Pharmacological Management of Hypercholesterolemia (Research Paper Sample)

Pharmacological Management of Hypercholesterolemia
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Abstract
This paper gives an elaborate explanation on the pharmacodynamics of statins and its uses in the management of hypercholesterolemia among patients of different ages. The mode of action of the drug and the reaction site is also explained in details. This helps the paper to achieve its specific objective of detailed analysis in the care and management of hypercholesterolemia. Consideration on the contra indications and the adverse effects of statins is obtained from several peer reviewed medical journals. Myopathy and fatigue being the most common side effects of statins, the paper strives to give the best method in the management of the effects CITATION Len97 \l 1033 (Lennenas H, 1997). Analysis of the different adverse effects caused by the specific brands of statins such as Pravastatin and Atorvastatin has also been highlighted CITATION Ste04 \l 1033 (Stefano Bellosta, 2004). The effects caused by drug-drug interactions and food-drug interactions on patients under statins have been discussed in depth and the proper clinical management process presented.
The normal level of cholesterol in the body is between 140-200 mg per deciliter (mg/dL). In instances where the level of cholesterol is high in the body, the condition is referred to as hypercholesterolemia CITATION Maryland14 \l 1033 (Maryland University, 2014). There are mainly two types of lipoproteins within the body, the Low Density Lipoprotein (LDL) and the High Density Lipoprotein (HDL). A high level of the LDL in the blood is the main cause of hypercholesterolemia CITATION Maryland14 \l 1033 (Maryland University, 2014). The LDL carries about 65-75% of the plasma cholesterol in the blood from the liver to the rest of the body CITATION Cipolle2004 \l 1033 (Cipolle, 2004).
These incidences of high levels of LDL an individual is at a higher risk of developing of atherosclerotic and coronary heart diseases popularly referred to as (CHD). Examples of coronary heart disease include myocardial infarction and coronary thrombosis. The main causes of hypercholesterolemia are: sedentary lifestyles, diet with high fat contents and genes that predispose one to the condition CITATION Maryland14 \l 1033 (Maryland University, 2014).
Timely intervention of the condition is far more effective as compared to late intervention through medicines. The condition has no early noticeable symptoms and hence as a result the diagnosis is mainly through blood test CITATION Johnshopkins20133 \l 1033 (Johns Hopkins Medicine, 2013). In the case where the condition has progressed, the symptoms include; angina, heart attack stroke and pain while walking CITATION heartUK14 \l 1033 (heart, 2014).
Pharmacological interventions of hypercholesterolemia include the administering of HMG-CoA reductase inhibitor popularly referred to as satins CITATION Cipolle2004 \l 1033 (Cipolle, 2004). The satins are known reversible inhibitors of the microsomal reductase HMG-CoA. The microsomal enzyme is essential in the conversion of HMG-CoA to melavonate CITATION SteinEvan94 \l 1033 (Evan, 1994).
This leads to the up---regulated microsomal production of the HMG-CoA reductase and the cell surface receptors of the LDL CITATION SteinEvan94 \l 1033 (Evan, 1994). This reduction in the synthesis of cholesterol does not cause any significant imbalance in the body. Due the reduction in the amount of LDL synthesized, the production of cholesterol to the cell is done through the de novo process CITATION SteinEvan94 \l 1033 (Evan, 1994).
There is a significance increase in the hepatic LDL recapture sites and the enhancement of the catabolism of the LDL CITATION Sultan2014 \l 1033 (Sultan Qaboos University, 2010). Statins also increase the production of the High Density Proteins serum in the body. This serum is associated with a low level of CAD. A decrease in the level of LDL in the blood streams means a reduction in hyperlipidimia in the blood. As a result there is a decrease in the risk factors associated with coronary Heart Disease.
Several drugs fall in the category of statins and are widely used in the long term management of hypercholesterolemia. These drugs include Atorvastatin, Rosuvastatin, Simvastatin, Fluvastatin and Pravastatin CITATION Cipolle2004 \l 1033 (Cipolle, 2004). Statins are mainly preferred due to their relative simplicity in administering the dose to the patient. A single dose during bedtime is highly recommended for the patient CITATION Cipolle2004 \l 1033 (Cipolle, 2004). The drugs reduce the level of LDL in the body by 18-55% and increase the level of HDL by 5-15% CITATION Cipolle2004 \l 1033 (Cipolle, 2004). Despite the fact that the drugs belong to the same category of statins there dosage is completely different due to the difference in concentration.
