phram prepu 10: Drug Therapy for Dyslipidemia

The nurse is preparing to teach a client with hyperlipidemia about the prescribed cholestyramine. Which instruction should the nurse prioritize for the client?

"Eat foods high in dietary fiber." Explanation: The nurse should instruct the client taking cholestyramine to eat foods high in dietary fiber to prevent constipation. The nurse should instruct the client to exercise to prevent constipation. Clients are asked to take a water-soluble form of vitamin A (not vitamin D) if they are experiencing impaired digestion of fats and absorption of the fat-soluble vitamins due to long-term therapy of bile acid sequestrants.

The nurse is taking a health history on a 58-year-old client who is taking atorvastatin for high cholesterol. What assessment question should the nurse prioritize related to the safe use of this drug?

"How many alcoholic drinks do you have in a typical day or week?" Explanation: Hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors are contraindicated with active liver disease or a history of alcohol-related liver disease, so it is important for the nurse to ask about the client's use of alcohol. For most clients, heavy alcohol use would be more dangerous than high caffeine intake or the use of OTC medications. Exercise has multiple benefits and should be encouraged by the nurse, but it is unrelated to safe medication use.

Which would be classified as a bile acid sequestrant?

Cholestyramine Explanation: Cholestyramine is classified as a bile acid sequestrant. Lovastatin is a HMG-CoA reductase inhibitor. Ezetimibe is a cholesterol absorption inhibitor. Gemfibrozil is classified as a fibrate.

Elevated blood lipids are a major risk factor for atherosclerosis and vascular disorders. From where are blood lipids derived?

Diet Explanation: Blood lipids, which include cholesterol, phospholipids, and triglycerides, are derived from the diet or synthesized by the liver and intestine. Medications, exercise, and the kidneys do not play a role in synthesis.

A patient with hyperlipidemia is prescribed ezetimibe. Which ongoing assessment should the nurse perform during treatment?

Frequently monitor blood cholesterol. Explanation: 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 what as the storage location of bile acids?

Gallbladder Explanation: The presence of fatty acids, lipids, and cholesterol in the duodenum stimulates contraction of the gallbladder and the release of bile, which contains bile acids. Once their action is completed, they are reabsorbed and recycled to the gallbladder, where they remain until the gallbladder is stimulated again.

The nurse instructs a client to take the prescribed pravastatin at bedtime based on understanding that:

Greater drug effectiveness is achieved at this time. Explanation: The drug is administered at bedtime because the highest rates of cholesterol synthesis occur between 12 and 5 AM, and the drug should be taken when it will be most effective.

The pharmacology instructor is discussing medications used in the treatment of dyslipidemia. Which drug class would the instructor identify as the most widely used dyslipidemia drugs?

HMG-CoA reductase inhibitors Explanation: 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.

What is the most common reason for an elevated cholesterol level in a client who does not have a genetic disorder of lipid metabolism?

His dietary intake of saturated fat Explanation: Unless a person has a genetic disorder of lipid metabolism, the amount of cholesterol in the blood is strongly related to dietary intake of saturated fat.

A client asks how ezetimibe will help to treat high lipid levels. The nurse explains that:

It decreases the absorption of cholesterol in the small intestine. Explanation: Ezetimibe inhibits the absorption of cholesterol by the small intestine. Fibric acid derivatives work by stimulating catabolism of triglyceride-rich proteins. Gemfibrozil reduces the production of triglycerides by the liver.

A nurse is preparing to administer colesevelam to a client with hyperlipidemia. The nurse determines cautious administration is warranted after noting which condition in the client's history?

Liver disease Explanation: Bile acid resins should be used cautiously in clients with diabetes, liver, peptic ulcer or kidney disease, and during pregnancy and lactation. Colesevelam is administered with caution in clients with liver disease. Niacin is used with caution in clients with unstable angina. Statins should be used cautiously in clients with hypotension and an acute infection.

The nurse is preparing to administer colestipol to the client. Which method should the nurse prioritize to administer this medication?

Mix the drug in 90 mL of liquid. Explanation: The nurse should mix the drug in 90 mL of liquid, soups, cereals, carbonated drinks, or pulpy fruits when administering the colestipol granules to the client. Cholestyramine powder is mixed in 2-6 fluid ounces of water. Colestipol tablets are not crushed. Colesevelam tablets are taken once or twice daily with meals.

