m It lowers the abnormal lipid levels.

m Lipids composed of cholesterol, triglycerides,

and phospholipids are transported in the body
and are bound to protein in various amounts.
m These w

  are classified as

w  
w  
w

 
(VLDL), w  
w

  (LDL), and
   
w

  (HDL).
m The HDL (friendly or ´goodµ lipoproteins) have
a higher percentage of protein and less lipids.
Their function is to remove cholesterol from the
bloodstream and deliver it to the liver.
m The other three lipoproteins are
composed mainly of cholesterol and
triglycerides and contribute to
atherosclerotic plaque in the blood
vessels. They are ´badµ lipoproteins.
m When cholesterol, triglycerides, and LDL
are elevated, the client is at risk for
coronary artery disease (CAD).
 efore antilipidemics are prescribed, nondrug
therapy should be initiated for decreasing blood
pressure. The saturated fats and cholesterol in the
diet should be reduced. Total fat intake should be
300 mg or less. The client should read labels on
containers and buy appropriate foods. Clients
should choose lean meats, especially chicken and
fish.
ut in many cases, diet alone will not lower blood
lipid levels. ecause 75% to 85% of serum
cholesterol is endogenously (internally) derived,
dietary modification alone will typically lower total
cholesterol levels by only 10% to 30%. This, and the
fact that adherence to dietary restrictions is often
short lived, explains why many clients do not
respond to diet modification alone.
½xercise is an important aspect of the
nonpharmacologic method to reduce
cholesterol. For the hypertensive older
adult, exercise can be walking and
bicycling. If the client is obese, body-
weight reduction decreases cholesterol
levels and he risk of CAD. Smoking is
another risk factor that should be
eliminated. Smoking increases LDL
cholesterol and decreases the HDL.
If nonpharmacologic methods are
ineffective for reducing cholesterol and
the lipoproteins LDL, and VLDL, and


w
  remains, antilipidemic
drugs are prescribed.
It must be emphasized to the client that
dietary changes need to be made and
an exercise program followed even after
drug therapy has been initiated.
Drugs that lower lipid levels include:
G IL½- ACID S½
½STRANTS
G FIRAT½S (FIRIC ACID)
G NICOTINIC ACID
G H½ATIC 3-HYDROXY-3 THYGL
TARYL
CO½NZYM½ A (HMG-CoA) R½D
CTAS½
INHIITORS (STATINS).
m Cholestyramine resin ( uestran)

m Colestipol HCl (Colestid)

