Antilipemic+and+Diuretic+Agents

= __** A ** n ** ti ** l ** ip ** e ** mi ** c ** Dr ** u ** g ** s __& Di__u__retic __A__ge__n__ts

Cholestrol is a fat-soluble crystalline steroid widely distributed in the body, especially in the bile, blood, brain tissue, liver, kidneys, adrenal glands, and myelin sheaths of nerve fibers It is found in animal fats, oils, and egg yolk and is used to make steroid hormones, cell membranes, and bile acids
 * What is cholestrol?? **

﻿Very-low-density lipoprotein (VLDL)- produced by the liver and transports endogenous lipids to the cells High-density lipoprotein (HDL)- "GOOD cholestrol" responsible for "recycling" cholestrol
 * Different types of cholestrol **



Low-density lipoprotein (LDL)- "BAD cholestrol﻿"- binds to the vessels Total cholestrol <200 mg/dL Triglycerides <150 mg/dL LDL <130 mg/dL HDL >60 mg/dL
 * Healthy cholestrol level ranges **

** Are you at risk for high blood cholestrol?? **
 * Men 45+ Women 55+
 * Women with premature menopause not on estrogen replacement therapy
 * Family Hx: Premature CHD
 * Current cigarette smoker
 * Hypertensive
 * Low HDL ("good cholestrol") levels <35 mg/dL
 * Diabetes mellitus


 * <span style="color: #ff0000; font-family: Tahoma,Geneva,sans-serif; font-size: 200%;">Treatment **
 * <span style="color: #000000; font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">All **non-drug** treatments such as **exercise** and **diet** need to be tried for **6 months** <span style="color: #000000; font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">and __fail__ before drug therapy is considered.


 * <span style="color: #000000; font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">Antilipidemic drugs are used as adjunct therapy with diet therapy and the drug choice is based on the lipid profile of the patient.


 * <span style="color: #000000; font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">**Cholestrol medications** are administered at **night** because the liver and HMG-CoA is working its hardest at night

<span style="color: #000000; font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">- They work by inhibiting HMG-CoA reductase, which is used by the liver to produce cholestrol <span style="color: #000000; font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">- Side effects include upset GI, rash, headache, myopathy, elevation in liver enzymes <span style="color: #000000; font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">- Side effects include constipation, heartburn, belching, bloating <span style="color: #000000; font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">- High dosage required <span style="color: #000000; font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">- Side effects include flushing, pruritus, and GI distress <span style="color: #000000; font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">- Side effects include abdominal discomfort, diarrhea, nausea, blurred vision, etc.
 * <span style="color: #ff0000; font-family: Tahoma,Geneva,sans-serif; font-size: 200%;">Drugs **
 * <span style="color: #000000; font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">"Statin Sisters" (Atorvastatin, Rosuvastatin, Simvastatin)- most potent LDL reducers
 * <span style="color: #000000; font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">Bile Acid Sequestrants (Questran)- prevent resorption of bile acids which are necessary for the absorption of cholestrol
 * <span style="color: #000000; font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">Niacin (Nicotinic Acid)- lipid-lowering properties by increasing lipase which breaks down lipids
 * <span style="color: #000000; font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">Fibric Acid Derivatives (Lopid)- same action as Niacin but also suppress release of free fatty acid and decrease triglyceride levels and increase HDL
 * <span style="color: #000000; font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">Cholestrol Absorption Inhibitor (Zetia)- inhibits absorption of cholestrol, high ADL levels

//**<span style="color: #ff0000; font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">WARNING: EDUCATE PATIENT TO REPORT MUSCLE PAIN OR DISCOMFORT TO PHYSICIAN RIGHT AWAY BECAUSE MUSCLE PAIN CAN PROGRESS TO RHABDOMYOLYSIS AND CAN CAUSE SEVERE STRAIN ON THE KIDNEYS LEADING TO KIDNEY FAILURE... AND POSSIBLY EVEN DEATH. **//
 * <span style="color: #ff0000; font-family: Tahoma,Geneva,sans-serif; font-size: 200%;">Nursing Implications **
 * Assess patient's diet, exercise level, weight, height, vs, tobacco and alcohol use, and family hx
 * Assess baseline liver function, if there are problems DO NOT start patients on antilipemic drugs
 * If your patient is taking long-term therapy medications supplemental fat-soluble vitamins (A,D,K) are needed
 * Take with meals to decrease GI upset
 * Educate the importance of diet and exercise
 * No medications an hour before antilipemic drug or 4-6 hours after
 * Often cause constipation so increase fluid and fiber in patient's diet
 * Monitor liver function


 * <span style="color: #ff0000; font-family: Tahoma,Geneva,sans-serif; font-size: 200%;">Therapeutic effects of antilipemic drugs **
 * <span style="font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">Decreased cholestrol
 * <span style="font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">Decreased triglycerides

<span style="color: #0000ff; font-family: Tahoma,Geneva,sans-serif; font-size: 300%;">Diuretic Agents! <span style="color: #0000ff; font-family: Tahoma,Geneva,sans-serif; font-size: 300%;"> <span style="font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">Drugs that work in the functional unit of the kidney, <span style="font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">the nephron, to accelerate the rate of urine formation <span style="font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">resulting in the removal of sodium and water

<span style="color: #0000ff; font-family: Tahoma,Geneva,sans-serif; font-size: 300%;">Types of Diuretics:

<span style="font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">- CAI's block the action of carbonic anhydrase resulting in resorption of water decreasing and urine production increasing <span style="font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">-Useful in glaucoma, epilepsy, and edema <span style="font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">-Contraindications with individuals who have hypokalemia, hyponatremia, or renal or hepatic dysfunction
 * <span style="font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">Carbonic anhydrase inhibitors **
 * <span style="font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">Acetazolamide (Diamox)

