Drugs to Manage Cholesterol & Triglycerides
When teaching the nursing student about coronary heart disease, which statement will the nurse include in the session?
"Coronary heart disease occurs because of the formation of atherosclerotic plaques."- "Coronary heart disease is nonlethal and cannot be prevented by antilipemic medications." "Coronary heart disease cannot be prevented by changing lifestyle modifications." "Coronary heart disease is due to decreases in the cholesterol levels to below 200 mg/dL." 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 with hypercholesterolemia who is taking 20 mg of simvastatin as prescribed. After a few days, the patient's urinalysis reports indicated the presence of myoglobin. What instruction would the nurse receive from the primary health care provider?
"Give 10 mg of medication daily." "Give the medication before meals." "Discontinue administering the medication." "Give the medication with 250 mL of water." The presence of myoglobin in the urine indicates that the patient has rhabdomyolysis, an adverse effect of statins such as simvastatin. Rhabdomyolysis is characterized by the breakdown of muscle proteins and can be fatal. The primary health care provider would instruct the nurse to discontinue the medication. Reducing the dose of the medication to 10 mg, giving the medication before meals, or administering the medication with high amounts of fluids does not prevent rhabdomyolysis.
Which patient's statement indicates a need for further medication instruction about colestipol?
"I might need to take fat-soluble vitamins to supplement my diet." "The medication may cause constipation, so I will increase fluid and fiber in my diet." "I should take this medication 1 hour after or 4 hours before my other medications." "I should stir the powder in as small an amount of fluid as possible to maintain potency of the medication."- Colestipol is a powder that must be well diluted in fluids before administration to avoid esophageal irritation or obstruction and intestinal obstruction. The powder should not be stirred because it may clump; it should be left to dissolve slowly for at least 1 minute. The other statements are true and do not need further instruction.
Which statement made by the patient indicates to the nurse that understanding of the discharge instructions on antihyperlipidemic medications has occurred?
"I will stop taking the medication if it causes nausea and vomiting." "It is important to double my dose if I miss one, to maintain therapeutic blood levels." "I will continue to modify my diet and keep exercising to help increase my high-density lipoprotein serum levels."- "Antihyperlipidemic medications will replace the other interventions I have been doing to try to decrease my cholesterol." Antihyperlipidemic medications are an addition to, not a replacement for, the therapeutic regimen of diet modification combined with exercise that is used to decrease serum cholesterol levels. The dose should never be doubled if one is missed nor stopped because of side effects. If the medication causes nausea or vomiting, the healthcare provider should be notified.
Which statement indicates the patient understands discharge instructions regarding cholestyramine?
"I will weigh myself weekly." "I will have my blood pressure checked weekly." "I will take cholestyramine with water, fruit juice, or soup."- "I will take cholestyramine 1 hour before my other medications." Cholestyramine can cause impaction; thus, mixing the powder with water, fruit juice, or soup will reduce the risks of esophageal irritation and impaction. Blood pressure and weekly weights are not necessary while taking this drug. This medication should be taken 2 hours before other medications.
The nurse is assessing a patient's understanding of discharge instructions regarding cholestyramine. Which response assures the nurse that the patient has learned the instructions?
"I will weigh myself weekly." "I will increase fiber in my diet."- "I will have my blood pressure checked weekly." "I will take cholestyramine 1 hour before my other medications." Cholestyramine can cause constipation; thus increasing fiber in the patient's diet is appropriate. All other drugs should be taken 1 hour before or 4 hours after cholestyramine to facilitate proper absorption. Monitoring the patient's weight and blood pressure are both important nursing interventions for patient teaching but are less likely to affect the dosage of cholestyramine.
Which discharge instructions should the nurse include for a patient prescribed cholestyramine?
"Mix the drug with water or juice."- "Take with all other morning medications." "Take 325 mg of aspirin 30 minutes before each dose." "Notify the health care provider if upper abdominal discomfort occurs." Cholestyramine is supplied in powdered form. The nurse should instruct the patient to mix the powder with liquids that include water, fruit juices, and soups because swallowing it can cause esophageal irritation. Certain oral medications should be administrated 1 hour before the sequestrant or 4 hours after. Flushing can occur with niacin and can be reduced by taking 325 mg of aspirin 30 minutes before each dose. Gemfibrozil increases the risk of gallstones manifested with symptoms such as upper abdominal discomfort.