m Colesevelem (Welchol)
0 One of the first antilipidemics introduced in
1959.
0 It is a resin that binds with bile acids in the
intestine and is effective against
hyperlipidemia type II. The drug comes in a
gritty powder, which is mixed thoroughly in
water or juice.
0 Route and dosage: (adult) O, ² 4 g t.i.d.
before meals, and at bedtime; mix powder
in 120- 240 ml of fluid; maximum: 24 g/day.
0
ses and considerations:
- for type II hyperlipoproteinemia (LDL).
Decrease in LDL is apparent in 1 wk. Drug
powder should be mixed well in fluid. It
does not have any effecton VLDL and HDL
but could increase triglyceride levels. GI
upset and constipation can occur. Vitamin
A, D, K deficiency may occur because of
decreased GI absorption.
A regnancy category: c
A rotein binding: unknown
A Half ² life: unknown
0 Side effects and adverse reactions
- constipation and eptic ulcer. ½arly
signs of peptic ulcer are nausea, and
abdominal discomfort, followed later by
abdominal pain and distention.
0 Constipation can be decreased or
alleviated by increasing intake of fluid and
foods high in fiber.
0 To avoid GI discomfort, the drug must be
taken with and followed by sufficient fluids.
0 For self- administration
- instruct client to mix the powder well in
water or juice.
0
sually same with questrans.
0 Route and dosage: (adult) O, -3 tablets (625
mg/ tab) b.i.d. or 6 tabs, daily.
0
ses and contraindications:
it has a cholesterol- lowering effect by
binding with bile acid salts in the intestines to
form an insoluble complex with fecal
excretions, thus reducing circulating
cholesterol including LDL. Triglycerides might
be slightly increased.
0 Contraindicated with bowel obstruction.
0 May be used in combination with other statin
drugs.
0 regnancy category: 
0 Is a resin antilipidemic similar to cholestyramine.
oth are effective in lowering cholesterol.
0 ile- acid sequestrants should not be used as
the only drug therapy in clients with elevated
triglycerides because they typically raise
triglyceride levels.
0 Route and dosage: (adult) O, 10 ² 30 g/ day
in divided doses before meals.
0
sed to reduce cholesterol and LDL levels.
Contraindications are same with
cholestyramine.
0 regnancy category: C
0 Advice client that constipation may
occur with cholestyramine and
colestipol. Increasing fluid intake and
foodbulk should help to alleviate the
problem.
G Clofibrate
(Atromid ² S)
G Gemfibrozil (Lopid)
0 oth are fibric derivatives that are effective in
reducing triglycerides and VLDL levels. They are
used primarily to reduce hyperlipidemia type IV
but can also be used for type II hyperlipidemia.
0 These drugs are highly protein boundand should
not be taken with anticoagulants because they
compete for protein sites.
0 The anticoagulant dose should be reduced during
antilipidemic therapy.
0 Clofibrate, once a popular antilipidemic, is not
suggested for long- term use because of its many
side effects such as cardiac dysrhythmias, angina,
thromboembolism, and gallstones.
m robucol, a biphenol, is poorly absorbed
after oral dosage. It lowers the LDL and
cholesterol levels in type II
hyperlipidemia, but it is not as effective
as other antilipidemic drugs. It is highly
lipid soluble and is stored in body fat;
thus it is slow to eliminate from the body.
Diarrhea may result from use. robucol is
contraindicated for clients with cardiac
dysrhythmias.
Nursing Interventions
m Advise client taking clofibrate and probucol
that decreased libido and impotence may
occur and should be reported. Drug
dosage can be change or another
antilipidemic may be ordered.
m Instruct clients with diabetes or those at risk
for developing diabetes to monitor blood
glucose levels if they take gemfibrozil.
Dietary changes or insulin adjustment may
be necessary.
m Advise client with cardiac dysrhythmias to
tell the health care provider before starting
probucol. Cardiac dysrhythmias should be
monitored and reported.
m Also known as vitamin 2, reduces VLDL
and LDL. Nicotinic acid is effect on the
lipid profile is highly desirable. ecause it
has numerous side effects and large
doses are required, as few as 20% of
clients can tolerate niacin initially.
However, with proper client counseling,
careful drug titration, and concomitant
use of aspirin, this number can be
increased to as high as 60% to 70% .
m Route and dosage: (adult)
O: initially: 100 mg t.i.d.; maintenance: 1-3
g/d after meals in 3 divided doses, max: 6 g/d.
m
ses and considerations: for VLDL and LDL:
types II, III, IV, V hyperlipidemia. Doses are 100
times higher than for RDA (recommended daily
allowance) to lower VLDL.
m regnancy category: C
m : uk; half-life: 45 mins
m Side effects: GI disturbances, flushing of the
skin, abnormal liver function ( elevated serum
liver enzymes), hyperglycemia, hyperuricemia.
m However, aspirin and careful drug titration can
reduce side effects to a manageable level in
most clients.
Nursing Interventions:
m Instruct client to take the drug with meals
to decrease GI discomfort.
G Atorvastatin Calcium (Lipitor)
G Fluvastatin Sodium ( Lescol)
G Lovastatin (Mevacor)
G ravastatin Sodium( ravachol)
G Rosuvastatin Calcium ( Crestor)
G Simvastatin ( Zocor)
The statin drugs, first introduced in 1987, inhibit
the enzyme HMG CoA reductase in
cholesterol biosynthesis; thus the statins are
called HMG CoA Reductase Inhibitors. y
inhibiting cholesterol synthesis in the liver,
this group of antilipidemics decreases the
LDL and slightly increases the HDL
cholesterol. Reduction of LDL cholesterol
may be seen in as early as 2 wks. The statin
group has been useful in decreasing CAD
and reducing mortality rates.
m
ses: to decrease cholesterol levels and to
decrease serum lipids especially LDL, and
triglycerides.
m Mode of Action: inhibits HMG-CoA
reductase. HMG-CoA Reductase is
necessary for hepatic production of
cholesterol.
m Dosage:
adult: O: 10 mg/daily, may increase dose
up to 80 mg/ daily
children: safety is not established
Contraindications
0 Active Liver disease and pregnancy
Caution: history of liver disease, increase
alcohol ingestion, trauma, severe
metabolic endocrine disorders,
uncontrolled seizures.
0 Side effects include headache, rash/
pruritus, constipation/ diarrhea, sinusitis,
pharyngitis (RAR½).
0 Adverse reactions: rhabdomyolysis,
myalgia, photosensitivity, cataracts.
harmacokinetics
Absorption: rapid
Distribution: protein binding: 98%
Metabolism: half life: 14 h, metabolites:20-30 h
½xcretion: primarily in the bile; some via urine

harmacodynamics
O: Onset: 2 wks for decrease in cholesterol
peak: 1-2 hrs; 2-4 wks to be effective
duration: 24 hrs
m
ses and considerations: treatments of
types IIA and II hyperlipidemia, total
cholesterol, and elevated triglycerides.
HDL is slightly increased. Monitor liver
function (liver enzymes).
m regnancy category: X; half life: 1.2 h;
: 98%
m Route and dosage: A: O: initially: 20-40
mg at bedtime; maintenance: 20-
80mg/d.
m Was the first statin used to decrase
cholesterol. It is effective in lowering LDL
(type II) with in several weeks.
m GI disturbances, headaches, muscle
cramps,and tiredness are early
complaints.
m Serum liver enzymes should be
monitored, and an annual eye
examination is needed because
cataract formation may result from
lovastatin therapy.
m Route and dosage: AD
LT:O: initially: 5-
10 mg/d in evening; maintenance: 20-80
mg/d in evening; max: 80 mg/d
m
ses and considerations
monitor liver enzymes.
m regnancy category: X
m : 95%
m Half life: unknown
m ½xplain to client that the serum liver enzyme
levels are periodically monitored.
m ½ncourage client to report promptly any
unexplained muscle tenderness or
weakness that may be caused by
rhabdomyolysis.
m Instruct client not to abruptly stop the statin
drug because a seriuos rebound effect
mightt occur and that could lead to an AMI
and possible death. efore stopping a
statin, client should talk to his or her health
care provider.
m Route and dosage: adult:O: 10 mg
daily
m
ses and considerations: it inhibits
cholesterol absorption in the small
intestine. Also, it reduces the total
cholesterol, LDL, triglycerides, and
increases HDL. Caution use should be
with liver dysfunction and serum
transaminase levels.
m regnancy category: C
´ No matter what people say
against you doesn·t really matter,
it only does when you listen to
what they say«.µ

Thank you!!!!!!!!!!!!