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Hmg muztaba

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HMG COA REDUCTASE INHIBITOR

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Hmg muztaba

  1. 1. HMG-CoA Reductase Inhibitors Joanne Ong California State University, San Marcos School of Nursing Pharmacology and Pathophysiology NURS 312 Gary Veale, RN, MSN, Ed. July 16, 2015
  2. 2. HMG-CoA Reductase Inhibitors Prototype drug: Atorvastatin
  3. 3. Pharmacologic class: HMG-CoA reductase inhibitors Therapeutic class: Lipid-lowering agents/statin Pregnancy risk: Pregnancy Category X Contraindicated with pregnancy and lactation due to its potential for adverse reactions on the fetus or neonate
  4. 4. Examples include: Atorvastatin (Lipitor) (Prototype) Fluvastatin (Lescol) Lovastatin (Mevacor) Pitavastatin (Livalo) Pravastatin (Pravachol) Rosuvastatin (Crestor) Simvastatin (Zocor) HMG-CoA Reductase Inhibitors
  5. 5.  HMG-CoA reductase is an enzyme responsible for cholesterol synthesis. Inhibiting this enzyme will lower the levels of serum cholesterol and LDL levels, an important element of developing atherosclerosis, and slightly increase HDL levels, the “good cholesterol,” due to the fat metabolism shift (Karch, 2013, p. 788).  This drug class is typically used for treatment of hyperlipidemia/hypercholester olemia and to slow progression of CAD (Karch, 2013, p. 789)
  6. 6. According to the literature search of Thomas et al. (2010) in the PubMed database from January 1984-April 2009, they found that “from large, randomized, controlled trials show that statin therapy lowers both all-cause and coronary heart disease mortality and reduces myocardial infarction, stroke and the need for revascularization in individuals aged ≥65 years who have a history of coronary heart disease… there is substantial potential for statin treatment to provide benefits in this population.”
  7. 7. Statin, the drug of choice for lowering cholesterol levels… New guidelines on November 2013, jointly issued by the American College of Cardiology (ACC) and the American Heart Association (AHA) will greatly impact the treatment of hyperlipidemia…  25% increase of overall population that is treated with statins over the next 3 years, increasing from 3,909,407 (27.7%) patients to 4,892,668 (34.7%) patients (Tran et al., 2013).  Statins will be utilized as a primary prevention medication for patients aged 40 to 75 years who were not on any anti-cholesterol medications at baseline (Tran et al., 2013).  “…increase the overall number of statin prescriptions by 25% and will decrease the number of non-statin cholesterol-lowering medication prescriptions by 68% during the next 3 years” (Tran et al., 2013).
  8. 8. Pathophysiology Hyperlipidemia  lipids are cholesterol and triglycerides  elevated levels of serum cholesterol and triglycerides  increased level of the lipoprotein LDL (“bad cholesterol”) and low level of HDL (“good cholesterol”)  high lipids will increase risk of atherosclerosis and CAD Atherosclerosis  type of arteriosclerosis (hardening of arteries).  fatty, fibrous plaque formed in the lining of the arteries (aorta and its branches, coronary and cerebral) (Porth, 2011, p. 411)  leading cause of coronary artery disease, stroke and peripheral artery disease (Porth, 2011, p. 411)
  9. 9. Therapeutic Goals  Treatment for hyperlipidemia/hypercholesterolem ia/dyslipidemia  Increase HDL levels “the good cholesterol”  Help to slow progression of CAD  Prevent MI (in patients with CAD or high risk from developing CAD)  Reduction of the risk of undergoing revascularization procedures  Statins adjunct with proper diet (low-fat, low-cholesterol) and exercise (Karch, 2013, p. 786-789)
  10. 10. Adverse Effects Most common (GI): flatulence, abdominal pain, cramps, N/V, constipation (CNS): headache, dizziness, blurred vision, insomnia, fatigue, cataract development More serious: Rhabdomyolysis (rovustatin), increased liver enzymes and acute liver failure (atorvastatin and fluvastatin) Rhabdomyolysis
  11. 11. Nursing Management and Interventions  Monitor lipid blood level  Administer medication at bedtime (atorvastatin may be given anytime of the day)  Monitor LFTs (liver damage)  Lifestyle changes to decrease risk for CAD  Cholesterol lowering diet  Contraceptives for women of childbearing age (Pregnancy category X)  Monitor for side effects  Assess for compliance with treatment regimen (Karch, 2013, p. 791-792)
  12. 12. Lipid Blood Level Total cholesterol = Normal <200, Borderline High 200- 239, High ≥240 Low-density lipoprotein cholesterol (LDL) = Optimal <100, Normal 100-129, Borderline High 130-159, High 160-189, Very High ≥190 High-density lipoprotein cholesterol (HDL) “the good cholesterol” = Low <40, high ≥60 high level is good, low level is bad. Triglycerides = Normal <150, Borderline High 150- 199, High 200-499, Very High ≥500 (Karch, 2013, p. 782)
  13. 13. Drug-herbal interaction: St. John’s Wort may decrease levels and effectiveness of lovastatin and simvastatin (Deglin & Vallerand, 2009). Drug-food interaction: Large quantities of grapefruit juice increase blood levels and increase risk of rhabdomyolysis (Deglin & Vallerand, 2009). Hyperlipidemia: herbal therapy Garlic – decrease total cholesterol and triglyceride levels and to Increase HDL levels. Olive (oil and leaf) – when part of a diet high in monounsaturated fats, may lower cholesterol levels. Onion – used as raw herb for hypercholesterolemia (Springhouse, 2009)
  14. 14. Reference Deglin, J. H., & Vallerand, A. H. (2009). Davis's drug guide for nurses. Philadelphia, PA: F.A. Davis. Karch, A.M. (2013). Focus on nursing pharmacology. (6th ed.). Philadelphia: Lippincott, Williams & Wilkins. ISBN: 978-1-4511-2834-5 Porth, C.M. (2011). Essentials of Physiology (3rd ed.). Philadelphia: Lippincott, Williams & Wilkins. ISBN: 9781582557243 Springhouse (2009) Nursing Herbal Medicine Handbook (3rd ed.). Lippincott, Williams and Wilkins ISBN-13 9781582554174 Thomas, J. E., Tershakovec, A. M., Jones-Burton, C., Sayeed, R. A., & Foody, J. M. (2010). Lipid Lowering for Secondary Prevention of Cardiovascular Disease in Older Adults. Drugs & Aging, 27(12), 959-972. doi:10.2165/11539550-000000000-00000 Tran, J. N., Caglar, T., Stockl, K. M., Lew, H. C., Solow, B. K., & Chan, P. S. (2014). Impact of the New ACC/AHA Guidelines on the Treatment of High Blood Cholesterol in a Managed Care Setting. American Health & Drug Benefits, 7(8), 430-441.
  15. 15. Patient Handout https://magic.piktochart.com/output/7015033- untitled-infographic-conflict-copy-conflict-copy

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