Cholesterol & TG Drugs
A patient with a serum cholesterol level of 275 mg/dL is prescribed simvastatin. What instructions should the nurse provide to the patient? Select all that apply. 1 "Avoid taking the drug with grapefruit juice." 2 "Notify your health care provider if your urine becomes discolored." 3 "Notify your health care provider if muscle pain occurs within 1 day." 4 "Notify your health care provider if muscle pain occurs after 3 days." 5 "Take aspirin 30 minutes before taking simvastatin."
1, 2, 4 Rationale: Simvastatin is a hydroxymethylglutaryl-coenzyme A (HMG Co-A) reductase inhibitor that causes rhabdomyolysis as an adverse effect. Grapefruit juice inhibits the enzyme cytochrome P450 3A4 (CYP3A4) that is required for the metabolism of simvastatin. This will increase levels of the drug in the body, resulting in rhabdomyolysis. Rhabdomyolysis is associated with the breakdown of muscle proteins that are excreted in the urine, changing the color of the urine. Simvastatin starts acting after 3 days of administration and can cause muscle pains. These should be reported to the health care provider because it may progress to rhabdomyolysis if simvastatin administration is not stopped. Muscle pain after one day may be due to some other cause and not the drug. Taking a small dose of aspirin is suggested before taking niacin to reduce the incidence of cutaneous flushing.
A patient with hypercholesterolemia is prescribed lovastatin. After reviewing the patient's medical history, the nurse discovers that the medication is not safe to prescribe for the patient and reports this finding to the health care provider. What did the nurse find in the patient's medical history? 1 The patient has leukemia. 2 The patient has renal disease. 3 The patient has hepatic disease. 4 The patient has chronic pulmonary disease (COPD).
3 Rationale: Lovastatin can cause an increase in liver enzymes and should not be prescribed to patients with preexisting liver disease. Statins induce cell death in malignant cells. Cell death occurs via apoptosis, and lovastatin concentrations are used in the treatment of leukemia. Statins slow the progress of chronic kidney disease by reducing kidney inflammation or improving the function of kidney tissues. Statins reduce COPD. Lovastatin can be prescribed to the patient with leukemia, renal disease, and COPD. Topics
The nurse is providing care for a patient receiving a statin to manage cholesterol levels. For which adverse effects will the nurse monitor in this patient? Select all that apply. 1 Gallstone development 2 Nonalcoholic fatty liver disease 3 Increased serum transaminase levels 4 Unexplained muscle pain or tenderness 5 Elevated creatinine kinase (CK) level with muscle pain
3, 4, 5 Rationale: Statins can injure the liver, so transaminase levels should be monitored and the statin discontinued if the transaminase level is excessively high. Statins can cause muscle injury, so the patient should be instructed to report unexplained muscle pain or tenderness so that signs of myositis or rhabdomyolysis can be evaluated immediately. CK levels should also be measured and evaluated if the patient develops muscle pain. Statins should be avoided in patients with alcoholic or viral hepatitis but may be used in patients with nonalcoholic fatty liver disease. Gemfibrozil, a fibrate, not statins, place the patient at increased risk for developing gallstones.
A patient with hyperlipidemia has been prescribed simvastatin. The nurse instructs the patient to undergo a liver function test and a kidney function test every 3 to 6 months. Which drug therapy-related complication is the nurse trying to prevent? 1 Cirrhosis 2 Hepatitis 3 Nephritis 4 Rhabdomyolysis
4 Rationale: Simvastatin may cause rhabdomyolysis, which is characterized by the breakdown of muscle protein. The elimination of myoglobin from the body may impair kidney functioning and cause acute renal failure. The nurse should monitor the levels of liver enzymes that indicate liver function. To prevent the development of rhabdomyolysis, the nurse should suggest the patient undergo liver and renal function testing every 3 to 6 months. Simvastatin does not cause cirrhosis, hepatitis, or nephritis. Cirrhosis is caused by chronic alcohol consumption. Nephritis is caused by aminoglycosides.
