8LvlLWL8 lC8 PA8MA

ChapLer 22

1ypes of Llplds
- 1rlglycerldes (neuLral faLs) ma[or sLorage form of faL ln Lhe body and only Lype of llpld LhaL
serves as an lmporLanL energy source 90 of LoLal llplds ln Lhe body
- hosphollplds essenLlal Lo bulldlng plasma membranes (ex LeclLhln)
- SLerolds such as CPCLLS1L8CL bulldlng blocks of vlLamln u blle aclds corLlsol esLrogen and
LesLosLerone

LlpoproLelns LransporLs llplds ln Lhe body

1ypes of LlpoproLelns
- LowdenslLy llpoproLeln (LuL)/bad cholesLerol LransporLs cholesLerol from Lhe llver Lo Lhe
Llssues and organs CholesLerol ls Lhen sLored ln Llssues (lncludlng blood vessels) for laLer use
(normal values 100 opLlmal 100129 near or above opLlmal 130139 borderllne hlgh
160189 hlgh 190 very hlgh)
- very lowdenslLy llpoproLeln prlmary carrler of Lrlglycerldes ln Lhe body Can become LuL
(normal values 130 normal 130199 borderllne hlgh 200499 hlgh 300 very hlgh)
- PlghdenslLy llpoproLeln (PuL)/ good cholesLerol manufacLured ln Lhe llver and small lnLesLlnes
and asslsLs ln Lhe LransporL of cholesLerol away from Lhe body Llssues and back Lo Lhe llver
(normal value 40 low 60 hlgh)

u8uCS lC8 LlluS

3 hydroxy 3 methy|g|utary| coenzyme A (nMGCoA) reductase |nh|b|tors] Stat|ns
Clue ends wlLh S1A1ln
roLoLype drug aLorvasLaLln (LlplLor)
harmacoklneLlcs
CnseL 2 weeks
eak lasma concenLraLlon 12h
CholesLerol reducLlon 24 wk
Palfllfe 14 h
uuraLlon unknown

AnaLomy PMCCoA reducLase serves as Lhe prlmary regulaLory slLe for cholesLerol blosynLhesls lL ls
regulaLed by negaLlve feedback (hlgh levels of LuL wlll shuL down lLs producLlon)

AcLlon Lhe drug lnhlblLs Lhe PMCCoA reducLase whlch resulLs ln less cholesLerol blosynLhesls 1he llver
wlll respond by maklng more LuL recepLors leadlng Lo fasLer excreLlon of LuL
use 1o decrease cholesLerol (for hypercholesLerolemla) and LuL levels
Slde effecLs headache faLlgue muscle or [olnL paln and hearLburn Serlous slde effecL 8habdomyolysls
breakdown of muscle flbers usually due Lo muscle Lrauma or lschemla 1hls can lead Lo acuLe renal
fallure
urugLodrug lnLeracLlon Macrolldes AZCLL anLlfungals flbrlc acld agenLs and lmmunosuppressanL
lncrease chances of myopaLhy
nurses' responslblllLles
- MosL should be admlnlsLered ln Lhe evenlng (wlLh meals) cholesLerol blosynLhesls ls hlgher aL
nlghL (LxcepLlon aLorvasLaLln because of longhalf llfe)
- MonlLor Llpld proflle lnsLrucL paLlenL LhaL he/ she should be nC for aL leasL 810 hours prlor Lo
blood collecLlon
- MonlLor CreaLlnlne phosphoklnase lndlcaLor of rhabdomyolysls
- MonlLor Llver funcLlon LesL
- uo noL glve Lo pregnanL and breasLfeedlng woman pregnancy caLegory x
- ulscourage paLlenL from drlnklng alcohol
- Assess paLlenL for slde effecLs and lnsLrucL paLlenL Lo reporL Lhem

||e Ac|d kes|ns] Sequestrants

roLoLype drug CholesLyramlne (CuesLran) approved for use ln chlldren
Pow Lo prepare Mlx cholesLyramlne powder wlLh 60 Lo 180 mL of waLer non carbonaLed
beverages hlghly llquld soups or pulpy frulLs Lo prevenL esophageal lrrlLaLlon lace Lhe conLenLs of Lhe
packeL of resln on Lhe surface of fluld Allow lL Lo sLand wlLhouL sLlrrlng for 2 mlnuLes occaslonally
Lwlrllng Lhe glass and Lhen sLlr slowly Lo prevenL foamlng
harmacoklneLlcs
CnseL 2438 h
eak 13 wk
Palfllfe unknown
uuraLlon 24 wk

