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Chapter 30 Coordinating Care for Patients With Cardiac Disorders
Table 30.2 Medications Used in the Treatment of Coronary Artery Disease
Medication Classification
Mechanism of Action
Exemplars
Nursing Implications
HMG-CoA reductase inhibitors (Statins)
Atorvastatin (Lipitor) Simvastatin (Zocor)
Monitor: z Cholesterol levels z For side effects such as muscle pain, cramping, and weakness Severe side effects include liver failure and rhabdomyolysis. Monitor: z Liver function z Urine output amount and color z Myoglobin levels Administered via subcutaneous injections every 2–4 weeks An alternative for patents who cannot take statins Teach self-administration technique. Monitor: z Cholesterol levels z For side effects such as back pain, cold/flu symptoms
Statins reduce cholesterol synthesis in the liver and increase clearance of LDL from the blood.
PCSK9 inhibitors
Evolocumab (Repatha)
Increase LDL breakdown by blocking the action of a protein that destroys receptor cells in the liver that aid in eliminating cholesterol.
Cholesterol absorption inhibitors
Inhibit the absorption of cholesterol through the small intestine. Reduce cholesterol production and remove LDL cholesterol by reducing the liver’s production of very-low-density lipoproteins (VLDLs) and by speeding the clearance of triglycerides from the blood.
Ezetimibe (Zetia)
Monitor: z Cholesterol levels Monitor: z Cholesterol levels
Fibric acids
Gemfibrozil (Lopid)
Should not be initiated in patients on statin therapy because of an increased risk for muscle symptoms or rhabdomyolysis. Contraindicated in breastfeeding women as it is excreted in breast milk Baseline hepatic transaminases, fasting blood glucose, and uric acid should be obtained before initiation, and again during up-titration. Repeat labs every 6 months. Should not be used in individuals with baseline fasting triglyceride levels ≥ 300 mg/dL because severe triglyceride elevations can occur.
Nicotinic acid
Reduces the production of triglycerides and VLDLs and increases HDL levels
Niacin (Niaspan)
Bile acid sequestrants
Cholestyramine (Questran)
Convert more cholesterol into bile acids, which are excreted in stool, thereby lowering cholesterol. Usually used in combination with statin therapy—will result in a further 10%–25% decrease in LDL-C levels
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