A patient receiving atorvastatin therapy to reduce high cholesterol levels calls the clinic and reports, "I am experiencing severe pain in both my legs." What is the nurse's best response? 1 "Stop taking the drug and visit the clinic immediately." 2 "Continue taking the drug; leg pain is a common side effect." 3 "Stop taking the drug if the symptoms persist for another week." 4 "Continue taking the drug along with niacin and a pain killer."
1 Rationale: The patient may have pain in both legs because of myopathy, an adverse effect of atorvastatin. It progresses to a life-threatening condition called rhabdomyolysis, which involves the breakdown of muscle proteins leading to renal failure and death. The nurse should instruct the patient to stop taking the drug and immediately visit the clinic. The nurse will not instruct the patient to continue the drug as it is a life-threatening condition and requires immediate medical attention. The nurse will instruct the patient to watch for the symptoms; rhabdomyolysis further worsens the patient's condition, leading to renal failure. Administration of niacin, along with atorvastatin, further increases the breakdown of muscle proteins and causes rhabdomyolysis. The nurse should ask the patient to stop taking the medication until confirming the cause of the leg pain.
A patient with hyperlipidemia has been prescribed simvastatin. While caring for the patient, the nurse unknowingly administers niacin along with simvastatin. Which complication may the patient have due to the drugs' interaction? 1 Myopathy 2 Blurred vision 3 Bowel obstruction 4 Hepatic dysfunction
1 Rationale: There would be drug interactions between niacin and a hydroxymethylglutaryl-CoA synthase (HMG-CoA) reductase inhibitor such as simvastatin. This may result in myopathy, which may lead to rhabdomyolysis. Blurred vision is the adverse effect produced by statins when administered alone. Colesevelam may cause bowel obstruction as it binds with bile and other substances in the intestinal tract to form an insoluble complex. Simvastatin can cause hepatic dysfunction in patients who have preexisting liver disease by increasing the liver enzymes. Blurred vision, bowel obstruction, and hepatic dysfunction are not caused by the coadministration of niacin and simvastatin.
What are the common side effects of fenofibrate, a fibric acid derivative? Select all that apply. 1 Rash 2 Constipation 3 Cutaneous flushing 4 Nausea and abdominal pain 5 Increase in gallstone formation
1, 4, 5 Rationale: Rash, nausea, abdominal pain and an increase in gallstone formation are the adverse effects produced by fenofibrate. Diarrhea, not constipation, is a common side effect of fibric acid derivatives. Cutaneous flushing is an adverse effect produced by niacin. Constipation and cutaneous flushing are not associated with fenofibrate.
The nurse is caring for a patient prescribed gemfibrozil. For which patient should the nurse question the use of this drug? 1 A patient with history of gallstones 2 A patient with elevated triglycerides 3 A patient with cardiovascular disease 4 A patient with elevated very-low-density lipoprotein (VLDL) levels
1 Rationale: Gemfibrozil is indicated to reduce elevated triglycerides and VLDL levels primarily in patients who have not responded adequately to diet modification. It also can raise high-density lipoprotein but does not reduce LDL to a significant degree. Gemfibrozil increases the risk of gallstone formation and should not be used in patients with preexisting gallbladder disease. This medication is not contraindicated with heart disease.
When will the nurse administer hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins)? 1 In the evening 2 With breakfast 3 With an antacid 4 On an empty stomach
1 Rationale: The liver produces the majority of cholesterol during the night. Thus, it is best to give HMG-CoA reductase inhibitors (statins), which work to decrease this synthesis, during the evening so that blood levels are highest coinciding with this production. Because this drug tends to elevate the liver enzyme level, it may not be advisable to take the drug on an empty stomach. The liver produces the majority of cholesterol during the night, so it is not ideal to give the drug during breakfast. An antacid is generally given to prevent stomach upset.
