.
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Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
Classification of Hyperlipidemics




Fibric acid derivatives
HMG-CoA reductase inhibitors
(HMGs or statins)
Niacin (nicotinic acid)
Bile acid sequestrants
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Fibric Acid Derivatives
Reduce the synthesis of triglycerides in
the liver



Decrease VLDL and LDL
Increase HDL
Side effects


Nausea, flatulence, bloating, diarrhea, and
liver changes
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Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
HMG-CoA Reductase Inhibitors
Inhibit HMG-CoA reductase



Enzyme used by the liver to produce
cholesterol
Lowers the rate of cholesterol production
Side effects




Liver changes
GI upset, constipation, or diarrhea
Atorvastatin is very effective.
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Vitamin B3 Niacin
Requires higher doses than when used
as a vitamin





Decreases triglycerides
Increases HDL
Effective and inexpensive
Often used in combination with other lipidlowering agents
Side effect


Hypotension from vasodilation
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Bile Acid Sequestrants
Bile acids are necessary for absorption
of cholesterol
Mechanism of action



Combine with bile acids


Form insoluble complex
Result
•
Prevent resorption of bile acids from small intestine
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Bile Acid Sequestrants:
Therapeutic Uses
Treatment of hyperlipidemia



Decrease the triglyceride levels
Increase HDL by as much as 25%
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Side Effects of Hyperlipidemics







Abdominal discomfort
Diarrhea or constipation
Nausea
Headache
Increased risk of gallstones
Prolonged prothrombin time
Liver studies: dysfunctional changes,
elevated enzymes
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Hyperlipidemics
All hyperlipidemic agents


Take several weeks to show effectiveness
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Nursing Implications
Contraindications



Biliary obstruction and active liver disease
Liver function studies
Long-term therapy



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Requires supplemental fat-soluble vitamins
(A, D, E, and K)
Take with meals to decrease GI upset.
(continues)
Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.
(continued)
Nursing Implications


Obtain a thorough health and medication
history
Assess dietary patterns, exercise level,
height and weight, vital signs, and family
history (genetics, and tobacco and
alcohol use)
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