FORD: CH: 33 Antihyperlipidemic Drugs
A client asks the nurse about herbal products that can help to lower serum cholesterol and triglycerides. Which herbal product would the nurse include in the response? 1) Black cohosh 2) Ginseng 3) Feverfew 4) Garlic
Correct response: Garlic Explanation: Research has shown that garlic is helpful in lowering serum cholesterol and triglyceride levels. Ginseng is used to enhance memory. Feverfew is used in the herbal treatment of migraine headaches. Black cohosh is beneficial in the menopause and hot flashes.
The three major classes of drugs used to control blood lipids are statins, bile acid resins (or sequestrants), and fibrates. Which is a fibrate? 1) Cholestyramine 2) Colestipol 3) Gemfibrozil 4) Colesevelam
Correct response: Gemfibrozil Explanation: Gemfibrozil is a fibrate. Colestipol, colesevelam, and cholestyramine are bile acid resins.
An elderly client with dyslipidemia has had fenofibrate added to the existing medication regimen. In addition to having the lipid profile drawn on a regular basis, the nurse should educate the client about the need for what ongoing laboratory testing during therapy? 1) INR and aPTT 2) Liver panel 3) Complete blood count (CBC) 4) Reticulocyte count
Correct response: Liver panel Explanation: Because of the risk for hepatotoxicity, clients taking fenofibrate require serial testing of liver enzyme levels. There is no specific need for follow-up with CBCs, coagulation tests, or reticulocyte counts.
A client is taking lovastatin. Which are noted as the most common adverse effects? 1) Hiccups, nasal congestion, and dizziness 2) Increased appetite and blood pressure 3) Nausea, flatulence, and constipation 4) Fatigue and mental disorientation
Correct response: Nausea, flatulence, and constipation Explanation: The most common adverse effects of statins are nausea, constipation, diarrhea, abdominal cramps or pain, headache, and skin rash. The client will not experience increased appetite and blood pressure as adverse effects of statins. The client will not experience fatigue and mental disorientation as adverse effects of statins. The client will not experience hiccups, nasal congestion, and dizziness as adverse effects of statins.
The nurse should be cognizant that niacin therapy is the most effective method of achieving which cardiac-related goal? 1) decreased LDL cholesterol levels 2) reduced total cholesterol levels 3) mitigating the health consequences of hyperlipidemia 4) increased concentration of HDL cholesterol
Correct response: increased concentration of HDL cholesterol Explanation: Niacin, the most effective drug for increasing the concentration of HDL cholesterol, is most helpful in preventing heart disease when used in combination with another dyslipidemic drug such as a bile acid sequestrant or a fibrate. None of the other goals are primarily associated with niacin therapy.
A client has been prescribed lovastatin for high cholesterol. The nurse's teaching plan will include a basic explanation of how the drug produces its therapeutic effect. The nurse will explain that lovastatin lowers cholesterol levels in which manner? 1) is a hormone. 2) inhibits cholesterol syntheses. 3) is a bile-acid resin. 4) consists of a fibric acid derivative.
Correct response: inhibits cholesterol syntheses. Explanation: Lovastatin belongs to a group of drugs classified as statins. These drugs work by inhibiting cholesterol synthesis in the liver. Fibric acid derivatives and bile-acid resins also decrease cholesterol levels but they work at different sites. Fibric acid derivatives work on lipoproteins and triglycerides to reduce cholesterol, and bile-acid resins work in the gastrointestinal tract and bind bile salts in the intestine. Lovastatin is not a hormone.
A 54-year-old client has a cholesterol level of 240 mg/dL (6.2064 mmol/L). What serum concentration of cholesterol would this client have? 1) High 2) Desirable 3) Very high 4) Optimal
Correct response: High Explanation: High is rated at >240 mg/dL (6.2064 mmol/L). The other options are incorrect.
The nurse is teaching a 45-year-old client about ways to lower cholesterol level. What effects of exercise does the nurse describe? 1) Increases high-density lipoproteins (HDLs) and decreases low-density lipoproteins (LDL) 2) Increases LDL and decreases triglycerides 3) Decreases HDL and increases LDL 4) Decreases both HDL and LDL
Correct response: Increases high-density lipoproteins (HDLs) and decreases low-density lipoproteins (LDL) Explanation: Moderate exercise increases HDL levels, which assist in lowering LDL levels. Exercise also decreases triglyceride levels.