The nurse is caring for a patient who has coronary heart disease (CHD). The nurse tells the patient, "Your cholesterol levels are abnormal; you are at a high risk of having a heart attack." What did the nurse discover regarding the lipoprotein levels in the patient's blood report? 1 High levels of low-density lipoproteins (LDLs) 2 High levels of high-density lipoproteins (HDLs) 3 Low levels of very-low-density lipoproteins (VLDLs) 4 Low levels of intermediate-density lipoproteins (IDLs)
1 Rationale: A high level of LDL refers to high cholesterol levels in the blood, because LDL is almost entirely composed of cholesterol. This cholesterol is bad cholesterol, which promotes the formation of atherosclerotic plaque, resulting in CHD. HDL is good cholesterol, which has a cardioprotective action. Low levels of VLDLs are the result of a low-fat diet; however, it does not cause high cholesterol levels. Low levels of IDLs do not increase the risk of CHD; they are useful for the production of bile acids.
A patient is prescribed omega 3-acid ethyl esters and simvastatin for hyperlipidemia. The nurse is looking at the patient's medication history and expresses concern over which medication? 1 Aspirin 2 Lisinopril 3 Nifedipine 4 Levothyroxine
1 Rationale: Aspirin is the medication the nurse is concerned about when the patient is taking omega 3-acid ethyl esters and simvastatin. Because large doses of omega-3 fatty acids can impair platelet function, which leads to prolonged bleeding time, the drugs should be used with care while taking anticoagulants or antiplatelets. Lisinopril, levothyroxine, and nifedipine are not a concern when taking omega 3-acid ethyl esters and simvastatin.
When teaching the nursing student about coronary heart disease, which statement will the nurse include in the session? 1 "Coronary heart disease occurs because of the formation of atherosclerotic plaques." 2 "Coronary heart disease is nonlethal and cannot be prevented by antilipemic medications." 3 "Coronary heart disease cannot be prevented by changing lifestyle modifications." 4 "Coronary heart disease is due to decreases in the cholesterol levels to below 200 mg/dL."
1 Rationale: Coronary heart disease (CHD) occurs because of the formation of atherosclerotic plaques inside the walls of the coronary arteries. CHD is lethal and can be prevented by antilipemic medications that lower the serum cholesterol levels, if diagnosed early. Antilipemic therapy is used as primary prevention in patients with known risk factors for CHD. Cholesterol levels above 200 mg/dL increase the risk for developing coronary artery disease. The risk of CHD also increases with an unhealthy lifestyle, which should be modified.
The nurse is caring for a patient who has hypercholesterolemia and newly prescribed atorvastatin. Which instruction will the nurse receive from the primary health care provider for the safe administration of the medication? 1 "Administer 2 mg of atorvastatin orally." 2 "Administer 10 mg of atorvastatin orally." 3 "Administer 100 mg of atorvastatin orally." 4 "Administer 120 mg of atorvastatin orally."
2 Ratioanle: The nurse should ensure safe administration of medication by educating the patient on taking the correct dose as prescribed. To provide effective treatment, the primary health care provider would instruct the nurse to administer 10 mg of atorvastatin orally. The oral administration of 2 mg atorvastatin may not be effective because of a lower concentration of the drug at the site of action. The oral administration of 100 mg and 120 mg of atorvastatin may lead to adverse effects due to an overdose of the drug.
The nurse understands that cholesterol is carried through the blood by lipoproteins. Which lipoprotein is most closely associated with coronary atherosclerosis? 1 Apolipoprotein B-100 2 Low-density lipoprotein (LDL) 3 High-density lipoprotein (HDL) 4 Very-low-density lipoprotein (VLDL)
2 Rationale: Cholesterol is the primary core lipid of LDLs, which are responsible for carrying cholesterol to tissues outside the liver. Of all the lipoproteins, LDLs are the most significant contributors to coronary atherosclerosis. When pharmacologic agents are used to lower cholesterol, the primary goal is to reduce elevated LDL levels. The other lipoproteins are not associated as heavily with atherosclerosis, and HDL is considered a protective lipoprotein against atherosclerosis.
