Pharmacology, part 22: Cardiovascular Medications for Cholesterol

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In this article, we cover cardiovascular medications for cholesterol. Cholesterol, both “good” and “bad,” is present in every cell of the body and has important natural functions when it comes to digesting foods, producing hormones, and generating vitamin D.

The Nursing Pharmacology video series follows along with our Pharmacology Flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.

Cool Chicken When you see this Cool Chicken, that indicates one of Cathy's silly mnemonics to help you remember. The Cool Chicken hints in these articles are just a taste of what's available across our Level Up RN Flashcards for nursing students!

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Cholesterol

Lipids are fats, and the lipids you need to know about are cholesterol (high density, and low density) and triglycerides.

Cholesterol is a waxy, fat-like substance. Excess cholesterol in the blood can combine with other substances to form plaque and lead to atherosclerosis. There are several different kinds of cholesterol. Total cholesterol is simply the combined amount of triglycerides, LDL, and HDL cholesterol in your body.

The expected range for total cholesterol is under 200 mg/dL. Total cholesterol greater than 200 mg/dL indicates increased risk for atherosclerosis (clogged arteries), heart disease, and myocardial infarction (heart attack).

The lab value ranges for total cholesterol, HDL, LDL and triglycerides, are just some of the key lab values covered in our lab value flashcards for nursing students, which we created to make remembering these levels easy!

Low-density lipoprotein (LDL)

LDL cholesterol is usually referred to as the “bad” cholesterol because it collects in the walls of blood vessels, increasing the risk of health problems such as heart attack or stroke. Cathy’s favorite way to remember that LDL is the bad cholesterol is to remember “L is for Lousy.”

The expected range for LDL cholesterol is less than 130 mg/dL. The level should be less than 100 mg/dL for patients at high risk for cardiovascular disease.

LDL cholesterol levels over 130 mg/dL indicates increased risk for atherosclerosis, heart disease, and myocardial infarction.

Learn about dietary sources of LDL vs. HDL cholesterol in our Nutrition series, which follows along with our Nutrition Essentials for Nursing Flashcards.

High-density lipoprotein (HDL)

HDL cholesterol is known as the “good” cholesterol because it helps remove other forms of cholesterol from the bloodstream via the liver. Higher levels of HDL cholesterol are associated with a lower risk of heart disease.

The expected range for HDL cholesterol is greater than 45-55 mg/dL depending on sex. Decreased levels are associated with increased risk of heart disease.

Triglycerides

Triglycerides are a type of fat in your body. After eating, your body converts any calories it doesn’t use right away into triglycerides that are then stored in your fat cells. High triglycerides can contribute to the hardening of arteries, which increases the risk of stroke, heart attack and heart disease.

The expected range for triglycerides is between 35 and 160 mg/dL depending on sex. Elevated levels indicate increased risk for atherosclerosis, heart disease, and myocardial infarction.

Statins - atorvastatin, simvastatin

Atorvastatin (Lipitor) and simvastatin (Zocor) are prescription medications used to treat hypercholesterolemia (high cholesterol). They help lower “bad” cholesterol and fats (LDLs, triglycerides) and raise “good” cholesterol (HDL) in the blood.

Mode of action

Atorvastatin and simvastatin work by slowing the production of LDL cholesterol in the body to decrease the amount of cholesterol buildup on the walls of the arteries that can block blood flow to the heart, brain, and other parts of the body. They also increase the production of HDL cholesterol, which can help remove the LDL cholesterol in the body.

Side effects

Side effects of lipids like atorvastatin and simvastatin can include GI upset, muscle pain, hepatotoxicity (liver damage caused by exposure to drugs), and rhabdomyolysis (muscle injury where the muscles break down).

Patient teaching

When administering atorvastatin and simvastatin, it’s important to advise the patient to take these medications with their evening meal because cholesterol is synthesized at night.

Cool Chicken “Statin” looks like “Satin” sheets that you crawl into at bedtime… the same time you take your statin drugs. Most end in -statin.

You must educate patients to immediately report any muscle aches or pain along with dark "tea" or "cola" colored urine, as these are signs of rhabdomyolysis. Also, educate patients to avoid grapefruit juice!

