McKenna's Pharmacology for Nursing, 2e

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Lipid-lowering agents

Learning objectives Upon completion of this chapter, you should be able to: 1. Outline the mechanisms of fat metabolism in the body and discuss the role of hyperlipidaemia as a risk factor for coronary artery disease. 2. Describe the therapeutic actions, indications, pharmacokinetics, contraindications and cautions, most common adverse reactions and important drug–drug interactions associated with the bile acid sequestrants, HMG-CoA inhibitors, cholesterol absorption inhibitors and other agents used to lower lipid levels. 3. Discuss the use of drugs that lower lipid levels across the lifespan. 4. Compare and contrast the prototype drugs cholestyramine, atorvastatin and ezetimibe with various other agents used to lower lipid levels. 5. Outline the care considerations, including important teaching points, for people receiving drugs used to lower lipid levels.

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Glossary of key terms antihyperlipidaemic agents: general term used for drugs used to lower lipid levels in the blood bile acids: cholesterol-containing acids found in the bile that act like detergents to break up fats in the small intestine cholesterol: necessary component of human cells that is produced and processed in the liver, then stored in the bile until stimulus causes the gallbladder to contract and send the bile into the duodenum via the common bile duct; a fat that is essential for the formation of steroid hormones and cell membranes; it is produced in cells and taken in by dietary sources chylomicron: carrier for lipids in the bloodstream, consisting of proteins, lipids, cholesterol, and so forth endocannabinoids: endogenous substances that activate nervous system receptors that are important in the regulation of appetite, food intake and metabolism high-density lipoprotein (HDL): loosely packed chylomicron containing fats, able to absorb fats and fat remnants in the periphery; thought to have a protective effect, decreasing the development of coronary artery disease hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase: enzyme that regulates the last step in cellular cholesterol synthesis hyperlipidaemia: increased levels of lipids in the serum, associated with increased risk of coronary artery disease development low-density lipoprotein (LDL): tightly packed fats that are thought to contribute to the development of coronary artery disease when remnants left over from the LDL are processed in the arterial lining metabolic syndrome: a collection of factors, including insulin resistance, abdominal obesity, low high-density lipoprotein and high triglyceride levels, hypertension and proinflammatory and prothrombotic states that increase the incidence of coronary artery disease risk factors: factors that have been identified as increasing the risk of the development of a disease; for coronary artery disease, risk factors include genetic predisposition, gender, age, high-fat diet, sedentary lifestyle, gout, hypertension, diabetes and oestrogen deficiency

LIPID-LOWERING AGENTS Bile acid sequestrants cholestyramine colestipol

OTHER LIPID-LOWERING AGENTS Fibrates

HMG-CoA reductase inhibitors atorvastatin

Cholesterol absorption inhibitor ezetimibe

fluvastatin pravastatin rosuvastatin simvastatin

fenofibrate gemfibrozil Vitamin B nicotinic acid