Drug Therapy for Dyslipidemia
You are discharging a patient home on HMG-CoA inhibitor therapy. What statement by the patient demonstrates that they have a clear understanding of the teaching you have done? a) "I won't need to follow that diet any more because this drug will take care of my lipids." b) "I should take this drug first thing in the morning with a full glass of water." c) "I should take this drug at bedtime, since my body makes lipids mostly at night." d) "This drug will protect me from having a heart attack or stroke."
Answer: "I should take this drug at bedtime, since my body makes lipids mostly at night." Rationale:HMG-CoA inhibitors should be taken at bedtime because the body makes lipids mostly at night. Diet is still important when taking these drugs, and they have not been shown to decrease the development of CAD or to prevent heart attacks or strokes.
The client wants to know the difference between triglycerides and cholesterol. Which of the following responses by the nurse would be correct? a) "Triglycerides are found in your blood. Cholesterol is found in the gallbladder." b) "Triglycerides transport cholesterol throughout the body." c) "Triglycerides and cholesterol are fatlike substances found in your blood." d) "Triglycerides are found in your blood. Cholesterol is how the fat is transported."
Answer: "Triglycerides and cholesterol are fatlike substances found in your blood."
A patient with primary hypercholesterolemia has been prescribed 10 mg of ezetimibe per day by a physician. The physician has instructed the nurse to continue the drug therapy for 3 days. The drug is available in 10 mg capsules. How many capsules of the drug should the nurse administer the patient during the entire therapy? a) 2 capsules b) 1 capsule c) 3 capsules d) 4 capsules
Answer: 3 capsules Rationale: The nurse should administer 3 capsules of ezetimibe to the patient during the therapy.
An appropriate goal for a client taking niacin would be to reduce total serum cholesterol to which level? a) <275 mg/dL b) <239 mg/dL c) <200 mg/dL d) <100 mg/dL
Answer: <200 mg/dL
An appropriate goal for a client taking niacin would be to reduce total serum cholesterol to which level? a) <275 mg/dL b) <200 mg/dL c) <239 mg/dL d) <100 mg/dL
Answer: <200 mg/dL Rationale: A total serum cholesterol level of <200 mg/dL is recommended. The other options are incorrect.
The nurse is taking a health history on a 38-year-old male bar owner who is taking atorvastatin (Lipitor) for high cholesterol. The nurse will be sure to ask a specific group of questions regarding the patient's use of what? a) Nicotine b) Caffeine c) Herbal therapy d) Alcohol
Answer: Alcohol Rationale: HMG-CoA reductase inhibitors are contraindicated with liver disease or a history of alcoholic liver disease. Nicotine, caffeine, or herbal therapies are usually not identified as producing any drug-to-drug interactions with atorvastatin.
What should the nurse review about an antihyperlipidemic medication with the client when completing discharge counseling? Select all that apply: a) Reason for taking the prescribed drug b) Drug name c) Dosage form d) Correct dose e) Frequency of administration
Answer: All
Which of the following activities increases high-density lipoproteins? a) Regular aerobic exercise b) All of these c) Weight loss d) Smoking cessation
Answer: All of these
What is HMG-CoA reductase? a) An enzyme used to make bile acids b) An enzyme that combines with proteins to become chylomicrons c) An enzyme used immediately for energy d) An enzyme that controls the final step in production of cellular cholesterol
Answer: An enzyme that controls the final step in production of cellular cholesterol
A nurse who provides care in a busy clinic is aware of the high incidence and prevalence of hyperlipidemia and the consequent need for antihyperlipidemics in many patients. Treatment of high cholesterol using statins would be contraindicated in which of the following patients? a) A resident of a long-term care facility whose Alzheimer disease is being treated with donepezil (Aricept) b) An obese male client who is a heavy alcohol user and who has cirrhosis of the liver c) A female client who had a laparoscopic cholecystectomy (gall bladder removal) earlier this year d) A 72-year-old man who has emphysema and a 55-pack-year history of cigarette smoking
Answer: An obese male client who is a heavy alcohol user and who has cirrhosis of the liver Rationale: Active liver disease is a contraindication to the use of statins. As well, heavy alcohol use increases the risk of liver dysfunction. Respiratory disease, recent surgery, and organic cognitive deficits do not preclude the use of statins for high cholesterol.