Nursing care

When caring for a patient on atorvastatin and simvastatin, it’s important to monitor their liver function due to the increased risk of hepatotoxicity and their creatine kinase levels due to the risk of rhabdomyolysis.

Cholesterol absorption inhibitor - ezetimibe

Ezetimibe (Zetia) is a prescription medication used to help lower cholesterol in the blood. It can be used alone or with other cholesterol-lowering drugs such as Lipitor and Zocor.

Mode of action

Ezetimibe works to prevent hypercholesterolemia by inhibiting the absorption of cholesterol in the small intestine.

Cool Chicken Ezetimibe will help cholesterol “zip” through the small intestine.

Side effects

Side effects with ezetimibe include muscle pain and hepatotoxicity.

What to monitor

When caring for a patient on this medication, their liver function and creatine kinase (CK) levels will need to be monitored.

Bile acid sequestrants - colesevelam, cholestyramine

Bile acid sequestrants, also known as bile acid resins or BARs, are a class of medications used to help lower cholesterol levels in the body. Two important medications to know in this class are colesevelam (Welchol) and cholestyramine (Questran).

Mode of action

Colesevelam (Welchol) and cholestyramine (Questran) work by binding to bile acids in the intestine, which helps increase excretion of cholesterol and brings down LDL levels.

Side effects

The key side effects of both colesevelam and cholestyramine include constipation and GI upset.

Cool Chicken If you eat a lot of lamb (which is high in fat and cholesterol), you may need colesevelam for hypercholesterolemia. Coleslaw is a good source of fiber to prevent constipation with colesevelam or cholestyramine!

Patient teaching

When caring for a patient on bile acid sequestrants like colesevelam or cholestyramine, it’s important to advise the patient to increase their fiber and fluid intake to prevent the side effects of constipation. The medication should be taken with food and a full glass of water.

Drug interactions

These medications can interfere with fat-soluble vitamin absorption. Vitamins A, D, E, and K are called fat-soluble vitamins because they are soluble (dissolvable) in organic solvents and are absorbed and transported in a manner similar to that of fats.

Antilipemic medications (gemfibrozil, fenofibrate)

Gemfibrozil (Lopid) and fenofibrate (Lipidil) are medications used to help lower fats (triglycerides) and raise “good” cholesterol (HDL) in the blood. They belong to a group of drugs known as “fibrates” or fibric acid derivatives.

Cool Chicken Maybe if you ate more foods with fiber, you wouldn’t need gemfibrozil or fenofibrate to control your cholesterol.

Mode of action

Gemfibrozil and fenofibrate work by decreasing triglyceride production and transport.

Side effects

Side effects of gemfibrozil and fenofibrate can include GI upset, gallstones, hepatotoxicity, and muscle pain.

If you notice, hepatotoxicity is a possible adverse effect of all these antilipemic medications. Remembering that cholesterol is synthesized in the liver can help you to remember this as an adverse effect!

Patient teaching & monitoring

Patients will need to be advised to take these medications at least 30 minutes before breakfast and dinner. Also, due to the increased risk of hepatotoxicity, it’s important to monitor the patient’s liver function during therapy.

Niacin

Niacin (vitamin B3) is water-soluble and one of the eight B vitamins. Niacin helps turn the food you eat into the energy you need and is important for the development and function of the cells in your body. When taken in large doses, it can be used to treat hypercholesterolemia (high cholesterol) by decreasing lipoprotein and triglyceride synthesis.

Cool Chicken My face doesn’t look very nice after taking niacin (because it is flushed)!

Side effects

The key side effect of niacin is flushing of the face, GI upset, pruritus (itchiness), hepatotoxicity and hyperglycemia.

What to monitor

When caring for a patient taking niacin, it’s important to monitor their liver function due to the side effect of hepatotoxicity. Niacin should also be used cautiously in patients with diabetes due to the side effect of hyperglycemia (high blood sugar).

Full Transcript: Pharmacology, part 22: Cardiovascular Medications for Cholesterol

Okay, in this video, we are going to cover cholesterol medications, or antilipemic medications if you're feeling fancy.

The first class we're going to talk about are statins.

So statin medications are used for hypercholesterolemia. They are also used for prevention of coronary heart disease in patients who are at high risk.

So statins, their mode of action is to decrease LDLs which are the bad cholesterol. So L for lousy. They also increase production of HDLs which is the good cholesterol. So H for happy.