The nurse teaches the nursing student about statin drugs. Which statements by the student indicate effective learning? Select all that apply.
"Statins can be used along with gemfibrozil." "Simvastatin is the less potent inhibitor of CYP3A4 enzyme." "Fluvastatin with warfarin increases the risk of bleeding."- "Pravastatin is not as effective as simvastatin for the inhibition of CYP3A4."- "Atorvastatin with cyclosporine decreases the risk of rhabdomyolysis." Fluvastatin increases the risk of bleeding when taken along with warfarin. This effect is observed because of an increase in the concentration of warfarin in the presence of statins. Pravastatin inhibits cytochrome P450 3A4 (CYP3A4) to a much lesser extent than simvastatin because it is less potent than other statins. Statins should not be taken along with gemfibrozil because it increases the risk of rhabdomyolysis. Simvastatin is the most potent inhibitor of the CYP3A4 enzyme. Atorvastatin with cyclosporine increases the risk of rhabdomyolysis secondary to drug interaction.
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.
"Take your medication in the morning, with a full glass of water, for best results." "Lower the total fat and saturated fat in your diet by increasing your intake of fresh fruits and vegetables and whole grains."- "Do not start any new medications without first talking to your health care provider."- "Take one 325-mg aspirin 30 minutes before your dose to lessen the problem of flushing and itching that can occur with this drug." "Before starting this medication a blood test will be done to check your total cholesterol level and measure liver enzymes."- 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 is prescribed a therapeutic lifestyle change (TLC) diet. The patient understands the diet when he states which of the following?
"The TLC diet was prescribed to help me reduce my low-density lipoproteins (LDL) cholesterol and maintain a healthy weight."- "The TLC diet was prescribed to help me reduce my high-density lipoproteins (HDL) and gain weight." "The TLC diet was prescribed to help me lose weight and keep if off." "The TLC diet was prescribed for me to eat more trans fats (T), lean (L) meat, and have few carbohydrates (C) each day." The TLC diet stands for therapeutic lifestyle changes and was prescribed to help reduce LDL cholesterol and maintain a healthy weight. The diet is not used to reduce HDL, gain weight, nor eat more trans fats and fewer carbohydrates.
The nurse is caring for a patient prescribed gemfibrozil. For which patient should the nurse question the use of this drug?
A patient with history of gallstones A patient with elevated triglycerides A patient with cardiovascular disease A patient with elevated very-low-density lipoprotein (VLDL) levels 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.
Which therapeutic lifestyle changes are shown to reduce low-density lipoprotein (LDL) cholesterol? Select all that apply.
Active exercise for 30-60 minutes five days a week- Reduction of tobacco to occasional use Active exercise for 15 minutes two to three days a week Reduction of saturated fat intake- Weight loss with metabolic syndrome-
The nurse understands that cholesterol is carried through the blood by lipoproteins. Which lipoprotein is most closely associated with coronary atherosclerosis?
Apolipoprotein B-100 Low-density lipoprotein (LDL)- High-density lipoprotein (HDL) Very-low-density lipoprotein (VLDL) 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.
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?
Aspirin- Lisinopril Nifedipine Levothyroxine 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.
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?
Cirrhosis Hepatitis Nephritis Rhabdomyolysis- 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.
The nurse is caring for a patient who has elevated triglyceride levels and is unresponsive to HMG-CoA reductase inhibitors. What does the nurse expect the primary health care provider to prescribe to the patient?
Colestipol Gemfibrozil- Simvastatin Cholestyramine Gemfibrozil can be prescribed to the patient because it promotes catabolism of triglycerides and is highly effective in lowering plasma triglyceride levels. Cholestyramine lowers the cholesterol level, particularly the low-density lipoprotein (LDL) cholesterol level. It is used for constipation. Colestipol lowers the cholesterol level, particularly the LDL cholesterol level by increasing the destruction of LDL, and it is not as effective as statins. Simvastatin is used primarily to lower total and LDL cholesterol levels as well as triglyceride levels. It cannot be used in the patient as the patient is unresponsive to statins.
Which assessment finding in a patient taking a hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor will the nurse act on immediately?
Decreased hemoglobin Elevated liver function tests- Elevated low-density lipoprotein (LDL) cholesterol Elevated high-density lipoprotein (HDL) cholesterol 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.
The nurse is teaching a group of patients about dietary approaches to reduce cholesterol levels. Which statement is most important to include in the teaching?
