pharmacologic treatment so lipids platelets um we're looking at as far as our first pharmacological line of treatment we're looking at lipids hypercholesterolemia that means um that there is elevated lipids in the blood right so lipids are synthesized in the liver so when we're looking at a medication that helps control lipids it's an anti-piling okay so this is these are anti-polymic agents or therapies and these are lipid lowering agents that we're talking about so hmg coa reductase inhibitors these are otherwise known as statins so you're going to see the last part of those drug names um set as statins so that's going to help you remember hopefully that they are hmg coa redectase inhibitors so just really quick this is a slide we're referring to just so you can keep up for those of you that are visual so just kind of follow along this is just showing how it um lowers lipids in the blood so hmg coa reductase inhibitors are statins mechanism of action what it does is inhibits hmg-coa reductase enzyme activity right we have um hmg coast reductase in many pathways of our body so this inhibits that enzyme activity basically because the liver requires hmg coa reductase in order to produce cholesterol so if we inhibit it we actually help to lower lipids because the body won't have what it needs in order to produce cholesterol all right decrease total cholesterol really that's the goal that we're the therapeutic goal that we're aiming for right so we're going to decrease total cholesterol may affect individual types of cholesterol meaning it can affect hdl and adl and so what we're doing is decreasing the rate of cholesterol production indications would be hypercholesterolemia right so elevated cholesterol in the blood and then precautions i'm sorry i'm sucking on a um cough drop so if you're hearing weird noises my allergies are killing me so okay precautions are hyperglycemia pre-existing muscle weakness altered neurostatus pre-existing confusion and dementia liver dysfunction elevated liver function tests of unknown cause so these particular class of drugs can affect glucose levels the pathway on that they're not exactly sure as to why for pre-existing muscle weakness i'm going to show you a slide in a minute statins are known to break down muscle so if the patient has pre-existing muscle weakness you won't really want to be precautious so one of the slides i'm going to show you would explain that better here in a second um these drugs are metabolized in the liver so if the patient had any type of liver dysfunction or elevated liver function then that would be something that we want to make sure that we are precautious about contraindications pregnancy category x basically the studies just kind of demonstrate fetal abnormalities that can occur and then liver dysfunction again liver disease elevated liver enzymes that's something really important to remember about this particular class of drug is making sure that we're monitoring the patient's liver function so side effects alright guys side effects again hyperglycemia again they're not really sure as to why it could decrease insulin release or maybe even peripheral glucose uptake mechanisms they're not really quite clear about all right myopathy and rhabdomyolysis so myopathy is basically a condition of the muscle right and rhabdomyolysis rhabdomyolysis occurs with direct or even indirect muscle injury so what happens is there is a release of cpk cpk is otherwise known as creatinine phosphokinase that's an enzyme that's mostly found in the heart but it's also found in the brain and it's found in the skeletal muscle so if there's any type of muscle damage the cpk increases okay so we have a release of cpk myoglobin and protein myoglobin is iron and oxygen binding red protein that's found in the muscles okay and then of course protein this occurring can actually cause kidney failure and what happens is you're going to see the patient have really dark brown to reddish urine it almost looks like coca-cola okay so what i'm gonna do really quick is show you on the slide let me move this out of the way okay so see what you're seeing here basically in this powerpoint slide is there is some type of muscle injury right you see the little muscle on the bone something happens there's injury or insult and then all of a sudden because of that injury or insult that muscle starts releasing cpk starts releasing myoglobin starts releasing protein so you see these big old protein molecules cpk molecules basically make it very difficult for that kidney to filter them because they're very large molecules and you see the kidney starts to fail so you see the back end of the kidney is producing that dark reddish brown urine and they call it myoglobinuria so it looks like basically coca-cola and that's what's happening there it's always thought that powerpoint slide was like perfect for showing you what's actually occurring with rhabdomyolysis so basically what we do with those types of patients that we flush them full of fluid help filter out um and excrete all of those large molecules and get our kidney function back okay so we said myopathy aroubdomyolysis again those are two very very important things you're going to want to remember for statin drugs for this particular class of drug headache memory loss and confusion um can cause some gi disturbances again liver dysfunction that's probably one of the most common nursing action so we're looking at optimal dosing time optimal dosing time for these type of drugs you're going to want to remember is at night why because most cholesterol is actually synthesized when dietary intake is at its lowest so when is that at night when we're sleeping because we're generally not eating assess patient education narrow function muscle weakness glucocontrol gi symptoms and urinary changes and then again something important to remember for this particular drug class is the various drug and grapefruit interactions so there is a chemical basically that grapefruit contains that interferes with the body's ability to metabolize certain certain statin medications so what can happen is a patient will have increased statin blood levels and side effects follow lipid panel monitor glucose and lfts lfts are liver function tests as a nurse also what was really important to remember for this particular drug class is educating a patient that it takes weeks we're looking at maybe six to eight weeks to even see a change in cholesterol so this isn't a medication i take today and tomorrow my cholesterol is better okay so really educate your patients about these medications they need to stay compliant with them take them as prescribed and it will take at least six to eight weeks before they see any type of change in their cholesterol examples of drugs in class so the start prototypes are what you need to remember atorvastatin and simvastatin both end in statins you're going to want to remember that as your lipid lowering agents where your hmg coa reductase inhibitors is actual class