The clinic nurse has been assigned to a 43-year-old man who is obese and loves to eat. He has been diagnosed with hyperlipidemia and has been prescribed lovastatin. Which of the following dietary instructions would be a priority for the nurse to discuss with the patient? a) Increase intake of milk and other dairy products b) Drink more grapefruit juice and increase intake of soluble fiber c) Decrease intake of plant stanols d) Avoid drinking grapefruit juice and decrease intake of fatty acids
Answer: Avoid drinking grapefruit juice and decrease intake of fatty acids
Statin drugs help lower cholesterol, LDL, and triglycerides by which of the following mechanisms? Select all that apply: a) Decreasing absorption of cholesterol from the GI tract. b) Promoting the breakdown of cholesterol. c) Increasing the storage of cholesterol as fat. d) Decreasing the breakdown of fat to cholesterol. e) Inhibiting the manufacturing of cholesterol.
Answer: B and E
Statin drugs help lower cholesterol, LDL, and triglycerides by which of the following mechanisms? Select all that apply: a) Decreasing absorption of cholesterol from the GI tract. b) Promoting the breakdown of cholesterol. c) Increasing the storage of cholesterol as fat. d) Decreasing the breakdown of fat to cholesterol. e) Inhibiting the manufacturing of cholesterol.
Answer: B and E
Which substance would a group of students identify as being responsible for breaking up dietary fats into smaller units? a) Micelles b) Chylomicrons c) Cholesterol d) Bile acids
Answer: Bile Acids Rationale: Bile acids act like a detergent in the small intestine and break up fats into small units. These small units are called micelles. High levels of cholesterol are part of bile acids. Chylomicrons are carriers for micelles. (less)
Which of the following would be classified as a bile acid sequestrant? a) Gemfibrozil b) Lovastatin c) Ezetimibe d) Cholestyramine
Answer: Cholestyramine
Your patient asks you what will the atorvastatin (Lipitor) they are prescribed do for them. What is an expected outcome for this patient? a) Decrease in serum cholesterol and LDL levels b) Decrease in sitosterol and serum cholesterol c) Decrease in serum cholesterol only d) Decrease in camperterol and LDL levels
Answer: Decrease in serum cholesterol and LDL levels
A male client takes cholesterol absorption inhibitors as a monotherapy without statins. He develops mild hepatic insufficiency. What would the nurse expect the physician to do? a) Maintain the current dosage of his medication b) Discontinue his medication c) Decrease the dosage of his medication d) Increase the dosage of his medication
Answer: Decrease the dosage of his medication Rationale: Cholesterol absorption inhibitors as monotherapy (without statins) require dosage reduction in clients with mild hepatic impairment.
Recommended treatments for patients with dyslipidemia are made according to their blood levels of total and LDL cholesterol and risk factors for cardiovascular disease. What does the impact of existing cardiovascular disease have on recommendations? a) Decreases target serum triglyceride level b) Decreases target serum LDL level c) Increases target serum HDL level d) Has no effect
Answer: Decreases target serum LDL level
Elevated blood lipids are a major risk factor for atherosclerosis and vascular disorders. From where are blood lipids derived? a) Exercise b) Diet c) Medications d) Kidneys
Answer: Diet
Which of the following are examples of modifiable risk factors for hyperlipidemia? (Select all that apply) a) Diet b) Women older than 55 years c) Weight d) Men older than 45 years e) Post menopausal female
Answer: Diet and Weight Rationale: Modifiable risks factors for hyperlipidemia are weight, diet, and physical inactivity. Non-modifiable risk factors for hyperlipidemia are age, gender, and family history.
What intervention may help the client increase HDL levels? a) Leg elevation b) TED hose c) Exercise d) Smoking cessation
Answer: Exercise
What intervention may help the client increase HDL levels? a) Exercise b) Leg elevation c) Smoking cessation d) TED hose
Answer: Exercise Rationale: It is known that HDL levels increase during exercise, which could explain why people who exercise regularly lower their risk of CAD.