HMG-CoA reductase inhibitors (statins) are classified as which pregnancy category? 1) Pregnancy Category C 2) Pregnancy Category X 3) Pregnancy Category B 4) Pregnancy Category A
Correct response: 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.
Which might occur in a client receiving colestipol? 1) Increased vitamin K absorption 2) Vitamin A deficiency 3) Thrombosis 4) Fecal incontinence
Correct response: Vitamin A deficiency Explanation: With cholestyramine, malabsorption of fat soluble vitamins may occur, leading to deficiencies of vitamins A, D, E, and K. Subsequently, the client is at risk for increased bleeding due to decreased absorption of vitamin K and decreased production of clotting factors. Fecal impaction, not incontinence, may occur.
In addition to being synthesized in the liver and intestine, from where are blood lipids derived? 1) medications 2) exercise 3) kidneys 4) diet
Correct response: 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 with a diagnosis of cardiovascular disease is taking atorvastatin calcium to reduce serum cholesterol. What is the goal of therapy for LDL cholesterol for a client taking atorvastatin calcium? 1) 75 to 85 mg/dL (1.94 to 2.20 mmol/L) 2) 100 to 115 mg/dL (2.59 to 2.98 mmol/L) 3) less than 130 mg/dL (3.37 mmol/L) 4) less than 60 mg/dL (1.55 mmol/L)
Correct response: less than 130 mg/dL (3.37 mmol/L) Explanation: In clients with a diagnosis of cardiovascular disease, the goal of therapy is an LDL below 130 mg/dL (3.37 mmol/L).
A client who is receiving cholestyramine also takes digoxin. The nurse teaches the client about the drug and administration. The client demonstrates understanding of the teaching when stating: 1) "I'll take the cholestyramine at 8 AM and the digoxin at 9 AM." 2) "I'll take the digoxin about 15 minutes before the cholestyramine." 3) "I will take the digoxin about an hour before the cholestyramine." 4) "I need to take both drugs at the same time of the day."
Correct response: "I will take the digoxin about an hour before the cholestyramine." Explanation: The absorption of digoxin can be decreased or delayed with cholestyramine, a bile acid sequestrant. Therefore, the digoxin should be taken 1 hour before for 4 to 6 hours after the cholestyramine.
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? 1) Phospholipids 2) Triglycerides 3) Nitroglycerin 4) Cholesterol
Correct response: Cholesterol Explanation: Cholesterol is the portion of blood lipids involved in the formation of atherosclerotic plaques.
The client has been taking rosuvastatin for hyperlipidemia. The client now presents with severe weakness and states barely being able to move the extremities. The nurse suspects the client has which? 1) pruritis. 2) cholelithiasis. 3) cholecystitis. 4) rhabdomyolysis.
Correct response: rhabdomyolysis. Explanation: An adverse reaction of rosuvastatin is muscle toxicity, which may cause rhabdomyolysis. Rhabdomyolysis is the breakdown of muscle that can cause pain, weakness, nausea, and even kidney damage. Gallbladder disorders are related to the use of fibric acid derivatives. Any medication can cause pruritis, however, it is not related to weakness manifested by the use of rosuvastatin.
A client who has been taking a statin has seen an improvement in his cholesterol laboratory values; however, the low-density lipoprotein remains elevated. What medication will be added to the medical regime? 1) Vitamin D 2) Calcium carbonate 3) Digoxin 4) Cholestyramine
Correct response: Cholestyramine Explanation: Cholestyramine is administered to clients to reduce LDL cholesterol in clients who are already taking a statin drug. Digoxin is not given to lower LDL cholesterol. Vitamin D is not given to lower LDL cholesterol. Calcium carbonate is not given to lower LDL cholesterol.
Which agent would a nurse identify as a cholesterol absorption inhibitor? 1) Fenofibrate 2) Simvastatin 3) Colestipol 4) Ezetimibe
Correct response: Ezetimibe Explanation: Ezetimibe is a cholesterol absorption inhibitor. Simvastatin is a HMG-CoA reductase inhibitor. Colestipol is a bile acid sequestrant. Fenofibrate is classified as a fibrate.
A nurse is caring for a client prescribed nicotinic acid for hyperlipidemia. The nurse would assess the client for which findings as a possibility? 1) Weakness 2) Flushing of the skin 3) Tachycardia 4) Dyspnea
Correct response: Flushing of the skin Explanation: The nurse should inform the client prescribed nicotinic acid that flushing of the skin is generally experienced by clients during this treatment. Weakness, tachycardia, and dyspnea are not adverse reactions associated with nicotinic acid.