Side effects for statins are going to be very important for you to remember. So that includes hepatotoxicity, muscle pain, rhabdomyolysis, as well as GI upset.

In terms of administration, you're going to advise your patient to take this medication with their evening meal because cholesterol is synthesized at night.

So the tip I got from one of our crew members is that statin kind of looks like satin. So you take your statin right before you crawl into your satin sheets at night. And it just helps you to remember when this type of medication is administered.

Also during therapy, you're going to want to closely monitor your patient's liver function because of that risk of hepatotoxicity. You're also going to want to monitor their creatine kinase levels because of the risk of rhabdomyolysis.

And then lastly, you want to advise your patient to avoid alcohol and avoid grapefruit juice while taking their statin.

Next let's talk about a cholesterol absorption inhibitor, which is ezetimibe.

Ezetimibe works to prevent hypercholesterolemia by inhibiting the absorption of cholesterol in the small intestine.

So my tip for you is that ezetimibe will help cholesterol zip through the small intestine and not get absorbed.

Key side effects with this medication include hepatotoxicity as well as muscle pain. So again, this was like the same side effects we had with the statins, and you'll see that it's going to be kind of consistent across these cholesterol medications.

So while the patient is taking ezetimibe, you want to closely monitor their liver function as well as their CK levels.

Now let's talk about our bile acid sequestrants, which include medications such as colesevelam and cholestyramine, which I hope I'm not butchering that name too much.

These medications are used for hypercholesterolemia.

They work by binding to bile acids in the intestine, which helps increase excretion of cholesterol and bring down LDL levels.

The key side effect with both of these medications is constipation as well as GI upset.

So some of my silly ways to try to remember these two medications is if you eat a lot of lamb, which is high in fat and cholesterol, you may need colesevelam to bring down your cholesterol levels.

Also, because these medications both start with the words Cole, I think about coleslaw, which is high in fiber, which you can eat to counteract the constipating effects of these medications.

So in terms of administration, you definitely want to advise your patient to increase their fiber and fluid intake to help prevent that constipation. They should take this medication with food and a full glass of water.

In addition, these medications can interfere with fat-soluble vitamin absorption. So this includes vitamins A, D, E, and K.

The way I remember which vitamins are fat soluble is I think about a fat deck of cards, and so that helps me remember A, D, E, and K.

We are going to cover our next class of antilipemic medications, which are fibric acid derivatives.

This class includes medications such as gemfibrozil and fenofibrate so you could see both of these medications have that Fib, which is how I remember that they are used for cholesterol, because I think if you ate more foods that were high in fiber, so F-I-B, then you wouldn't need a medication such as gemfibrozil or fenofibrate to lower your cholesterol. So it's a little bit of a stretch, but that's how I remember.

So these medications are used for hypercholesterolemia. They work by decreasing trigycleride production and transport. They also help increase levels of HDL, so that's our good cholesterol, our happy cholesterol.

Side effects can include GI upset, gallstones, hepatotoxicity, and muscle pain. So here we are again with hepatotoxicity and muscle pain. These are going to be very common side effects with cholesterol medication.

So in terms of teaching, you want to advise your patient to take this medication 30 minutes before breakfast and dinner, and we're also going to want to monitor their liver function during therapy because of the risk of hepatotoxicity.

Okay, the last medication we're going to cover here in this video is niacin.

Niacin is a water-soluble vitamin, it's B-3, and in large doses, it can be used to treat hypercholesterolemia by decreasing lipoprotein and triglyceride synthesis.

The key side effect with niacin is flushing of the face. So the way I remember this is that my face doesn't look very nice when I take niacin because of that flushing. Other side effects include GI upset, pruritus, which is itchiness, as well as hepatotoxicity and possible hyperglycemia.

So when your patient is taking niacin for hypercholesterolemia, you're going to want to monitor their liver function, because of that hepatotoxicity, and you're also going to want to use this medication cautiously in patients with diabetes because of the side effect of hyperglycemia.

Okay, in my next video, I will be covering vitamins, minerals, and electrolytes, which are used to correct imbalances in the bloodstream. So hang in there with me. We are almost through all these cardiovascular medications!

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1 comment

I ordered the Nursing flashcards and they are really helpful in my pharmacotherapeutic class.

kehinde

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