The nurse is caring for a patient who has hyperlipidemia and who has been prescribed gemfibrozil. On reviewing the medical history of the patient, the nurse learns that the patient is taking warfarin. What does the nurse anticipate after reviewing the patient's medical history? 1 The patient has an increased risk of infection. 2 The patient has an increased risk of bleeding. 3 The patient has an increased risk of vitamin K toxicity. 4 The patient has an increased risk of bowel obstruction.
2 Rationale: Gemfibrozil displaces warfarin from plasma albumin, thereby increasing anticoagulant effects. Hyperlipidemic drugs do not cause immune suppression; the patient would not have an increased risk of infection. Because the hyperlipidemic drug gemfibrozil reduces absorption of vitamin K, the patient may have a vitamin K deficiency rather than vitamin K toxicity. There may be an increased risk of bowel obstruction when bile acid sequestrants bind to other substances in the intestinal tract but not with this combination of drugs.
Which assessment finding in a patient taking a hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor will the nurse act on immediately? 1 Decreased hemoglobin 2 Elevated liver function tests 3 Elevated low-density lipoprotein (LDL) cholesterol 4 Elevated high-density lipoprotein (HDL) cholesterol
2 Rationale: HMG-CoA reductase inhibitors (statins) can cause hepatic toxicity; thus, it is necessary to monitor liver function tests. The nurse should act on this finding immediately. Decreased hemoglobin should be addressed, but not immediately. It is most likely not related to the administration of the HMG-CoA reductase inhibitor. Also, although an elevated LDL level must be addressed, it is not as high a priority as the elevated liver function test results. An elevated HDL is a positive finding and an encouraging result.
A patient with hypercholesterolemia has been prescribed simvastatin. Which action should the nurse perform while caring for the patient? 1 Instruct the patient to take aspirin for pain relief. 2 Inform the patient that this drug may cause nausea. 3 Inform the patient that allergies are a side effect of the drug. 4 Instruct the patient to discontinue the drug in case of muscle pain.
2 Rationale: Patients who are treated with simvastatin may have adverse effects such as nausea, vomiting, and fever. The nurse should teach the patient about the possible adverse effects of the drug therapy and to immediately report any signs of toxicity including muscle soreness, changes in urine color, fever, malaise, nausea, or vomiting. The nurse should not instruct the patient to administer aspirin for pain relief. Any pain should be reported because it can indicate rhabdomyolysis, which may cause renal failure and even death. The nurse should not advise the patient to discontinue the medication without consulting the health care provider. Simvastatin is contraindicated in patients with a known drug allergy.
The nurse is assessing a patient with diabetes who has hyperlipidemia. The patient asks the nurse to suggest either an herbal medication or a dietary modification to reduce cholesterol levels. Which suggestion given by the nurse would be most beneficial to the patient? 1 "Include flax seeds in your food." 2 "Eat foods rich in omega-3 fatty acids." 3 "Consume excessive amounts of garlic." 4 "Take 20 mg of St. John's wort regularly."
2 Rationale: The patient has diabetes and hyperlipidemia; therefore, the nurse should suggest that the patient include foods rich in omega-3 fatty acids, such as fish oil, in his or her diet. They are also available as fish oil products under the brand name Lovaza. This reduces cholesterol levels without altering blood glucose levels. Flax intake should not be suggested to a patient with diabetes because it may have potential hypoglycemic effects as a result of drug interactions. Garlic is contraindicated in patients with diabetes; the nurse should not suggest that the patient eats an excessive amount of garlic. St. John's wort is an herb used to treat depression and the symptoms associated with depression such as anxiety, loss of appetite, and insomnia. This is not helpful in reducing the cholesterol level.