A 45-year-old client who is a construction worker has been diagnosed with hyperlipidemia and has been prescribed lovastatin. The nurse will advise the client to do which? 1) change to another similar drug if lovastatin proves to be ineffective. 2) avoid prolonged exposure to sunlight. 3) use over-the-counter (OTC) drugs to treat any muscle cramps or pain. 4) drink moderate amounts of alcohol.
Correct response: avoid prolonged exposure to sunlight. Explanation: Since the client works outdoors most of the time, the nurse should advise him to avoid prolonged exposure to sunlight by wearing protective gear. Advising the client regarding the use of OTC drugs and drug changes would be better handled by the prescriber. The client should not drink moderate amounts of alcohol, but should avoid alcohol altogether while taking lovastatin.
A client has been diagnosed with moderately increased LDL, and the primary care provider wishes to start statin therapy. What is a potential disadvantage of statins that the health care provider should consider? Select all that apply. 1) Statins require regularly scheduled blood work. 2) Statins are nephrotoxic. 3) Statins are expensive. 4) Statins have an immunosuppressive effect. 5) Statins are contraindicated in clients with a history of myocardial infarction.
Correct Response: Statins require regularly scheduled blood work. Statins are expensive. Explanation: Because liver enzymes may be elevated during atorvastatin use, clients need liver function tests and repeat lipid profile testing on a routine basis. These drugs are also expensive. They are not nephrotoxic and do not suppress the immune system. Previous MI is an indication for their use, not a contraindication.
After teaching a client about prescribed statin therapy, the nurse determines that additional teaching is needed when the client makes which statement? 1) "I can take the drug with grapefruit juice." 2) "I should take the dose around bedtime." 3) "I need to be careful when I'm out in the sun." 4) "I should report any problems with muscle pain or weakness."
Correct response: "I can take the drug with grapefruit juice." Explanation: The client needs additional teaching when stating that they can take the drug with grapefruit juice. Instead, the client should choose juices other than grapefruit juice because of the risk for an enzyme reaction. The client should take the dose in the evening or at bedtime, use sunscreen and protective clothing to reduce the risk of photosensitivity reactions, and report any muscle pain, tenderness, or weakness to the primary health care provider.
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? 1) "Some clients experience mild chest pain initially." 2) "The more serious side effects of atorvastatin involve a risk of bleeding." 3) "The most common side effects of atorvastatin include some mild gastrointestinal upset." 4) "Most people who experience side effects from atorvastatin report stiffness in their joints."
Correct response: "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.
When describing the action of atorvastatin, which would the nurse include? 1) Blocking the enzyme that is involved in cholesterol synthesis 2) Binding with bile acids to form an insoluble complex that is excreted 3) Decreasing dietary cholesterol absorption from the small intestine 4) Stimulating the breakdown of lipoproteins from the tissues
Correct response: 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 preparing to administer a prescribed bile acid resin to a client with hyperlipidemia. The nurse understands that this class of drugs can decrease serum levels of several medications, primarily via which mechanism? 1) Inhibition of hepatic enzymes 2) Decreased gastrointestinal absorption 3) Increased renal excretion 4) Induction of hepatic enzymes
Correct response: Decreased gastrointestinal absorption Explanation: Bile acid resins can decrease the gastrointestinal absorption of several medications. Hepatic enzymes are inhibited by medications such as propranolol, metoprolol, and valproate to name a few by interfering with metabolism of the drugs. Induction of hepatic enzymes can be related to long-term alcohol abuse, use of spironolactone or phenytoin to name a few. Increased renal secretion can occur as a result of poison treatment to alkalize the urine so that it cannot be reabsorbed into the system but expelled via the urinary tract.
As part of a routine physical examination, a 60-year-old client's primary care provider has ordered blood work that includes cholesterol levels. What result would strongly suggest the need for an antihyperlipidemic drug? 1) Elevated HDL levels 2) Elevated LDL levels 3) A high ratio of HDL to LDL 4) Low VLDL levels
Correct response: Elevated LDL levels Explanation: Elevated LDL levels are considered a risk factor for coronary artery disease. Elevated HDL levels, low VLDL levels, and a high ratio of HDL to LDL are associated with a decreased risk of heart disease.