A 10-year-old is brought into the clinic for an annual check-up and is diagnosed with hypercholesterolemia. What type of hypercholesterolemia is most often seen in children? a) Familial b) Gender specific c) Diet resistant d) Exercise resistant
Answer: Familial
A male client's triglycerides are still elevated despite lifestyle changes. What does the nurse expect the physician to order for this client? a) Cholestyramine b) Atorvastatin c) Fenofibrate d) Niacin
Answer: Fenofibrate
Which drug is most effective in reducing serum triglyceride levels? a) HMG-CoA reductase inhibitors b) Bile acid sequestrants c) Niacin d) Fibrates
Answer: Fibrates
A nurse is caring for a patient prescribed nicotinic acid for hyperlipidemia. Which of the following are experienced by patients taking nicotinic acid? a) Weakness b) Flushing of the skin c) Dyspnea d) Tachycardia
Answer: Flushing of the skin
You are teaching your client about nicotinic acid, which the physician has prescribed for treatment of hyperlipidemia. What common adverse effect should you mention to the client? a) Flushing of the skin b) Drowziness c) Facial tics d) Fever
Answer: Flushing of the skin
A patient with hyperlipidemia is prescribed ezetimibe. Which of the following ongoing assessments should the nurse perform during treatment? a) Take a dietary history of the patient. b) Frequently monitor blood cholesterol. c) Inspect skin and eyelids for evidence of xanthomas. d) Obtain reports of fasting blood sugar levels.
Answer: Frequently monitor blood cholesterol. Rationale: The nurse should frequently monitor blood cholesterol as part of the ongoing assessment for a patient receiving ezetimibe. Taking a dietary history of the patient and inspecting the skin and eyelids for evidence of xanthomas are the pre-administration assessments that a nurse should perform for a patient receiving ezetimibe. The nurse obtains the reports of fasting blood sugar for a diabetic patient.
After teaching a group of students about fats and biotransformation, the instructor determines that the teaching was successful when the students identify which of the following as the storage location of bile acids? a) Liver b) Stomach c) Small intestine d) Gallbladder
Answer: Gallblader
Which of the following herbal products have shown in studies to lower serum cholesterol and triglycerides? (Choose one) a) Feverfew b) Ginseng c) Hawthorne berry d) Black cohosh e) Garlic
Answer: Garlic
Which of the following herbal products have shown in studies to lower serum cholesterol and triglycerides? (Choose one) a) Garlic b) Black cohosh c) Hawthorne berry d) Ginseng e) Feverfew
Answer: Garlic
A patient has been prescribed atorvastatin (Lipitor) comes to the clinic with complaints of acute muscle pain not associated with exercise or injury, which indicates potential rhabdomyolysis. The nurse knows that the use of atorvastatin with which of the following products places the patient at risk for rhabdomyolysis? a) Grapefruit juice consumption b) Over-the-counter (OTC) drug use c) Use of ginseng d) Use of saw palmetto
Answer: Grapefruit juice consumption
A 54-year-old patient, has a cholesterol level of 240 mg/dL. What serum concentration of cholesterol would this patient have? a) High b) Desirable c) Very high d) Optimal
Answer: High
What is the most common reason for an elevated cholesterol level in a client who does not have a genetic disorder of lipid metabolism? a) His alcohol intake b) His dietary intake of saturated fat c) His sedentary lifestyle d) His waist size
Answer: His dietary intake of saturated fat
What is the most common reason for an elevated cholesterol level in a client who does not have a genetic disorder of lipid metabolism? a) His dietary intake of saturated fat b) His alcohol intake c) His sedentary lifestyle d) His waist size
Answer: His dietary intake of saturated fat
A client diagnosed with hyperlipidemia is prescribed a statin. The nurse is reviewing the client's history and would notify the client's health care provider if which of the following conditions were noted in the client's history? a) Hypertension b) Asthma c) Liver disease d) Renal disease
Answer: Liver disease
A student asks the nursing instructor what the most common adverse effects of ezetimibe (Zetia) are. What would be the instructor's best response? a) Constipation and flank pain b) Neuropathy and flatulence c) Mild abdominal pain and diarrhea d) Bloating and flank pain
Answer: Mild abdominal pain and diarrhea
The nurse is performing patient education for a woman who will soon begin treatment of hyperlipidemia with simvastatin (Zocor). The patient has asked the nurse if there are any "bad side effects" that she should be aware of. Which of the following statements should underlie the nurse's response? a) The patient will have to schedule regular blood work to closely monitor her kidney function for the duration of treatment. b) The patient may experience a dry cough, especially at night, for the first few weeks after starting to take the simvastatin. c) Most patients tolerate statins well, with minor muscle aches being among the most common adverse effects. d) Many patients experience gastrointestinal upset with statins, which can be partially alleviated by taking the drug with food.
