Antilipemics

Question 1

Statin Use

Answer 1

• Primary therapy to lower LDLs and reduce cardiovascular risk

Question 2

Common Addon Therapies When LDLs Remain Above Target

Answer 2

• Ezetimibe
• PCSK9 Inhibitors

Question 3

Antilipemic Effects on Gut, Liver, Bloodstream

Answer 3

• Gut: Ezetimibe decreases lipid absorption
• Liver: Statins decrease cholesterol synthesis, PCSK9 Inhibitors increase hepatic clearance
• Bloodstream: Lower LDL lvls, decrease atherosclerotic cardiovascular disease risk

Question 4

Statin Mechanism of Action

Answer 4

• Inhibit cholesterol production in liver
• Increase LDL removal from the blood

Question 5

Statin Indications

Answer 5

• Hypercholesteremia
• Primary prevention of conditions caused by atherosclerosis

Question 6

Statin Contraindications

Answer 6

• Pregnancy
• Active liver disease
• Previous serious myopathy or rhabdomyolysis

Question 7

Statin Adverse Effects

Answer 7

• Common and usually mild: Headache, GI upset(nausea, diarrhea, constipation)
• Common but serious: Myopathy, significant liver enzyme elevation

Question 8

Statin Nursing Focus

Answer 8

• Assess for unexplained muscle pain or weakness, especially if accompanied by dark urine
• Reinforce reporting of new or worsening muscle pain

Question 9

Rosuvastatin Distribution

Answer 9

• Selective distribution to liver (site of cholesterol synthesis)
• Minimal penetration into peripheral tissues
• Lower risk of muscle toxicity than lipophilic statins
• Associated with lower rates of muscle pain

Question 10

Rosuvastatin Excretion

Answer 10

• Cleared mainly by liver
• Excreted unchanged into bile
• Very small amount of renal elimination

Question 11

Statin Drug Interactions

Answer 11

• Warfarin: Decreased warfarin metabolism, increased bleeding risk
• CYP3A4 Inhibitors: Decreased statin metabolism, increased risk of myopathy

Question 12

Statin Nursing Considerations

Answer 12

• Assess for muscle pain or weakness
• Avoid grapefruit juice and review other potential interactions
• Monitor LFT and CK trends

Question 13

Ezetimibe Mechanism of Action

Answer 13

• Inhibits cholesterol absorption at the brush border

Question 14

Ezetimibe Therapeutic Effects

Answer 14

• Decrease LDL cholesterol
• Minimal effect on triglycerides and HDL

Question 15

Ezetimibe Indications

Answer 15

• Dyslipidemia
• Used alone when statins are not tolerated
• Added to statin therapy when LDL targets are not achieved with a statin alone

Question 16

Ezetimibe Contraindications

Answer 16

• Active liver disease
• Pregnancy (limited safety data)

Question 17

Ezetimibe Adverse Effects

Answer 17

• GI upset
• Rare muscle-related symptoms (increased risk when combined with statins

Question 18

PCSK9 Inhibitor Mechanism of Action

Answer 18

• PCSK9 attaches to LDL receptors and causes them to break down, increasing blood LDL levels
• PCSK9 Inhibitors block PCSK9 in the blood

Question 19

PCSK9 Inhibitor Indications

Answer 19

• Treatment of dyslipidemia when other therapies are not sufficient

Question 20

PCSK9 Inhibitor Contraindications

Answer 20

Hx of hypersensitivity reaction

Question 21

PCSK9 Inhibitor Adverse Effects

Answer 21

• Muscle pain or weakness (rare)
• GI upset (mild)