AcLlon 8lnds blle aclds whlch conLaln a hlgh concenLraLlon of cholesLerol maklng large molecules LhaL
cannoL be absorbed by Lhe small lnLesLlnes Lhus cholesLerol wlll be excreLed ln Lhe feces
use 1o decrease cholesLerol (for hypercholesLerolemla)

Slde LffecLs LlmlLed Lo Cl such as bloaLlng and consLlpaLlon
urugLodrug lnLeracLlon 8lnds wlLh dlgoxln warfarln penlclllln and oLhers (decrease absorpLlon of Lhe
drug)
nurses' responslblllLles
- Assess bowel sounds
- Cenerally are noL glven durlng pregnancy and lacLaLlon (pregnancy caLegory C)
- 1ake medlcaLlon before meals
- 1ake oLher medlcaLlon 1 hour before or 4 hours afLer Laklng blle acld reslns
- lncrease fluld lnLake and advlse hlghbulk dleL
- 1ake vlLamln supplemenLs Lo replace Lhose LhaL are noL absorbed ln Lhe dleL
- MonlLor paLlenL's llver funcLlon (AS1 AsparLaLe amlnoLransferase AL Amlno phosphaLlse)

-|cot|n|c Ac|d] n|ac|n] v|tam|n b comp|ex
(excepL nlcoLlnamlde Lhls brand has no llpldlowerlng effecLs)
uose as a vlLamln 2 mg/day
uose as an anLlllpldemlc 2 Lo 3 g/day

use Lo decrease level of vLuL whlch ln Lurn ls synLheslzed Lo LuL Lhus reduclng LuL levels
Lrlglycerldes and lncreaslng PuL levels

Slde effecLs flushlng hoL flashes nausea excess gas and dlarrhea Serlous slde effecLs hepaLoLoxlclLy
and gouL

nurses' responslblllLles
- 1ake nlacln wlLh or afLer meals Lo prevenL Cl lrrlLaLlon
- 1ake nlacln wlLh cold beverages warm beverages lncreases flushlng
- 1ake asplrln as prescrlbed 30 mlnuLes prlor Lo nlacln
- lnsLrucL paLlenL Lo lmmedlaLely reporL adverse effecLs

|br|c ac|d agents

roLoLype drug gemflbrozll (Lopld)
harmacoklneLlcs
CnseL 12h
eak 12h
Palfllfe 13 h
uuraLlon 24 mo
AcLlon unknown
use reduces vLuL and lncreases PuL
Slde effecLs abdomlnal paln nausea dlarrhea and vomlLlng
urugLodrug lnLeracLlon lf use wlLh sLaLlns may lncrease rlsk of myoslLls and rhabdomyolysls lf use
wlLh warfarln poLenLlaLe anLlcoagulaLlon

nurses' responslblllLles
- lmmedlaLely reporL slgn of bleedlng
- MonlLor proLhrombln Llme (normal 1116 seconds) and lnLernaLlonal normallzed raLlo
(normal0812) (lf uslng warfarln 23)
- Assess pL lor hlsLory of gallbladder dlsease
- AdmlnlsLer drug wlLh meals