Eliminate red meat and pork from your diet." "Lower your cholesterol intake to 300 mg/day." "Read food labels and reduce your intake of saturated fats."- "Reduce salt consumption to keep your sodium intake to 2400 mg/day." An increase in dietary cholesterol intake does not produce a large increase in blood cholesterol because of the body's feedback system. When cholesterol intake increases, endogenous production decreases. However, because the body uses dietary saturated fats to make cholesterol, an increase in saturated fat intake can produce a significant increase in blood cholesterol levels. To lower blood cholesterol, it is most important to lower saturated fat intake. Although red meat and pork should be limited, it is not necessary to eliminate them from the diet. Sodium intake is not directly related to lowering cholesterol levels.
A patient with hyperlipidemia is prescribed atorvastatin; however, the patient does not want to take a pill and prefers powder form. What alternative medication available in powder form would be most beneficial for the patient?
Ezetimibe Fluvastatin Simvastatin Colesevelam- Colesevelam is a bile acid sequestrant and is also available in a powder form. The patient must be instructed to mix the powder thoroughly with food or fluids (at least 4 to 6 oz of fluid). This drug is considered second-line after the more potent statins. Fluvastatin, ezetimibe, and simvastatin are only available in tablet form and cannot be prescribed for the patient who has a fear of taking pills.
A patient is taking pravastatin sodium. Which assessment finding requires immediate action by the nurse?
Fatigue Headache Muscle pain- Slight nausea Patients who experience severe muscle pain while taking pravastatin sodium need to report the findings right away because this may be indicative of rhabdomyolysis, a muscle disintegration that can become fatal. Headaches, slight nausea, and fatigue are not high-priority symptoms and may not be caused by the medication. Muscle pain is the only one that is most likely caused by the medication with the most detrimental effects.
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.
Gallstone development Nonalcoholic fatty liver disease Increased serum transaminase levels- Unexplained muscle pain or tenderness- Elevated creatinine kinase (CK) level with muscle pain- 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.
Which drug is the most effective for lowering low-density lipoprotein (LDL) cholesterol?
Gemfibrozil Ezetimibe Atorvastatin- Cholestyramine 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 statins.
The nurse is caring for a patient who takes multiple cholesterol-lowering drugs. Which drug is least likely to cause systemic side effects?
Gemfibrozil Simvastatin Colesevelam- Nicotinic acid Colesevelam, a bile acid sequestrant, is a nonabsorbable resin that works directly in the gastrointestinal tract. Because it and other bile acid sequestrants (eg, cholestyramine [Questran] and colestipol [Colestid]) are not absorbed, they do not have systemic effects. The most common complication of bile acid sequestrants is constipation. The other agents have potential systemic adverse effects as they are systemically absorbed.
The nurse would question an order for colesevelam if the patient has which condition in the medical history?
Glaucoma Constipation- Renal disease Hepatic disease Colesevelam binds with bile acids and other substances in the gastrointestinal tract, thereby preventing their absorption and promoting their excretion. Constipation is the main complaint. Glaucoma, hepatic disease, and renal disease are not contraindications to using this medication.
Which are beneficial effects that can be derived from simvastatin and other drugs in this class? Select all that apply.
Improvement of liver function Reduction of risk of cardiovascular events- Reduction of low-density lipoproteins (LDLs)- Elevation of high-density lipoproteins (HDLs)- Stabilization of the plaque in coronary arteries- 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.
When will the nurse administer hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins)?
In the evening- With breakfast With an antacid On an empty stomach 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 teaching a medication regimen to a patient who has type II hyperlipoproteinemia and who has been prescribed cholestyramine. Of what will the nurse inform the patient during the teaching?
Include milk in the diet while taking this medication. Avoid taking vitamin A supplements while taking the medication. Avoid doing deep breathing exercises after taking the medication. Take other medications 1 hour before or 4 hours after the administration of cholestyramine.- Bile acid sequestrants such as cholestyramine should not be taken along with other medications because of reduced absorption. Other drugs must be taken at least 1 hour before or 4 to 6 hours after taking the bile sequestrant. Milk reduces peristalsis and is therefore not included in the diet. It reduces the absorption of fat-soluble vitamins (A, D, E, and K); therefore, to prevent a vitamin A deficiency, the nurse will suggest that the patient take vitamin A supplements. Cholestyramine does not impair the pulmonary function, so the patient does not need to avoid practicing deep breathing exercises.