Answer: Most patients tolerate statins well, with minor muscle aches being among the most common adverse effects. Rationale: Adverse effects of lovastatin are usually mild and transient; the drug is generally well tolerated. A fairly common complaint with all statins, including lovastatin, is nonspecific muscle aches or joint aches, weakness, and/or cramps (myalgias), which are not associated with any signs of muscle damage. GI upset and cough are not associated with the use of statins. Renal disease may contraindicate the use of statins, but frequent analysis of kidney function is not necessary for patients with no preexisting indications.
Your patient, a 37-year-old woman with moderately elevated lipid levels, requests immediate pharmacotherapy for her dyslipidemia. You explain that a period of intensive diet therapy and lifestyle modification will be utilized before drug therapy is considered. You explain the rationale for this regimen as: a) Therapeutic lifestyle changes are the preferred method for lowering blood lipids. b) Continued therapeutic lifestyle changes during drug therapy will guarantee success. c) Therapeutic lifestyle changes work only when used in conjunction with medications. d) None of the above.
Answer: Therapeutic lifestyle changes are the preferred method for lowering blood lipids.
A patient presents at the clinic after one week of taking pravastatin (Pravacol) with complaints of "just not feeling well." The nurse asks what liquid the patient has been taking their medication with and the patient tells the nurse that they drink a lot of grapefruit juice. The nurse should know that grapefruit juice increases the risk of which adverse effect? a) Nausea b) Diarrhea c) Toxicity d) Gastric ulceration
Answer: Toxicity Rationale: Grapefruit juice increases the risks of toxicity as it increases serum drug levels. It does not increase the risk of ulceration, nausea, or diarrhea.
After teaching a group of students about metabolic syndrome, the instructor determines that the teaching was successful when the students identify which characteristic? a) Blood pressure below 130/85 mm Hg b) Triglyceride level above 150 mg/dL c) Fasting blood glucose below 110 mg/dL d) Waist measurement over 40 inches in women
Answer: Triglyceride level above 150 mg/dL Rationale: Characteristics of metabolic syndrome include fasting blood glucose levels greater than 110 mg/dL, waist measurement over 40 inches in men and over 35 inches in women, triglyceride levels greater than 150 mg/dL or HDL levels less than 40 mg/dL in men or less than 50 mg/dL in women, blood pressure greater than 130/85 mm Hg, increased macrophages, levels of interleukin-6 and TNF, and increased plasminogen activator levels.
Cholesterol is the base unit for the formation of steroid hormones. a) False b) True
Answer: True
A 64-year-old client has increased levels of LDL, VLDL, cholesterol, and triglycerides and xanthomas in his knees and elbows. What type of dyslipidemia does he have? a) Type I b) Type IIa c) Type IIb d) Type III
Answer: Type IIb Rationale: Type IIb dyslipidemia is characterized by increased levels of LDL, VLDL, cholesterol, and triglycerides and lipid deposits (xanthomas) in the feet, knees, and elbows.
Which of the following adverse effects would a nurse expect to assess in a patient taking ezetimibe? a) Flatulence b) Constipation c) Mild abdominal pain d) Bloating
Answer: abdominal pain
Several months of treatment with a statin accompanied by lifestyle modifications have failed to appreciably improve a patient's cholesterol levels. Consequently, the patient has been prescribed cholestyramine. The nurse should recognize that this drugs achieves its therapeutic effect by a) inhibiting the synthesis of cholesterol. b) mitigating the harmful effects of atherosclerosis by promoting vasodilation. c) binding LDL to HDL. d) oxidizing cholesterol to bile acids.
Answer: oxidizing cholesterol to bile acids.
What should the nurse suggest to assist a client to improve his cholesterol levels? a) Limit exercise to the weekends b) Weight lifting c) Smoking cessation d) Diet high in polysaturated fats
Answer: Smoking cessation
The administration of cholestyramine (Questran) with warfarin (Coumadin) would most likely cause a client to present with which of the following? Select all that apply: a) Subtherapeutic INR b) Blood in the stool c) Bruising d) Calf pain and warmth e) Supratherapeutic INR
Answer: A and D Rationale: Co-administration of warfarin and cholestyramine can result in decreased anticoagulant effect leading to subtherapeutic INR and increase chance of clotting (signs and symptoms of DVT or PE).