CAkDICVASCULAk DkUGS

lAC1C8S 8LSCnSl8LL lC8 8
- Cardlac ouLpuL volume of blood pumped per mlnuLe (ml/mln)
- ls equal Lo PearL raLe (beaLs/mln) x sLroke volume (ml/beaL)
- SLroke volume Lhe amounL of blood pumped by a venLrlcle ln one conLracLlon
- AffecLed by 3 facLors preload afLerload and Lhe conLracLlllLy of Lhe hearL
- As preload lncreases sLroke volume also lncreases (SLarllng's law of Lhe hearL) As
afLerload lncreases sLroke volume decreases As conLracLlllLy lncreases sLroke volume
also lncreases and vlce versa
- erlpheral reslsLance frlcLlon LhaL reduces Lhe veloclLy of Lhe blood as lL flows Lhrough Lhe
vascular sysLem
- 1oLal blood volume approxlmaLely 3 L
8lnClLLS
- As Lhe hearL raLe/ sLroke volume lncreases cardlac ouLpuL also lncreases 1hus blood pressure
also lncreases As Lhe hearL raLe/ sLroke volume decreases cardlac ouLpuL also decreases 1hus
blood pressure also decreases
- As Lhe dlameLer of Lhe blood vessel lncreases (vasodllaLlon) Lhe perlpheral reslsLance
decreases 1hus blood pressure decreases As Lhe dlameLer of Lhe blood vessel decreases
(vasoconsLrlcLlon) Lhe perlpheral reslsLance lncreases 1hus blood pressure lncreases
- As Lhe blood volume lncreases Lhe blood pressure lncreases

P?SlCLCClCAL 8LCuLA1lCn Cl 8LCCu 8LSSu8L
- 8arorecepLors have Lhe ablllLy Lo sense pressure wlLhln Lhe blood vessels
- ChemorecepLors recognlze levels of oxygen and carbon dloxlde and Lhe pP ln Lhe blood

kAAS
decrease 8 sensed by Lhe barorecepLors/ decrease ln na+ sensed by Lhe chemorecepLors

!uxLaglomerular apparaLl wlll secreLe enzyme ren|n

Cnce ln Lhe blood ren|n wlll converL ang|otens|nogen a proLeln produce by Lhe llver Lo ang|otens|n I

When ang|otens|n I pass Lhe lungs lL wlll be converLed wlLh Lhe help of ang|otens|n convert|ng enzyme
(ACL) Lo ang|otens|n II

8ecepLor slLes for ang|otens|n II ls found



SmooLh muscles of Lhe adrenal corLex
8lood vessels

vasoconsLrlcLlon release of A|dosterone

lncreased 8 reabsorpLlon of na+
lncreaslng osmoLlc pressure
Lhus lncreaslng blood volume

lncreased 8

athophys|o|ogy of Cn

















MlLral sLenosls
lrequenL lnfecLlon ln Lhe upper alrway (Croup A beLa haemolyLlc sLrepLococcus)

Ascendlng lnfecLlon reaches Lhe mlLral valves uue Lo phagocyLosls Lhe lnflammaLory process leads Lo
Lhlckenlng of Lhe valvular Llssue causlng narrowlng of Lhe passageway of blood

8lood sLarLs Lo pool ln Lhe lefL aLrlum and lL backflow Lo Lhe pulmonary clrculaLlon More blood wlll
aggregaLe due Lo Lhe blood from Lhe rlghL slde of Lhe hearL

ulmonary congesLlon occurs (as manlfesLed by roducLlve cough uyspnea and crackles)

8lood wlll backflow Lo Lhe rlghL slde of Lhe hearL and ln Lurn Lo Lhe sysLemlc clrculaLlon (as manlfesLed
by [ugular neck veln dlsLenLlon hepaLomegaly asclLes spleenomegaly and edema ln Lhe lower
exLremlLles)

oLher causes such as dlabeLes hyperLenslon and oLhers

uecrease oxygenaLed blood flow Lrlggers a poslLlve feedback mechanlsm LhaL wlll Lrlgger Lhe hearL Lo
lncrease lLs hearL raLe

lncrease work load of Lhe hearL (leadlng Lo fallure)

ACL I-nII1CkS
Clue prll
AcLlon 8lock Lhe converslon of AngloLensln l Lo angloLensln ll Lhereby prevenLlng Lhe effecLs of
angloLensln ll

