Chapter 29: Antilipemic Drugs – Cholesterol & Lipid Management

Antilipemic Drugs – Cholesterol & Lipid Management on antilipemic drugs delves into the understanding and management of dyslipidemia, detailing the role of key lipids—triglycerides and cholesterol—and their transporters, the lipoproteins (including high-density lipoproteins [HDL], low-density lipoproteins [LDL], and very-low-density lipoproteins [VLDL]). A working knowledge of cholesterol homeostasis is presented, emphasizing the liver’s central role in metabolism and the impact of elevated lipid levels on Coronary Artery Disease (CAD). Atherosclerosis is explained as a chronic inflammatory process initiated by arterial injury, leading to the formation of characteristic foam cells and fatty streaks. Canadian guidelines focus treatment on reducing cardiovascular risk, prioritizing rigorous lifestyle changes (dietary modifications like DASH or Mediterranean diets, and exercise) before and alongside pharmacological interventions. Several major drug classes are explored: HMG-CoA reductase inhibitors, commonly termed statins (such as atorvastatin and rosuvastatin), are the most effective class, inhibiting the rate-limiting enzyme in cholesterol synthesis but requiring vigilant monitoring for serious adverse effects like myopathy and rhabdomyolysis. Other treatments include bile acid sequestrants (e.g., cholestyramine), which increase cholesterol excretion; nicotinic acid (niacin), known for causing cutaneous flushing; fibric acid derivatives (fibrates, e.g., gemfibrozil), which predominantly lower triglycerides; ezetimibe, which inhibits cholesterol absorption; and the newer PCSK9 inhibitors. Essential nursing care throughout antilipemic therapy involves comprehensive assessment for contraindications (such as liver disease or PKU), careful management of numerous drug and food interactions (like statins and grapefruit juice), patient education on the signs of toxicity, and persistent monitoring of liver function tests (ALT, AST) and lipid panel results.