After reviewing information about antihyperlipidemic drugs, a group of nursing students demonstrate understanding when they identify which medication as a fibric acid derivative (fibrate)? 1) Colesevelam 2) Niacin 3) Ezetimibe 4) Gemfibrozil
Correct response: 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 evaluating the effectiveness of drug therapy in a client with hyperlipidemia. Effective therapy is best demonstrated by which laboratory values? 1) HDL 78 LDL 115 Cholesterol 189 2) HDL 58 LDL 96 Cholesterol 178 3) HDL 82 LDL 96 Cholesterol 240 4) HDL 58 LDL 115 Cholesterol 210
Correct response: HDL 58 LDL 96 Cholesterol 178 Explanation: Normal HDL should be greater than 40 mg/dl, LDL should be less than 100 mg/dl, and total cholesterol should be less than 200 mg/dl.
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? 1) Heart disease 2) Glaucoma 3) Diabetes 4) Hypertension
Correct response: 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.
A client asks how ezetimibe will help to treat high lipid levels. The nurse explains that: 1) 2) stimulating catabolism of triglyceride-rich proteins 3) reduces the production of triglycerides by the liver 4) It decreases the absorption of cholesterol in the small intestine.
Correct response: 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.
The nurse is caring for a client with high serum cholesterol and triglyceride levels. In teaching the client about therapeutic lifestyle changes and the use of medications, the nurse explains that the desired goal for cholesterol levels is what? 1) Reduced low-density lipoprotein (LDL) values and increased HDL values 2) 1:1:1 ratio of LDL, HDL, and total cholesterol 3) Elevated blood lipids and fasting glucose less than 5.6 mmol/L (100 mg/dL) 4) Increased high-density lipoprotein (HDL) values and increased triglyceride values
Correct response: Reduced low-density lipoprotein (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.
A client is taking cholestyramine (Questran) and ezetimibe (Zetia). What administration guideline is most important for the nurse to teach this client? 1) The cholestyramine (Questran) is administered one hour before ezetimibe. 2) The ezetimibe inhibits cholesterol in the liver. 3) The two medications should be taken together. 4) The administration of ezetimibe (Zetia) is four hours after cholestyramine.
Correct response: The administration of ezetimibe (Zetia) is four hours after cholestyramine. Explanation: Ezetimibe (Zetia) should be taken one hour before or four hours after a bile acid sequestrant. The two medications should not be taken together. Ezetimibe acts in the small intestine to inhibit absorption of cholesterol and decrease the delivery of intestinal cholesterol in the liver. Cholestyramine should not be administered one hour after ezetimibe.
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? 1) Therapeutic lifestyle changes work only when used in conjunction with medications. 2) Continued therapeutic lifestyle changes during drug therapy will guarantee success. 3) The needed lifestyle changes are usually easy for most people to achieve. 4) Therapeutic lifestyle changes are the preferred method for lowering blood lipids.
Correct response: 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.
Which category of blood lipids is involved in the formation of atherosclerotic plaques? 1) phospholipids 2) cholesterol 3) triglycerides 4 nitroglycerin
Correct response: cholesterol Explanation: Blood lipids are a category of fatty acids, which are substances used within the body to perform essential functions. Cholesterol is the portion of blood lipids involved in the formation of atherosclerotic plaques. Triglycerides and phospholipids are not involved in the formation of plaque. Nitroglycerin is not a blood lipid.
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? 1) faster excretion 2) decreased absorption 3) increased first-pass effect 4) increased metabolism
Correct response: decreased absorption Explanation: Cholestyramine may decrease absorption of thiazide diuretics. None of the other options are associated with cholestyramine's effect on other medications.
Recommended treatments for clients with dyslipidemia are made according to their blood levels of total and low-density lipoproteins (LDL) cholesterol and risk factors for cardiovascular disease. What does the impact of existing cardiovascular disease have on recommendations? 1) decreases target serum LDL level 2) decreases target serum triglyceride level 3) has no effect on either LDL or HDL levels 4) increases target serum high-density lipoproteins (HDL) level
Correct response: decreases target serum LDL level Explanation: Existing cardiovascular disease entails a lower target LDL serum level in these clients. Such existing conditions are not considered in treating abnormal triglyceride or HDL levels.
The client is diagnosed with hyperlipidemia and prescribed lovastatin. Which is the most common adverse effects of lovastatin? 1) headache and flatulence. 2) increased appetite and blood pressure. 3) hiccups, sinus congestion, and dizziness. 4) fatigue and mental disorientation.
Correct response: headache and flatulence. Explanation: 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. Hiccups, sinus congestion, dizziness, fatigue, mental disorientation, increased appetite or hypertension are not common adverse effects of statin drugs.