HMG-CoA reductase inhibitors (statins) are classified as which pregnancy category?

Pregnancy Category X Explanation: HMG-CoA reductase inhibitors (statins) are in pregnancy category X and contraindicated during any stage of pregnancy. Medications in pregnancy category A are considered safe. Medications classified as pregnancy category B, studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women. For pregnancy category C, studies have shown adverse effects to the fetus; however, benefit may outweigh the potential harm—the risk has not been ruled out.

What should the nurse review about an antihyperlipidemic medication with the client when completing discharge counseling? (Select all that apply.) Reason for taking the prescribed drug Drug name Correct dose Frequency of administration Dosage form

Reason for taking the prescribed drug Drug name Correct dose Frequency of administration Dosage form Explanation: The nurse should review the reasons for the drug and prescribed therapy, including drug name, form and method of preparation, correct dose, and frequency of administration as part of a client's discharge counseling.

A client has had cholestyramine added to his or her treatment plan for dyslipidemia. What effect will cholestyramine have on the pharmacokinetics of the thiazide diuretic that the client is currently prescribed?

decreased absorption Explanation: Cholestyramine may decrease absorption of thiazide diuretics. None of the other options are associated with cholestyramine's effect on other medications.

A nurse is caring for a client who has been prescribed lovastatin to control blood lipid levels. While teaching the client about the medication, the nurse should caution against consuming large amounts of which?

grapefruit juice. Explanation: Consumption of large amounts of grapefruit juice during lovastatin therapy can increase serum drug levels. Consumption of water, high-fiber food, and orange juice does not increase serum drug levels.

The nurse is teaching a 45-year-old client about ways to lower cholesterol level. What effects of exercise does the nurse describe on high-density lipoproteins (HDLs) and low-density lipoproteins (LDLs)?

increases HDL and decreases LDL Explanation: Moderate exercise increases HDL levels, which assist in lowering LDL levels. Exercise also decreases triglyceride levels.

The nurse is caring for a client who has been diagnosed with high serum cholesterol and triglyceride levels. In teaching the client about therapeutic lifestyle changes and the use of medications, the nurse explains the desired goal for cholesterol levels is what?

reduced LDL values and increased HDL values Explanation: The desired goal for cholesterol readings is for a client to have low LDL and high HDL values. Consequently, a 1:1:1 ratio of LDL, HDL, and total cholesterol would not be desirable. HDL serves as a protective mechanism to reduce cholesterol, so higher levels are desirable. Elevated blood lipids are never desirable, but control of blood sugar levels reduces CAD risk.

After reviewing information about antihyperlipidemic drugs, a group of nursing students demonstrate understanding when they identify which medication as a fibric acid derivative (fibrate)?

After reviewing information about antihyperlipidemic drugs, a group of nursing students demonstrate understanding when they identify which medication as a fibric acid derivative (fibrate)? Gemfibrozil Explanation: Gemfibrozil is a fibric acid derivative. Colesevelam is a bile acid resin. Niacin is classified as a miscellaneous antihyperlipidemic. Ezetimibe is a miscellaneous antihyperlipidemic.

The nurse is providing education to an older adult client who has been prescribed atorvastatin. How should the nurse describe the common adverse effects of the drug?

"The most common side effects of atorvastatin include some mild gastrointestinal upset." Explanation: Statins like atorvastatin are usually well tolerated. The most common adverse effects (nausea, constipation, diarrhea, abdominal cramps or pain, headache, skin rash) are usually mild and transient. Chest pain, joint stiffness, and bleeding are not common adverse effects.

Blood lipids are a category of fatty acids, which are substances used within the body to perform essential functions. Which category of blood lipids is involved in the formation of atherosclerotic plaques?

Cholesterol Explanation: Cholesterol is the portion of blood lipids involved in the formation of atherosclerotic plaques.

The nurse is doing teaching about cholesterol and its role in cardiovascular disease. In addition to promoting cessation of cigarette smoking and a healthy lifestyle with diet and exercise to correct cholesterol abnormalities, the nurse explains that there are two modifiable conditions that have been cited as major risk factors for CAD and its complications. What are these two conditions?

Cholesterol abnormalities and hypertension Explanation: Four modifiable risk factors include cholesterol abnormalities, cigarette smoking, diabetes, and hypertension and have been cited as major risk factors for CAD and its complications.

