Quiz 29: Pharmacotherapy of Hyperlipidemia


David Hamilton had an elevated blood lipid level. He was undergoing cholestyramine medication for past couple of years as instructed by his Health Care Provider (HCP). Nurse should instruct about the prescribed drug and its adverse effect in the body. Patient should follow the lipid - reduction lifestyle apart from the medication. It involves the regular monitoring of blood lipid level as recommended by the Health Care Provider. The health promotion activities involve the optimum level weight maintenance, exercise, and in-take of soluble fibre, reduced cholesterol and saturated fats in diet and elimination of tobacco usage. In addition, the trans-fatty acids from the meat and dairy products are to be avoided.

Statins are a group of antihyperlipedemic drugs. The action of statins is as follows: • Statins inhibit the enzyme HMG-CoA reductace. This is an enzyme I liver that involves in the synthesis of cholesterol • Inhibition of enzyme results in decrease of production of cholesterol • This decreased cholesterol leads to increase in LDL membrane receptors • These receptors increase the clearance of LDL cholesterol in the blood circulation • Finally lowering the blood cholesterol Liver is the organ in the body that synthesizes cholesterol. Cirrhosis of liver is a condition in which the liver does not perform its normal functions. Decreased cholesterol synthesis leads to decreased LDL cholesterol. The statin drugs are contraindicated in clients with liver disease, if prescribed it is always recommended to do liver a liver function test (LFT) and liver enzymes test prior to prescription. A dose adjustment should be revised once in every 4 weeks along with the several tests performed to check the liver function. If the doses are not revised regularly, there may be an elevation of Alanine aminotransferase (ALT) and aspartate aminotransferase (AST). This may further lead to hepatic failure.

Belinda Cummings had elevated cholesterol level. So, the health care provider instructed the patient to undergo the medication (atorvastatin - 10 mg daily). Belinda Cumming was slightly obese with the low-carbohydrate diet. Dairy products especially cheese and potato chips are found to be her favourite foods. She occasionally drinks a glass of wine with dinner and smokes less than a pack of cigarettes per day. Therefore, Belinda Cumming's high cholesterol level is because of the food she intake and not by the heredity or by any other means.

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