Several factors have to be considered before any patient is put under medication, one main key factor is the age of the patient and any underlying chronic disease such as liver conditions or allergic reaction towards the drug.
Discussion
Atorvastatin, sometimes referred to us Lipitor, is an oral drug that is used in the long term management of hypercholesterolemia CITATION Sultan2014 \l 1033 (Sultan Qaboos University, 2010). Atorvastatin comes in a wide range of 10mg, 20mg, 40mg and 80mg.The dosage of the drug varies depending on the age of the patients CITATION Sultan2014 \l 1033 (Sultan Qaboos University, 2010). The dosage among adults is 10mg per day on the on the onset of the treatment and an increase in the dosage later in the management CITATION Sultan2014 \l 1033 (Sultan Qaboos University, 2010). Younger patients between the age of 10 and 17 years should be given 10mg tablets of Atorvastatin per day and the dosage increased to 20mg as the management progresses. Adjustments to the drugs can be made in the intervals of 2-3 weeks CITATION Cipolle2004 \l 1033 (Cipolle, 2004).
Lipitor calcium should never be combined with other forms of HMG-CoA or fibrates. The interaction between the two results to high chances of developing Myopathy CITATION Ste04 \l 1033 (Stefano Bellosta, 2004). Muscle pains are a common side effect of the drug when it is offered in combination therapy, thus the nurse should stop the combination therapy and report the case to the doctor. In the event of myopathy without combination therapy, the nurse should order the blood test in order to determine the level of serum creatine kinase (CK) CITATION GKM02 \l 1033 (G.K.McEvoy, 2002). High levels of the CK present in the blood (10-fold elevation) indicate myopathy caused by the drug. The therapy should be discontinued immediately.
During the management process of the patient, the nurse should be careful to note any adverse effect of the drugs to the patient. The drug should not be administered to pregnant or lactating women because of its potential harm to the fetus CITATION Sultan2014 \l 1033 (Sultan Qaboos University, 2010).
Lipitor has been known to have an adverse effect on the Central Nervous System, headaches and asthenia are the most common CITATION GKM02 \l 1033 (G.K.McEvoy, 2002). Constant and close monitoring of the patient should be taken in order to assess the severity of the drugs on the central nervous systems. The headaches should lessen with time and if not report to the resident doctor is advised.
The gastrointestinal tract (GI) can be affected by the drugs. In such a scenario the nurse should monitor the patient closely in the unlikely event that patient develops severe complications. In most cases, flatulence and abdominal pain may be experienced by the patient CITATION GKM02 \l 1033 (G.K.McEvoy, 2002).
The nurse should ensure that the patient does not take grapefruit juice while under medication. The juice reduces the metabolism of the drug in the liver and as a result it increases toxic levels in the body CITATION Sultan2014 \l 1033 (Sultan Qaboos University, 2010).
The nurse should observe and recommend antacids in the event that the flatulence persists. Other common side effect of the drug includes cramps, constipation, nausea, dyspepsia, heartburn CITATION Cipolle2004 \l 1033 (Cipolle, 2004). These side effects should lessen with time and close monitoring is advised. In case the side effects become worse and persists, it is advisable that the nurse reports the events to a doctor.
Of all the GI effects on the patient, liver failure is the most severe and life threatening. In order to prevent the occurrence of liver failure, the nurse should order liver functioning tests all through the therapy CITATION Cipolle2004 \l 1033 (Cipolle, 2004). In the event that the test shows a high level of AST and ALT in the liver, normally 3-4 times the normal level, the medication should be discontinued immediately CITATION Cipolle2004 \l 1033 (Cipolle, 2004).
Respiratory side effects are common among patients taking Atorvastatin. They include Sinusitis and pharyngitis CITATION GKM02 \l 1033 (G.K.McEvoy, 2002). In both cases of the nurse should monitor the patient to confirm whether the respiratory side effects are chronic. In chronic case the nurse should report the case to the doctor for further diagnosis in order to determine whether the patient will need specialized treatment.
Dermatological reaction due to the therapy is expected as a side effect. The most common is skin rash occurring in 1-4% of the patients during the clinical trials CITATION GKM02 \l 1033 (G.K.McEvoy, 2002). The patient should be monitored and the case reported to the doctor to obtain the right medicine. Possible combination therapy with antifungal should be avoided in order to prevent severe myopathy CITATION Cipolle2004 \l 1033 (Cipolle, 2004).
Pravastatin is also common type of oral drug in the category of HMG-CoA. The drug is also referred to as pravachol or Pravastatin sodiu...