Which of the following should be included by the nurse during client teaching to improve outcome? Select all that apply: a) Reviews measures to minimize gastrointestinal upset. b) Contacts dietitian for assistance with diet teaching. c) Emphasizes that drug therapy alone will significantly lower blood cholesterol levels. d) Stresses importance of taking drug exactly as prescribed. e) Instructs in possible adverse reactions and signs and symptoms to report to primary health care provider.
Answer: A, B, D, C
What cardiac risk factors are related to metabolic syndrome? (Select all that apply.) a) Central adiposity b) Reduced high density lipoprotein cholesterol c) Elevated fasting blood glucose d) Postural hypotension e) Elevated triglycerides
Answer: A, B, E Rationale: Metabolic syndrome is a group of cardiovascular risk factors that are linked with obesity and include elevated waist circumference (central adiposity), elevated triglycerides, reduced high density lipoprotein cholesterol, elevated blood pressure, and elevated fasting glucose.
What should the nurse tell a client about the normal skin reactions that can occur with the use of nicotinic acid? Select all that apply: a) Sensations of warmth are normal. b) Rash is normal. c) Flushing is normal. d) Pustule formation is normal. e) Tingling is normal.
Answer: A, C, E Rationale: Generalized skin flushing, a sensation of warmth, and severe itching and tingling can occur with the administration of nicotinic acid, especially are higher doses.
Your dad returned from his annual physical with the news that he has metabolic syndrome and is quite shaken with the news. Knowing the elements of metabolic syndrome, you begin to encourage him with non-pharmacologic measures he could implement to improve his risk factors. What do those non-pharmacologic measures include? Select all that apply. a) Begin to decrease intake of soluble fiber b) Begin a low-fat diet c) Begin regular walking program d) All of these
Answer: B and C Rationale: Decreasing dietary fat intake and instituting regular aerobic exercise will decrease weight, increase cardiovascular health, and reduce risk factors of metabolic syndrome.
A nurse is caring for a patient taking a cholestyramine drug. What instructions should the nurse give to this patient to prevent constipation? a) Take water-soluble form of vitamin A. b) Have a complete liquid diet. c) Eat foods high in dietary fiber. d) Have complete bed rest.
Answer: Eat foods high in dietary fiber
As part of a routine physical examination, a 60-year-old patient's primary care provider has ordered blood work that includes cholesterol levels. What result would most strongly suggest the need for treatment with an antihyperlipidemic drug? a) Elevated LDL levels b) A high ratio of HDL to LDL c) Elevated HDL levels d) Low VLDL levels
Answer: Elevated LDL levels
The nurse instructs a client to take the prescribed pravastatin at bedtime based on the understanding about which of the following? a) Compliance is enhanced with nighttime administration. b) Lack of dietary intake during sleep increases absorption. c) Adverse effects are less likely during the night. d) Greater drug effectiveness is achieved at this time.
Answer: Greater drug effectiveness is achieved at this time.
The nurse is evaluating the effectiveness of drug therapy in a client with hyperlipidemia. Effective therapy is best demonstrated by which laboratory values? a) HDL 58 LDL 96 Cholesterol 178 b) HDL 82 LDL 96 Cholesterol 240 c) HDL 78 LDL 115 Cholesterol 189 d) HDL 58 LDL 115 Cholesterol 210
Answer: HDL 58 LDL 115 Cholesterol 210 Rationale: Normal HDL should be less than 40 mg/dl, LDL should be less than 100 mg/dl, and total cholesterol should be less than 200 mg/dl.
The pharmacology instructor is discussing medications used in the treatment of dyslipidemia. Which of the following drug classes would the instructor identify as the most widely used dyslipidemia drugs? a) Niacin b) Bile acid sequestrants c) HMG-CoA reductase inhibitors d) Fibrates
Answer: HMG-CoA reductase inhibitors Rationale: HMG-CoA reductase inhibitors (or statins) are the most widely used dyslipidemia drugs. They are useful in treating most of the major types of dyslipidemia.
The most common adverse effects of lovastatin include which of the following? a) Increased appetite and blood pressure b) Headache and flatulence c) Hiccups, sinus congestion, and dizziness d) Fatigue and mental disorientation
Answer: Headache and flatulence Rationale: The most common adverse effects of statins include GI symptoms (including nausea, constipation, flatulence, and abdominal pain), headache, and muscle aches. These effects are usually mild and transient.