A male client presents to the health care provider's office with symptoms of hyperglycemia. He is taking his oral antidiabetic medication and has not modified his diet or exercise program in any way. When the nurse interviews the client, he states that he now takes flax seed to reduce his cholesterol level. What may occur as a result of taking flax seed?

Decreased absorption of his drugs Explanation: Flax or flax seed is used internally as a laxative and a dyslipidemic agent. Absorption of all medications may be decreased when taken with flax, resulting in a less than therapeutic effect.

Which adverse effect would a nurse expect to assess in a client taking ezetimibe?

Mild abdominal pain Explanation: Mild abdominal pain is a common adverse effect. Ezetimibe is not associated with bloating. Ezetimibe is not associated with flatulence. Diarrhea is a common adverse effect.

A patient with very high serum triglyceride levels is prescribed the fibric acid derivative clofibrate. In which of the following categories of patients is the use of clofibrate contraindicated?

Patients with primary biliary cirrhosis Explanation: The fibric acid derivative clofibrate is contraindicated in patients with primary biliary cirrhosis. The use of clofibrate is not contraindicated in patients with endocrine disorder. The HMG-CoA reductase inhibitors are used with caution in patients with a history of endocrine disorders. Niacin is contraindicated in patients with arterial bleeding. The fibric acid derivative clofibrate is not contraindicated in patients with respiratory depression.

What should the nurse suggest to assist a client to improve his cholesterol levels?

Smoking cessation Explanation: Lifestyle changes that can help improve cholesterol levels include a low-fat diet, regular aerobic exercise, losing weight, and not smoking.

A client with moderately elevated lipid levels requests immediate pharmacotherapy for dyslipidemia. The nurse explains that a period of intensive diet therapy and lifestyle modification will be utilized before drug therapy is considered based on what rationale?

Therapeutic lifestyle changes are the preferred method for lowering blood lipids. Explanation: Nonpharmacologic interventions are always preferred to pharmacologic ones if there is potential for success. Medications are to be used only when nonpharmacologic efforts have proven unsuccessful. Appropriate lifestyle changes should be maintained, but adherence will not guarantee success. Many clients may find lifestyle changes (e.g., smoking cessation) challenging.

The nurse explains to a client the action of a hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor. What enzyme does the nurse state this drug inhibits?

an enzyme that controls the production of cellular cholesterol Explanation: HMG-CoA reductase is an enzyme that controls the final step in production of cellular cholesterol. Some fats are used immediately for energy. Bile acids act like detergents to break down or metabolize fats into small molecules called micelles, which are absorbed into the intestinal wall and combined with proteins to become chylomicrons, to allow transport throughout the circulatory system. Cholesterol is a fat that is used make bile acids.

In addition to being synthesized in the liver and intestine, from where are blood lipids derived?

diet Explanation: Blood lipids, which include cholesterol, phospholipids, and triglycerides, are derived from the diet or synthesized by the liver and intestine. None of the remaining options are capable of synthesizing or even stimulating the synthesis of blood lipids.

A client's serum cholesterol is 286 mg/dL. Lovastatin (Mevacor) is prescribed. The nurse plans care based on the fact that the action of lovastatin:

inhibits the production of cholesterol. Explanation: Statin drugs inhibit the production of cholesterol and promote the breakdown of cholesterol. Bile acid resins bind to bile acids to form insoluble substances that cannot be absorbed.

A client diagnosed with hyperlipidemia has been taking atorvastatin for several months. How can the therapeutic effect of the medication be determined?

reviewing the client's laboratory blood work results Explanation: The benefits of lipid-lowering agents are frequently not perceived by the client and do not often change the client's day-to-day cardiac function or activity level. They are most often assessed by reviewing the client's cholesterol levels.

The client receives a prescription for niacin. The nurse is providing education about the medication and possible adverse effects. Which adverse affect would the nurse include?

"Some people get very flushed skin when they take this medication." Explanation: Niacin is associated with intense cutaneous flushing, nausea, and abdominal pain, making its use somewhat limited. A full body rash should always be reported and self-limiting nausea is not expected. There is no need to avoid shellfish or contrast solution when taking niacin.

When describing the action of atorvastatin, which would the nurse include?

