Hyperlipidemia diet therapy

Which of the following points would the nurse include when teaching a patient about drug and diet therapy for hyperlipidemia ... 

Short-term evaluation of therapy for hyperlipidemia is based on response to diet and drug treatment as measured in the clinical laboratory by total cholesterol, LDL-C, HDL cholesterol, and triglycerides. 

The cornerstone of treatment in primary hyperlipidemia is diet restriction and weight reduction. Limit or eliminate alcohol intake. Use drug therapy in conjunction with diet, and after maximal efforts to control serum lipids by diet alone prove unsatisfactory, when tolerance to or compliance with diet is poor or when hyperlipidemia is severe and risk of complications is high. Treat contributory diseases such as hypothyroidism or diabetes mellitus. 

Hypertriglyceridemia Hypertriglyceridemia in adult patients (Types IV and V hyperlipidemia) who present a risk of pancreatitis and who do not respond to diet. Consider therapy for those with triglyceride elevations between 1000 and 2000 mg/dL, and who have a history of pancreatitis or of recurrent abdominal pain typical of pancreatitis. 

Hypertriglyceridemia A6 unct /e therapy to diet for treatment of adult patients with hypertriglyceridemia (Fredrickson types IV and V hyperlipidemia). 

Niacin has been used clinically to lower serum cholesterol levels (see Chapter 23). It is used as adjunctive therapy in patients with hyperlipidemia. It is one of the drugs of first choice for patients who do not respond adequately to diet and weight loss. 

The answer is a. (Hardman, pp 875-898.) In type I hyperlipoproteinemia, drugs that reduce levels of lipoproteins are not useful, but reduction of dietary sources of fat may help. Cholesterol levels are usually normal, but triglycerides are elevated. Maintenance of ideal body weight is recommended in all types of hyperlipidemia. Clofibrate effectively reduces the levels of VLDLs that are characteristic of types 111, IV, and V hyperlipoproteinemia administration of cholestyramine resin and lovastatin in conjunction with a low-cholesterol diet is regarded as effective therapy for type 11a, or primary, hyperbetalipoproteinemia, except in the homozygous familial form. 

Hyperlipidemia can lead to atherosclerosis and subsequent cardiovascular incidents such as thrombosis and infarction. This condition is often treated by a combination of drug therapy and diet and life-style modifications. Pharmacologic interventions are typically targeted toward decreasing the synthesis of harmful (atherogenic) plasma components, including certain lipoproteins (IDL, LDL, VLDL) that are associated with atherosclerotic plaque formation. 

Dietary measures are always initiated first and may obviate the need for drugs. Exceptions are patients with familial hypercholesterolemia or familial combined hyperlipidemia in whom diet and drug therapy should be started simultaneously. Cholesterol, saturated fats, and trans fats are the principal factors that influence LDL levels, whereas total fat and calorie restriction is important in management of triglycerides. 

Treatment Low fat diet. No drug therapy is effective for Type I hyperlipidemia. 

Correct answer = A. Type l hyperlipidemia (hyperchylomicronemla) is treated with a low fat diet. No drug therapy is effective for this disorder. 

Nicotinic acid is approved for the treatment of hyper-cholesterolemia, hypertriglyceridemia, and familial combined hyperlipidemia (Fredrickson s type lla, Mb, IV, and V) (Table 30.2) in patients who have not responded to diet, exercise, and other nonpharmacological methods. It also is approved for nutritional supplementation, the prevention of pellagra, and as adjunct therapy for peripheral vascular disease and circulatory disorders. It is contraindicated in patients with hepatic disease and peptic ulcer disease. Additionally, because of its ability to elevate glucose and uric acid levels, especially when taken in large doses, nicotinic acid should be used with caution in patients who have or are predisposed to diabetes mellitus and gout (15,20,21). 

Clinical management of hyperlipidemia has been discussed in two well written manuscripts by authors with extensive experience.Their concepts should be borne in mind by all researchers in the atherosclerotic drug field. Proper dietary management is the primary approach and is essential to successful therapy. In fact most therapeutic failures are due to the inability of the patient to follow the prescribed diet. The diets used are directed toward reduction of obesity and replacement of meat and other saturated fat products with foods containing unsaturated fats and nonmeat high protein substances. 

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