Increased levels of low-density lipoprotein (LDL) combined with certain risk factors can lead to the development of which medical condition? (Choose one) a) Diabetes b) Heart Disease c) Hypertension d) Glaucoma
Answer: Heart Disease
The nurse is teaching a 45-year-old patient about ways to lower cholesterol levels, as they are elevated. One method to lower cholesterol levels is to exercise, which does what? a) Decreases both HDL and LDL b) Increases LDL and decreases triglycerides c) Increases HDL and decreases triglycerides d) Decreases HDL and increases LDL
Answer: Increases HDL and decreases triglycerides
A patient begins a gemfibrozil medication regimen to lower triglyceride levels. What effect does gemfibrozil have on lovastatin? a) Substantially increases the risk of myopathies b) Increases the blood level of lovastatin c) Increases the elimination of lovastatin d) Increases the effectiveness of lovastatin
Answer: Increases the blood level of lovastatin Rationale: Gemfibrozil may substantially increase the circulating blood levels of some statins, such as lovastatin. The combined use of a fibrate and a moderate-dose statin carries a somewhat increased risk of myopathy, but the incidence is low, especially if used in populations without multisystem diseases or currently taking multiple medications.
Which of the following lipid levels would the nurse interpret as being high? a) HDL cholesterol of 48 mg/dL b) LDL cholesterol of 180 mg/dL c) Triglyceride level of 160 mg/dL d) Total cholesterol of 200 mg/dL
Answer: LDL cholesterol of 180 mg/dL Rationale: LDL level of 180 mg/dL would be considered high. A total cholesterol level of 200 mg/dL would be considered borderline high. A triglyceride level of 160 would be borderline high. HDL level of 48 would be considered low to optimal. Levels about 60 mg/dL would be considered high. (less)
The physician prescribes fibrate for his client with elevated triglycerides. The client begins to self-administer niacin approximately 3 mg daily. What would the nurse expect the physician to order? a) Fibrate level b) CBC c) Electrolyte panel d) LFTs
Answer: LFTs Rationale: Niacin may cause hepatotoxicity, especially with doses greater than 2 g daily, with timed-release preparations, and if given in combination with a statin or a fibrate.
The most common adverse effects of lovastatin (Mevacor) include which of the following? a) Nausea, flatulence, and constipation b) Increased appetite and blood pressure c) Fatigue and mental disorientation d) Hiccups, sinus congestion, and dizziness
Answer: Nausea, flatulence, and constipation Rationale: Gastrointestinal problems such as nausea, vomiting, flatulence, constipation, or diarrhea can occur with lovastatin. Options B, C, and D are not the most common adverse effects of lovastatin.
A female client presents to the physician's office with complaints of a recurrence of her "hot flashes." The nurse understands that the client is taking what drug to treat her dyslipidemia? a) Atorvastatin b) Cholestyramine c) Fenofibrate d) Niacin
Answer: Niacin
A female client presents to the physician's office with complaints of a recurrence of her "hot flashes." The nurse understands that the client is taking what drug to treat her dyslipidemia? a) Atorvastatin b) Niacin c) Fenofibrate d) Cholestyramine
Answer: Niacin
A client is taking cholestyramine (Questran) and ezetimibe (Zetia). What administration guideline is most important to teach this client? a) The two medications should be taken together. b) The ezetimibe inhibits cholesterol in the liver. c) The administration of ezetimibe (Zetia) is four hours after cholestyramine. d) The cholestyramine (Questran) is administered one hour before ezetimibe.
Answer: The administration of ezetimibe (Zetia) is four hours after cholestyramine.
You are caring for a patient who has been prescribed lovastatin to control her blood lipid levels. While teaching her about the medication, you should caution her against consuming large amounts of a) grapefruit juice. b) high-fiber food. c) water. d) orange juice.
Answer: grapefruit juice
A 62-year-old man has been prescribed extended-release lovastatin. The nurse will instruct the patient to take the medication a) in the evening. b) in the early morning. c) at bedtime. d) in the afternoon.
Answer: in the evening Rationale: Patients who are prescribed extended-release lovastatin should take the medication at bedtime, without food, to be most effective. This is because most cholesterol synthesis occurs during this time. Immediate-release lovastatin should be taken after the evening meal. It would not be appropriate to take lovastatin in the afternoon or the early morning.