Blocking the enzyme that is involved in cholesterol synthesis Explanation: HMG-CoA reductase inhibitors, such as atorvastatin, block the enzyme involved in cholesterol synthesis. Bile acid sequestrants block bile acids to form insoluble complexes for excretion in the feces. Fibrates stimulate the breakdown of lipoproteins from the tissues and their removal from the plasma. Cholesterol absorption inhibitors work in the brush border of the small intestine to decrease absorption of dietary cholesterol from the small intestine.

A nurse is providing care to a client who has elevated levels of low-density lipoprotein (LDL). A review of the client's history reveals a sedentary lifestyle and a history of being overweight. The nurse understands that this combination of factors places the client at risk for which condition?

Heart disease Explanation: Increased levels of LDL in combination with other risk factors, such as increased weight, diet high in saturated fats, and lack of physical activity, can lead to the development of atherosclerotic heart disease. In diabetes high levels of blood glucose as well as HbA1c are seen. In clients with glaucoma, increased eye pressure causes damage to the optic nerve. Clients with hypertension left untreated can lead to kidney failure and stroke.

Statin drugs help lower cholesterol, LDL, and triglycerides by which mechanisms? (Select all that apply.) Statin drugs help lower cholesterol, LDL, and triglycerides by which mechanisms? (Select all that apply.) Decreasing absorption of cholesterol from the GI tract Promoting the breakdown of cholesterol Increasing the storage of cholesterol as fat Decreasing the breakdown of fat to cholesterol

Promoting the breakdown of cholesterol Inhibiting the manufacturing of cholesterol Promoting the breakdown of cholesterol and inhibiting the manufacture of cholesterol are the mechanisms by which statin drugs lower cholesterol.

The client presents for a routine clink visit to evaluate the long-term use of cholestyramine. The health care provider determines vitamin A and D should be prescribed at this time. The nurse determines which nursing diagnose is most appropriate at this time?

Risk for imbalanced nutrition: less than body requirements Explanation: Bile acid resins may interfere with the digestion of fats and prevent the absorption of the fat-soluble vitamins (vitamins A, D, E, and K) and folic acid. Therefore, the nursing diagnosis of risk for imbalanced nutrition: less than body requirements would be most appropriate. Adverse reactions associated with nicotinic acid such as flushing would suggest a risk for impaired skin integrity. Constipation would be associated with statin therapy. Risk for injury may be appropriate for clients taking fibrates or statins.

The nurse cares for a 10-year-old client who has been diagnosed with hypercholesterolemia. What is the most common cause of hypercholesterolemia in pediatric clients?

familial connection Explanation: Familial hypercholesterolemia may be seen in pediatric clients. Because of the importance of lipids in the developing nervous system, treatment is usually restricted to tight dietary restrictions to limit fats and calories. Gender, diet, or exercise-resistant hypercholesterolemia is possible in children, but they are not the most common causes.

A nurse is caring for a male patient who has a diagnosis of coronary artery disease (CAD). His drug therapy includes lovastatin. Because the patient has a history of severe renal disease, the nurse will assess for a(n):

increase in plasma concentration of lovastatin. Explanation: Patients with severe renal disease may have an increased plasma concentration of lovastatin because 10% of the drug is eliminated in the urine. Patients with renal disorders are not likely to experience a decrease in LDL or an increase in the statin tolerance level.

The nurse is preparing to teach a client about diet therapy when beginning bile sequestrant medication to lower lipid levels. What important point will the nurse include in the teaching plan?

increasing fiber intake Explanation: The nurse would want to teach this client to increase fiber intake to avoid constipation that often occurs with this medication. Protein intake does not need to be reduced, but the client should be taught to avoid fatty protein and instead meet protein needs with vegetable proteins, fish, and lean poultry. Carbohydrate intake should be reduced if weight loss is needed, otherwise, no change is needed. Fluid intake should be maintained or increased if there are no diagnoses that would contraindicate fluid intake to help avoid constipation.

The nurse is assessing a client who reports taking cholestyramine mixed with diet cola twice per day. What would the nurse assess the client for at this time?

knowledge deficit Explanation: Cholestyramine should be mixed with water or other noncarbonated fluids, so the nurse now recognizes the need for medication teaching and assesses the client's level of knowledge deficit. Nothing in this question indicates that the client is experiencing any adverse effects from the drug, so constipation would not be assessed. This practice does not create a risk of infection or malnutrition.