Laboratory reports indicate that a patient's serum cholesterol concentration is 250 mg/dL and triglyceride levels are 450 mg/dL. The health care provider prescribes gemfibrozil to lower cholesterol levels. What is the desired effect of the drug on the patient's lipoprotein levels? 1 There would be an increase in low-density lipoprotein levels. 2 There would be a decrease in low-density lipoprotein (LDL) levels. 3 There would be an increase in very-low-density lipoprotein (VLDL) levels. 4 There would be a decrease in high-density lipoprotein (HDL) levels.
2 Rationale: The serum cholesterol level of 250 mg/dL and the triglyceride levels of 450 mg/dL indicate that the patient has type IV hyperlipidemia. These patients have elevated VLDL levels. Gemfibrozil activates the enzyme lipoprotein lipase, an enzyme responsible for the breakdown of cholesterol. This drug decreases the VLDLs and increases the levels of LDL. A decrease in LDL levels occurs upon further continuation of the drug. Gemfibrozil increases HDL levels by converting LDL to HDL. However, in this case, HDL remains unchanged at the time of the serum test. The serum levels of VLDL are decreased by gemfibrozil because of the activation of the enzyme lipoprotein lipase that converts VLDL to LDL.
The nurse is assessing a patient who has hyperlipidemia and who is treated with antihyperlipidemic medications. The nurse realizes bile acid sequestrants may cause what interaction? Select all that apply. 1 Decreased urination 2 Binding with digoxin 3 Binding with warfarin 4 Inactivation with food 5 Elevated blood pressure
2, 3 Rationale: The bile-acid sequestrants can form insoluble complexes with other drugs. Medications that undergo binding cannot be absorbed and hence are not available for systemic effects. Drugs known to form complexes with the sequestrants include thiazide diuretics, digoxin, warfarin, and some antibiotics. To reduce formation of sequestrant-drug complexes, oral medications that are known to interact should be administered either 1 hour before the sequestrant or 4 hours after. Decreased urination is not related to bile acid sequestrants. These medications are not inactivated with food and may be taken with food or on an empty stomach. Blood pressure elevation is not associated with this class of drug.
The nurse is assessing a patient who has hyperlipidemia and who is prescribed gemfibrozil. Which condition(s) will the nurse assess in the patient before administering the drug? Select all that apply. 1 Muscle reflexes 2 Renal dysfunction 3 Gallbladder disease 4 Hepatic dysfunction 5 Level of consciousness
2, 3, 4 Rationale: Gemfibrozil is contraindicated in patients with gallbladder disease, hepatic dysfunction, and renal dysfunction, as the drug can worsen these conditions. The level of consciousness and muscular function is not affected by the drug, and, therefore, the nurse need not check these.
Which are beneficial effects that can be derived from simvastatin and other drugs in this class? Select all that apply. 1 Improvement of liver function 2 Reduction of risk of cardiovascular events 3 Reduction of low-density lipoproteins (LDLs) 4 Elevation of high-density lipoproteins (HDLs) 5 Stabilization of the plaque in coronary arteries
2, 3, 4, 5 Rationale: The statin drugs have many benefits, the most important being reduction of LDLs. They also promote an increase in HDLs, stabilization of atherosclerotic plaque, and reduced inflammation at the plaque site. Among other benefits, they also slow progression of coronary artery calcification. The statins reduce the overall risk of cardiovascular events. They can have serious adverse effects on the liver, but these are relatively rare.
The health care provider prescribes lovastatin for a patient discharged from the hospital after a myocardial infarction. Which instructions are most appropriate for the nurse to include in the patient's teaching plan? Select all that apply. 1 "Take your medication in the morning, with a full glass of water, for best results." 2 "Lower the total fat and saturated fat in your diet by increasing your intake of fresh fruits and vegetables and whole grains." 3 "Do not start any new medications without first talking to your health care provider." 4 "Take one 325-mg aspirin 30 minutes before your dose to lessen the problem of flushing and itching that can occur with this drug." 5 "Before starting this medication a blood test will be done to check your total cholesterol level and measure liver enzymes."
