McKenna's Pharmacology for Nursing, 2e

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P A R T 8  Drugs acting on the cardiovascular system

Adverse effects The most common adverse effects associated with eze- timibe are mild abdominal pain and diarrhoea. It is not associated with the bloating and flatulence that occurs with the bile acid sequestrants and another class of lipid-lowering drugs called fibrates. Other adverse effects that have been reported include headache, dizzi­ ness, fatigue, upper respiratory tract infection (URI), back pain and muscle aches and pains. Clinically important drug–drug interactions The risk of elevated serum levels of ezetimibe increases if it is given with cholestyramine, fenofibrate, gemfibrozil or antacids. If these drugs are used in combination, eze- timibe should be taken at least 2 hours before or 4 hours after the other drugs. The risk of toxicity also increases if ezetimibe is combined with cyclosporin. If this combination cannot be avoided, the person should be monitored very closely. If ezetimibe is combined with any fibrate, the risk of cholethiasis increases. The person should be monitored closely. Warfarin levels increase in a person who is also taking ezetimibe; if this combination is used, the person should be monitored very closely. Prototype summary: Ezetimibe Indications: Adjunct to diet and exercise to lower serum cholesterol levels; in combination with atorvastatin or simvastatin for the treatment of homozygous familial hypercholesterolaemia; with diet for the treatment of homozygous sitosterolaemia to lower sitosterol and campesterol levels. Actions: Works in the brush border of the small intestine to inhibit the absorption of cholesterol. Pharmacokinetics: Route Onset Peak Oral Moderate 4–12 hours T 1/2 : 22 hours; metabolised in the liver and small intestine and excreted in faeces and urine. Adverse effects: Headache, dizziness, abdominal pain, diarrhoea, URI, back pain, myalgia, arthralgia.

hypersensitivity reactions ; liver dysfunction or advanced age because the processing of the drug may differ from the norm ; current status of pregnancy or breastfeeding because the possible effects on the fetus or neonate are not know n. ■ ■ Perform a physical assessment to establish a baseline before beginning therapy and during therapy to determine its effectiveness and evaluate for any potential adverse effects. ■ ■ Monitor orientation and reflexes to detect changes in CNS function, such as dizziness, that could require safety measures. ■ ■ Monitor respirations and auscultate lungs for evidence of adventitious sounds to monitor changes in cardiac output. ■ ■ Inspect the abdomen for distension and auscultate bowel sounds for changes in gastrointestinal motility. ■ ■ Assess bowel elimination patterns, including frequency of stool passage and stool characteristics, to identify possible changes that could require intervention. ■ ■ Monitor the results of laboratory tests, including serum cholesterol and lipid levels, to evaluate the effectiveness of drug therapy , and liver function studies to monitor for toxic effects. ■ ■ Monitor serum cholesterol, triglyceride and LDL levels before and periodically during therapy to evaluate the effectiveness of this drug. ■ ■ Monitor liver function tests before and periodically during therapy to detect possible liver damage. ■ ■ Ensure that the person has attempted a cholesterol- lowering diet and exercise program for at least several months before beginning therapy to ensure the need for drug therapy. ■ ■ Encourage the person to make the lifestyle changes necessary to decrease the risk of CAD and to increase the effectiveness of drug therapy. ■ ■ Suggest the use of barrier contraceptives for women of childbearing age if the drug is being used in combination with a statin because there is a risk of severe fetal abnormalities if these drugs are taken during pregnancy. ■ ■ Provide comfort measures to help the person tolerate drug effects. These include readily available access to bathroom facilities to help with episodes of diarrhoea ; safety precautions to protect the individual if dizziness is an issue ; and analgesics for headache and muscle aches if appropriate. ■ ■ Offer support and encouragement to help the person deal with the diagnosis, needed lifestyle changes and the drug regimen. Implementation with rationale

Care for people receiving cholesterol absorption inhibitors

Assessment: History and examination

■ ■ Assess for contraindications or cautions: any known allergies to any component of the drug to avoid