Ang|otens|n II keceptor |ockers] antagon|st
Clue SarLan
AcLlon 8lock angloLensln ll ln Lhe recepLor slLes (smooLh muscles of blood vessels and adrenal corLex)

uses
- hyperLenslon (lowerlng perlpheral reslsLance and decreaslng blood volume)
roLoLype drug Lnalaprll (vasoLec)
harmacoklneLlcs
CnseL 1 h C 13 mln lv
eak 48 h C 4 h lv
Palfllfe 2 h
uuraLlon12 24 h C 4 h lv

- CPl (reducLlon of blood volume and decrease perlpheral reslsLance leads Lo decrease of afLer
load whlch ln Lurn leads Lo lncrease cardlac ouLpuL ln Lurn Lhls wlll lead Lo decrease workload
of Lhe hearL
roLoLype drug Llslnoprll (rlnlvll)
harmacoklneLlcs
CnseL 1 h
eak 68 h
Palfllfe 12 h
uuraLlon 24 h
- Myocardlal lnfarcLlon (decrease workload of Lhe hearL
Slde effecLs reflex Lachycardla hypoLenslon dlzzlness headache dry cough angloedema leadlng Lo
laryngeal swelllng neuLropenla or agranulocyLosls Pyperkalemla
urugLodrug lnLeracLlon oLher hypoLenslve (poLenLlaLlon) poLasslum supplemenLs and poLasslum
sparlng dlureLlcs (hyperkalemla)

nurses' responslblllLles
- Assess/ monlLor vlLal slgns Pold drug lf 8 ls low
- AdmlnlsLer flrsL dose aL bedLlme Lo avold hypoLenslon aL nlghL Llme
- MonlLor C8C (W8C) and assess for slgns of lnfecLlon
- MonlLor for slgns of hearL aLLack (chesL paln shorLness of breaLh)
- Avold foods rlch ln poLasslum'
- uo noL use ln pregnanL and breasLfeedlng woman (regnancy caLegory u)

Adrenerg|c drugs
AnaLomy
- CenLral nervous sysLem
- 8raln
- Splnal Cord
- erlpheral nervous sysLem
- Sensory
-SlghL
-Smell
-Pearlng
-1asLe
-1ouch
- MoLor
-SomaLlc/ volunLary
-AuLonomlc/ lnvolunLary
- SympaLheLlc/ flghL or fllghL
- arasympaLheLlc/ resL or relaxaLlon

SnS nS
neuroLransmlLLer Lplnephrlne/
noreplnephrlne
AceLylchollne
Lyes/ puplls dllaLes ConsLrlcL
Sallvary glands lnhlblL SLlmulaLe
PearL raLe lncrease raLe
and conLracLlons
uecrease raLe
and conLracLlons
8roncl/
bronchloles
dllaLe consLrlcL
Cl/Cu lnhlblL (buL SLlmulaLe
lncrease glucose
release ln Lhe
llver)

8ecepLor slLes
Alpha 1 all sympaLheLlc LargeL organs excepL Lhe hearL consLrlcLlon of blood vessel dllaLlon of puplls
Alpha 2 presynapLlc adrenerglc nerve Lermlnals lnhlblLlon of Lhe release of noreplnephrlne
8eLa 1 hearL and kldneys lncreased hearL raLe and conLracLon release of renln
8eLa 2 all sympaLheLlc LargeL organs excepL Lhe hearL lnhlblLlon of smooLh muscle

eta 1 adrenerg|c receptor b|ockers
Clue olol
AcLlon block noreplnephrlne ln Lhe recepLor slLes leadlng Lo decrease hearL conLracLlllLy () lnoLroplc
decrease conducLlvlLy () dromoLroplc and decrease hearL raLe () chronoLroplc

uses
- PyperLenslon
- CPl
roLoLype drug MeLropolol (Lopressor)
harmacoklneLlcs
CnseL 1013 mlns unknown lf susLalned release
eak 134 h 612 h lf susLalned release
Palfllfe 34 h
uuraLlon6h 24 h lf susLalned release
- Anglna
roLoLype drug ALenolol (1enormln)
harmacoklneLlcs
CnseL 1h
eak 24h
Palfllfe 14mln
uuraLlon 24 h
- uysrhyLmlas
roLoLype drug ropanolol (lnderal)
harmacoklneLlcs
CnseL 03 1 h
eak 12 h (6 h exLended release)
Palfllfe 33 h
uuraLlon612h 24 h lf exLended release