A patient with hypercholesterolemia has been prescribed simvastatin. Which action should the nurse perform while caring for the patient?
Instruct the patient to take aspirin for pain relief. Inform the patient that this drug may cause nausea.- Inform the patient that allergies are a side effect of the drug. Instruct the patient to discontinue the drug in case of muscle pain. 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.
What is the mechanism of action of ezetimibe?
It inhibits the biosynthesis of cholesterol in the liver. It decreases the adhesion of cholesterol on the arterial walls. It inhibits absorption of dietary and biliary cholesterol in the small intestine.- It inhibits the absorption of bile, thus causing the liver to produce bile from cholesterol. Ezetimibe works by selectively inhibiting the absorption of cholesterol and related sterols in the small intestine. The mechanism of action of ezetimibe does not involve the liver or arterial walls.
A patient with cardiovascular disease is taking rosuvastatin. Which finding would indicate a potential adverse effect of this drug?
Muscle pain and tenderness- Platelet count of 100 × 10 3/mm 3 Blood pressure of 140/90 mm Hg Wheezing and shortness of breath The statins, such as rosuvastatin, typically are well tolerated; however, in rare cases they can cause the serious adverse effect of myopathy and rhabdomyolysis. If unexplained muscle pain and tenderness develop, the prescriber should be notified. The other effects would not likely be caused by rosuvastatin.
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?
Myopathy- Blurred vision Bowel obstruction Hepatic dysfunction 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.
Rash- Constipation Cutaneous flushing Nausea and abdominal pain- Increase in gallstone formation- 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.
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?
Stop taking the drug and visit the clinic immediately."- "Continue taking the drug; leg pain is a common side effect." "Stop taking the drug if the symptoms persist for another week." "Continue taking the drug along with niacin and a pain killer." 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.
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?
Take atorvastatin at bedtime. Avoid all alcoholic beverages. Engage in moderate exercise.- Adhere to the blood test schedule. 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.
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?
The patient has a history of rhabdomyolysis. The patient took atorvastatin with gemfibrozil. The patient is taking the medication in the morning.- The patient consumed more than 8 ounces of grapefruit juice per day. 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.
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?
The patient has leukemia. The patient has renal disease. The patient has hepatic disease.- The patient has chronic pulmonary disease (COPD). 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.
An elderly patient with hypertension and hyperlipidemia who has been prescribed a statin medication comes for a follow-up visit after 4 months of therapy. The patient's laboratory reports show elevated blood cholesterol levels, and the urine examination reveals rhabdomyolysis. What could be the reasons for this condition? Select all that apply.
The patient is not responding to the treatment. The patient is taking cyclosporine along with statins.- The patient is eating fiber-rich food along with statins. The patient is taking grapefruit juice along with statins.- The patient is taking amiodarone along with statins.- Grapefruit juice, amiodarone, and cyclosporine inhibit the metabolic protein cytochrome P450 3A4 (CYP3A4) and thus decrease the metabolism of the statins. This leads to sustained blood levels of unmetabolized statins and rhabdomyolysis. As statins are not metabolized completely, less of the drug is available in the patient to decrease the blood cholesterol levels; the patient will still show elevated blood cholesterol levels with rhabdomyolysis. Statins are highly effective in reducing cholesterol levels, and it is unlikely that the patient is not responding to the therapy. Fiber intake does not affect the metabolic protein CYP3A4. It is unlikely that these symptoms are caused due to the intake of fiber-rich food.
Before the nurse administers simvastatin, which baseline data are collected to help prevent adverse effects of therapy? Select all that apply.
Uric acid Potassium Muscle pain- Liver enzymes- Renal function- Gastric distress- Simvastatin is a hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor, or statin, that is used to decrease the serum low-density lipoprotein cholesterol by decreasing its synthesis in the liver. The nurse checks the patient for muscle pain and assesses the liver enzymes because adverse effects of statin therapy include myositis, rhabdomyolysis, and liver dysfunction. The nurse assesses renal function because serious adverse effects of therapy involving the muscles can result in renal dysfunction. Gastric distress is also assessed to establish baseline data about nausea and vomiting, which are potential adverse effects of a statin. Assessment of the serum uric acid and serum potassium levels are reasonable nursing interventions before the administration of medication; however, these parameters are unrelated to the adverse effects of statin therapy.