2, 3, 5 Rationale: Lovastatin, simvastatin, and atorvastatin levels may be elevated when these drugs are combined with other drugs that inhibit cytochrome P450 3A4 (CYP3A4). Caution is warranted if these drugs are combined. Before starting a statin, obtain a baseline lipid profile that includes total cholesterol and obtain baseline liver function tests. The statins are taken once daily with food. It is recommended to take them with the evening meal because endogenous cholesterol synthesis increases during the night. The statins do not typically cause flushing and itching; that effect occurs with niacin. A diet low in total fat and saturated fat is recommended when antilipemic drugs are prescribed.
A patient with hyperlipidemia is treated with atorvastatin. On the follow-up visit, the nurse discovers that the patient has had no improvement in cholesterol levels. What could be the reason for this? 1 The patient has a history of rhabdomyolysis. 2 The patient took atorvastatin with gemfibrozil. 3 The patient is taking the medication in the morning. 4 The patient consumed more than 8 ounces of grapefruit juice per day.
3 Rationale: Patients who take statins such as atorvastatin should be taught to take the medication in the evening to get the best effects. Grapefruit juice increases the risk of rhabdomyolysis but only if more than one quart per day is taken. The drug increases the risk of rhabdomyolysis, but having a history of this disorder does not cause the drug to be ineffective.
The nurse provides teaching to a patient who will take atorvastatin at home. Which patient teaching is most likely to help maintain the antilipemic medication dosage at the lowest level possible? 1 Take atorvastatin at bedtime. 2 Avoid all alcoholic beverages. 3 Engage in moderate exercise. 4 Adhere to the blood test schedule.
3 Rationale: The nurse instructs the patient to engage in moderate-intensity exercise to improve cardiovascular conditioning. Exercise helps increase metabolism and promotes collateral circulation. Taking atorvastatin at bedtime, adhering to the blood test schedule, and avoiding alcoholic beverages all help manage adverse effects and aid in the early detection of serious adverse effects; however, these reasonable nursing interventions for patient teaching are less likely to affect the dosage of atorvastatin.
Which drug is the most effective for lowering low-density lipoprotein (LDL) cholesterol? 1 Gemfibrozil 2 Ezetimibe 3 Atorvastatin 4 Cholestyramine
3 Rationale: The statin drugs, such as atorvastatin, are the most effective drugs for lowering LDL cholesterol. They are better tolerated, have fewer adverse effects, and produce better clinical outcomes than any other agents available for lowering LDL. Cholestyramine, gemfibrozil, and ezetimibe are also cholesterol-lowering agents but are not classified as statin
The nurse is reviewing medication orders for a patient with type 2 diabetes and hypertension. In accordance with the American College of Physicians recommendations, which additional medication does the nurse expect to be ordered even if the patient does not have high cholesterol? 1 Niacins 2 Fibrate 3 Bile acid sequestrant 4 HMG co-A reductase inhibitor
4 Rationale: The American College of Physicians recommends an HMG co-A reductase inhibitor ( statin) for all patients with type 2 diabetes and an additional risk factor such as hypertension, smoking, age over 55 years even if they don't have high cholesterol. Bile acid sequestrants bind bile acids in the intestine, increase their excretion in the stool, and force the liver to convert cholesterol to produce more bile acids to replace those lost in the stool, which lowers the level of cholesterol in the blood. However, they are not the most recommended by the American College of Physicians for all patients with type 2 diabetes plus diagnosed ASCVD. Fibrates can increase the cholesterol content of bile and can increase the risk of gallstones so it is not recommended for patients with diabetes and additional risk factors. Niacin was once thought to be useful in lowering low-density lipoprotein cholesterol and triglyceride levels, but despite the previously demonstrated favorable effects on lipid levels, niacin does little to improve outcomes and can cause potential harm, so it is no longer recommended for use in managing cholesterol levels.