A|pha 1 adrenerg|c receptor b|ockers
Clue osln
AcLlon block noreplnephrlne ln Lhe recepLor slLes (arLerloles) leadlng Lo vasodllaLlon
uses
- PyperLenslon (wlLh oLher hyperLenslves because Lhey are noL flrsL llne anLlhyperLenslves)
roLoLype drug uoxazosln (Cardura)
harmacoklneLlcs
CnseL 2h
eak 26h
Palfllfe 912h
uuraLlon 24 h

A|pha 2 adrenerg|c agon|st
roLoLype Clonldlne (CALapres)
AcLlon sLlmulaLes presynapLlc adrenerglc nerve Lermlnals Lhereby lnhlblLlng release of noreplnephrlne
use hyperLenslon

Slde effecL bradycardla bronchoconsLrlcLlon hypoLenslon (orLhosLaLlc)dlzzlness headache
hypoglycaemla
urugLodrug lnLeracLlon use cauLlously wlLh oLher () lnoLroplc agenLs anLlhyperLenslve and oral
hypoglycaemlc agenLs and lnsulln (poLenLlaLlon)
nurses' responslblllLles
- use cauLlously wlLh breasLfeedlng woman because drug ls dlsLrlbuLed ln Lhe breasLmllk
(regnancy CaLegory C)
- Assess vlLal slgns uo noL glve lf 8 ls less Lhan 90/60 and lf aplcal pulse raLe ls less Lhan 60 bpm
- Assess for presence of asLhma and CCu (drug ls conLralndlcaLed)
- Assess urlne ouLpuL
- Assess for decrease llbldo and lmpoLence (prlaplsm palnful penlle erecLlon)
- Assess for slde effecLs

Ca|c|um Channe| |ockers
Clue plne( speclally selecLlve non selecLlve someLlmes does noL end wlLh plne)

AnaLomy
Changes ln Lhe permeablllLy of Lhe elecLrolyLe channels (plasma membrane) resulLs ln formaLlon of
elecLrlcal lmpulses When calclum enLers Lhe cell Lhrough channels ln Lhe plasma membrane muscular
conLracLlon occurs

AcLlon SelecLlve CC8 blocks calclum channels ln Lhe arLerloles Lhereby llmlLlng muscular conLracLlon
whlch ln Lurn leads Lo relaxaLlon of Lhe arLerlal smooLh muscle
roLoLype nlfedlplne (rocardla)
harmacoklneLlcs
CnseL 1030 mln
eak 30 mln
Palfllfe 23 h
uuraLlon 48h (24 h exLended release)

nonselecLlve CC8 arLerloles and hearL (myocardlum)lnhlblLs Lhe LransporL of calclum ln
myocardlal cells Lhereby causlng decrease hearL conLracLlllLy () lnoLroplc decrease conducLlvlLy ()
dromoLroplc and decrease hearL raLe () chronoLroplc

uses
- PyperLenslon (decrease perlpheral reslsLance)
- Anglna (decrease workload of Lhe hearL
Slde effecLs selecLlve (especlally lf fasL acLlng) reflex Lachycardla hypoLenslon dlzzlness llghL
headedness
urugLodrug lnLeracLlon use cauLlously wlLh oLher () lnoLroplc agenLs and anLlhyperLenslve
(poLenLlaLlon)
nurses' responslblllLles
responslblllLles
- use cauLlously wlLh breasLfeedlng woman because drug ls dlsLrlbuLed ln Lhe breasLmllk
(regnancy CaLegory C)
- Assess vlLal slgns uo noL glve lf 8 ls less Lhan 90/60 and lf aplcal pulse raLe ls less Lhan 60 bpm
- 8eporL welghL loss or galn of 2 lbs and more ln 24 hours
- MonlLor for slgns of CPl edema crackles dob