Antilipemic agents reduce hyperlipidemia that may lead to additional health problems such as stroke, myocardial infarction, angina, and heart failure. Medications should be used in adjunct with a healthy diet and exercise regime approved by the patient’s health care provider.

Atorvastatin

Mechanism of Action: Atorvastatin inhibits HMG-CoA reductase and cholesterol synthesis, which reduces LDL (low-density lipoprotein).

Indications: This medication is used for hyperlipidemia and the prevention of cardiovascular disease.

Nursing Considerations: Do not use with patients who have hepatic disease.

This medication is contraindicated with patients who are pregnant or breastfeeding. Do not give to patients under 10 years of age.

Use caution with geriatric patients due to increased risk for myopathy.

Side Effects/Adverse Effects: Patients who are pregnant or breastfeeding should not take this medication. A health care provider will assess routine liver function for a patient taking atorvastatin. Nausea, diarrhea, dyspepsia, increase in blood glucose, rhabdomyolysis, myalgia, or muscle spasms may be produced by taking this medication. Rhabdomyolysis is a condition in which damaged skeletal muscle breaks down rapidly, causing muscle pain and weakness. Some of the muscle breakdown products are harmful to the kidneys and can cause kidney failure. There may be tea-colored urine or an irregular heartbeat with rhabdomyolysis.^[1]

Patient Teaching & Education: Patients should take the prescribed medication as directed and avoid consuming grapefruit juice during drug therapy. The medication should be used with dietary modifications. If the patient experiences muscle pain, tenderness, or weakness, these should be reported to the health care provider.^[2]

Now let’s take a closer look at the medication grid on atrovastatin in Table 6.11a.^[3]

Table 6.11a Atorvastatin Medication Grid

Ezetimibe

Mechanism of Action: Ezetimibe blocks the absorption of cholesterol in the small intestines to reduce LDL.

Indications: This medication is used for treatment of hyperlipidemia and familial hypercholesterolemia.

Nursing Considerations: If medication is combined with HMG-CoA reductase inhibitors, do not give to pregnant or breastfeeding patients.

Side Effects/Adverse Effects: Use with caution when ezetimibe is combined with additional medication. Patients may experience arthralgia, rhabdomyolysis, hepatic impairment, dizziness, upper respiratory infections, or diarrhea if they are taking this medication. Minimal side effects were reported with monotherapy.^[4]

Patient Teaching & Education: Patients should take the prescribed medication as directed and avoid consuming grapefruit juice during drug therapy. The medication should be used with dietary modifications. If the patient experiences muscle pain, tenderness, or weakness, this should be reported to the health care provider.^[5]

Now let’s take a closer look at the medication grid for ezetimibe in Table 6.11b.^[6]

Table 6.11b Ezetimibe Medication Grid

Cholestyramine

Mechanism of Action: Cholestyramine works by binding to bile acids in the intestines, preventing their reabsorption, and promoting their excretion in the feces.

Indications: Bile acid sequestrants are given to reduce the amount of bile acids available for the body to use in producing cholesterol, leading to a decrease in cholesterol levels.

Nursing Considerations: Monitor the patient’s lipid profile, liver function tests, and vitamin levels. These medications should not be used in patients with a history of bowel obstruction or in patients with triglyceride levels greater than 500 mg/dL.

Side Effects/Adverse Effects: Adverse effects of bile acid sequestrants include constipation, bloating, flatulence, and abdominal discomfort.

Patient Teaching & Education: Patients should be advised to increase their fluid and fiber intake to alleviate these symptoms. These medications can also interfere with the absorption of fat-soluble vitamins, so patients should be advised to take supplements as prescribed.

Now let’s take a closer look at the medication grid for cholestyramine in Table 6.11c.

Table 6.11c Cholestyramine Medication Grid^[7]

Niacin

Mechanism of Action: Niacin works by inhibiting the synthesis of triglycerides and LDL cholesterol.

Indications: Niacin is given to reduce the production of very low-density lipoprotein (VLDL) and low-density lipoprotein (LDL) cholesterol, while increasing the levels of high-density lipoprotein (HDL) cholesterol in the blood.

Nursing Considerations: Nursing considerations for administration include monitoring lipid profiles, liver function tests, and blood glucose levels. Patients should be advised to take niacin with meals to minimize adverse effects. Patients should also be advised to report any adverse effects to their health care provider.

Side Effects/Adverse Effects: Adverse effects of niacin include flushing, itching, and tingling, particularly in the face, neck, and chest.

Patient Teaching & Education: Patients should also be advised to avoid hot beverages or alcohol, as these can exacerbate flushing. Niacin can also cause liver toxicity, so liver function tests should be monitored regularly. In addition, niacin can increase blood glucose levels, so patients with diabetes should have their blood glucose levels monitored closely. Patients should be advised to take niacin with meals to minimize adverse effects.

Now let’s take a closer look at the medication grid for niacin in Table 6.11d.

Table 6.11d Niacin Medication Grid^[8]