<span style="font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">-Inhibits sodium and chloride resorption resulting in the dilation of blood vessels and reduced peripheral vascular resistance <span style="font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">-Used for individuals with edema from HF or renal disease, hypertension, and hypercalcemia <span style="font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">- <span style="color: #ff0000; font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">Potassium depletion <span style="font-family: Tahoma,Geneva,sans-serif; font-size: 150%;"> is an important drug effect to know **patient will probably be on K+ supplements**
 * <span style="font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">Loop Diuretics **
 * <span style="font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">Furosemide (Lasix)
 * <span style="font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">-Very useful when rapid diuresis is needed, however it may cause <span style="color: #ff0000; font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">orthostatic hypotension <span style="color: #000000; font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">(Educate patient on this risk and advise them to sit down if dizzy and to stand up slowly) **

<span style="color: #000000; font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">-Pulls water into the blood vessels and nephron from the surrounding tissues <span style="color: #000000; font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">-Used in the early stages of acute renal failure when there is decreased urine production <span style="color: #000000; font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">-Also used to excrete toxic substances, reduction of intracranial pressure and cerebaral edema <span style="color: #ff0000; font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">Should always be administered intravenously through a FILTER !
 * <span style="color: #000000; font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">Osmotic Diuretics ****
 * <span style="color: #000000; font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">Mannitol (Osmitrol)

<span style="font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">-Prevents potassium from being pumped into the tubule resulting in the excretion of potassium and increasing the excretion of sodium and water <span style="font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">-Used for hyperaldosteronism, hypertension and reversing the potassium loss from Loop and Thiazide drugs <span style="color: #ff0000; font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">**Important side effect to be aware of is hyperkalemia*** //<span style="font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">Most commonly used diuretics! // <span style="font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">-Inhibit tubular resoprtion of sodium and chloride ions resulting in water, sodium and chloride excretion which dilates the arterioles by direct relaxation <span style="font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">-Used in hypertension, edema, diabetes insipidus and used with other agents to treat HF <span style="color: #ff0000; font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">IMPORTANT DRUG REACTION TO BE AWARE OF IS DIGOXIN+THIAZIDE= DIGOXIN TOXICITY
 * <span style="font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">Potassium Sparing Diuretics **
 * <span style="font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">Spironolactone (Aldactone)
 * <span style="font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">Thiazide and Thiazide-like Diuretics ****
 * <span style="font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">hydrochlorothiazide (Esidrix, HydroDIURIL)

<span style="color: #000000; font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">-Teach patients to eat more potassium-rich foods when taking any **but** the potassium-sparing agents <span style="color: #000000; font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">-Foods High in Potassium Include: <span style="color: #000000; font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">-Potassium supplements are usually not recommended when potassium level exceed 3 mEq/L -Assess baseline fluid volume status, input and output, serum electrolytes, weight, and vital signs---> **especially postural BPs** -Take in the morning to avoid interference with sleep patterns
 * <span style="color: #000000; font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">Nursing Implications **
 * <span style="color: #000000; font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">Bananas
 * <span style="color: #000000; font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">Oranges
 * <span style="color: #000000; font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">Dates
 * <span style="color: #000000; font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">Raisins
 * <span style="color: #000000; font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">Plums
 * <span style="color: #000000; font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">Fresh Vegetables
 * <span style="color: #000000; font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">Potatoes
 * <span style="color: #000000; font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">Meat
 * <span style="color: #000000; font-family: Tahoma,Geneva,sans-serif; font-size: 150%;">Fish

MONITOR FOR DIGOXIN TOXICITY WHEN TAKING A DIURETIC

-Teach patients to change positions slowly and rise slowly after sitting/lying to prevent dizziness or fainting --> **Orthostatic hypotension** -The physician should be notified if the patient gains 2 or more pounds in a day or 5 more pounds in a week -The physician should be notified if fluid loss from nausea/vomiting/or diarrhea occur

S/S HYPOKALEMIA, MUSCLE WEAKNESS, CONSTIPATION, IRREGULAR PULSE RATE, OVERALL FEELING OF LETHARGY

-Avoid licorice--> it can lead to an additive hypokalemia in patients taking thiazides

**Adverse Effects** = Metabolic alkalosis, drowsiness, lethargy, hypokalemia, tachycardia, hypotension, leg cramps, restlessness, decreased mental alerrtness **Therapeutic Effects** = Reduction in edema, fluid volume overload, reduction of hypertension


 * Test Your Knowledge: **

1) Carbonic Anhydrase Inhibitors are useful in the treatment of ___.

2) What type of Diuretic is useful when rapid dieresis is needed?

3) How should Mannitol (Osmitrol), an osmotic diuretic me administered?

4) Name 3 side effects of potassium-sparing diuretics.

5) What is an important drug regimen to be aware of?

Answers: 1) Glaucoma, Edema, Epilepsy, High-altitude Sickness 2) Loop Diuretic 3) Intravenously through a filter 4) Gynecomastia, Urinary frequency, Amenorrhea, Irregular menses, Postmenopausal bleeding, Hyperkalemia 5) Digoxin + thiazides = increased digoxin toxicity

Petges, N. (2011). Antilipemic & Diuretic Agents, Pharmacological Concepts, Aurora, IL Lilly, L., Harrington, S., & Snyder, J. (2011). Pharmacology and the nursing process. (6th ed.). St. Louis: Mosby
 * References: **