Lipid Lowering Drugs

A patient must wait how long after the administration of a bile-acid sequestrant before taking another medication?

4 hours

Saturated fats should be what percent of the caloric intake?

< 7%

Which medication will most likely be prescribed for a patient in need of more omega-3 fatty acids? a. Lovaza b. Zetia c. Niacin d. A bile-acid sequestrant

A

When taking a fibrate, you need to monitor all of the following tests EXCEPT: a. INR b. Uric acid c. Prothrombin time d. Total bilirubin

B

What is the most effective medication for lowering triglyceride levels? a. Statins b. Niacin c. Bile-acid sequestrants d. Fibrates

D

Statins should be taken at what time of the day?

Evening

What medicines are used to premedicate patients prior to Niacin?

ASA or ibuprofen to limit flushing

Cholesterol is mainly produced when?

At night

How does ezetimibe (Zetia) work?

Blocks reabsorption of dietary and biliary cholesterol

How often should adults be screened for high cholesterol?

Every 5 years

The triglycerides are carried by which lipoproteins?

VLDL

Lovaza is used to decrease which lipid?

Triglycerides.

What are the side effects of ezetimibe (Zetia)?

*Myopathy*, *rhabdomyolysis*, *pancreatitis, hepatitis*, thrombocytopenia.

Fibrates can cause what gastrointestinal dysfunction?

*Gallstones*, nausea, diarrhea, and abdominal pain

What is the most effective medication for lowering LDL, total cholesterol, and raising HDL? a. Statins b. Niacin c. Bile-acid sequestrants d. Fibrates

A

Which of the following labs would be unnecessary to monitor when taking niacin? a. CK b. LFTs c. Glucose levels d. Uric acid

A

Which discharge instructions should the nurse include for a patient prescribed cholestyramine [Questran]? a. Mix the drug with water or juice. b. Take with all other morning medications. c. Take 325 mg of aspirin 30 minutes before each dose. d. Notify the healthcare provider if upper abdominal discomfort occurs.

A (Cholestyramine [Questran] is supplied in powdered form. 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 and fenofibrate increase the risk of gallstones manifested with symptoms such as upper abdominal discomfort.)

Which drug is the most effective for lowering LDL cholesterol? a. Atorvastatin [Lipitor] b. Cholestyramine [Questran] c. Gemfibrozil [Lopid] d. Ezetimibe [Zetia]

A (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.)

Which are beneficial effects that can be derived from simvastatin [Zocor] and other drugs in this class? (Select all that apply.) a. Reduction of LDLs b. Elevation of HDLs c. Stabilization of the plaque in coronary arteries d. Reduction of risk of cardiovascular events e. Improvement of liver function

A B C D (The statin drugs have many benefits, the most important being reduction of LDLs. They also promote an increase in HDLs, stabilization of atherosclerotic plaque, and reduced inflammation at the plaque site. Among other benefits, they also slow progression of coronary artery calcification. The statins reduce the overall risk of cardiovascular events. They can have serious adverse effects on the liver, but these are relatively rare.)

The healthcare provider prescribes lovastatin [Mevacor] for a patient discharged from the hospital post-myocardial infarction. Which instructions are most appropriate for the nurse to include in the patient's teaching plan? (Select all that apply.) a. "Do not start any new medications without first talking to your healthcare provider." b. "Before starting this medication a blood test will be done to check your total cholesterol level and to measure liver enzymes." c. "Take your medication in the morning, with a full glass of water for best results." d. "Take one 325-mg aspirin 30 minutes before your dose to lessen the problem of flushing and itching that can occur with this drug." e. "Lower the total fat and saturated fat in your diet by increasing your intake of fresh fruits and vegetables and whole grains."

A B E (Lovastatin, simvastatin, and atorvastatin levels may be elevated when these drugs are combined with other drugs that inhibit CYP3A4. If these drugs are combined, caution is warranted. Before starting a statin, obtain a baseline lipid profile that includes total cholesterol and obtain baseline LFTs. 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.)

Carbohydrates may increase WHAT? a. High density lipoproteins b. Triglycerides c. Low density lipoproteins d. Very low density lipoproteins

B

Statins cause what two severe adverse effects? a. Nausea and vomiting b. Hepatotoxicity and myopathy c. Ototoxicity and hypokalemia d. Renal failure and tinnitus

B

What is a common side effect of taking niacin? a. Tinnitus b. Flushing c. Constipation d. Orthopnea

B

What is the most effective medication for raising HDL? a. Statins b. Niacin c. Bile-acid sequestrants d. Fibrates

B

The nurse is caring for a patient prescribed a cholesterol-lowering drug. Which drug is least likely to cause systemic side effects? a. Simvastatin [Zocor] b. Colesevelam [Welchol] c. Nicotinic acid [Niaspan] d. Gemfibrozil [Lopid]

B (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 bile acid sequestrants' most common complication is constipation. The other agents have potential systemic adverse effects.)

Your patient is taking a statin. They state they do not have muscle pain. Which of the following tests would NOT need to be monitored? a. AST b. CK c. ALT d. Total bilirubin

B (Creatine kinase does not need to be monitored unless the patient has muscle pain, to monitor for myopathy.)

Which of the following is NOT a gastrointestinal dysfunction caused by fibrates? a. Gallstones b. Constipation c. Nausea d. Abdominal pain

B (Fibrates causes diarrhea)

A nurse is giving instruction to a client who is receiving Cholestyramine (Questran) for the treatment of hyperlipidemia. Which of the following statements made by the client indicates the need for further instructions? A. "This medication comes in a powder that must be mixed with juice or water before administration". B. "I will avoid eating foods rich in saturated fats". C. "I will continue taking nicotinic acid as part of the treatment". D. "Constipation, belching and heartburn are some of the side effects".

C

A patient who cannot take a statin will most likely be prescribed what medication? a. A fibrate b. Bile-acid sequestrant c. Exetimibe (Zetia) d. Niacin

C

Bile-acid sequestrants are taken to lower what? a. HDL b. VLDL c. LDL d. Triglycerides

C

One of your patients just turned 20 years old. How often should you instruct them to be screened for high cholesterol? a. Every year b. Every 2 years c. Every 5 years d. Every 10 years

C

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? a. "Lower your cholesterol to 300 mg/day." b. "Eliminate red meat and pork from your diet." c. "Read food labels and reduce your intake of saturated fats." d. "Reduce salt consumption to keep your sodium intake to 2400 mg/day."

C (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.)

The nurse understands that cholesterol is carried through the blood by lipoproteins. Which lipoprotein is most closely associated with coronary atherosclerosis? a. Very-low-density lipoprotein (VLDL) b. Apolipoprotein B-100 c. Low-density lipoprotein (LDL) d. High-density lipoprotein (HDL)

C (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.)

A patient with an elevated triglyceride level is prescribed a sustained-release form of nicotinic acid [Slo-Niacin]. Which laboratory value is most important for the nurse to monitor for in this patient? a. Blood urea nitrogen (BUN) b. Complete blood count (CBC) c. Alanine aminotransferase (ALT) d. Creatine kinase (CK)

C (The alanine aminotransferase (ALT or SGPT) would receive priority, because nicotinic acid is hepatotoxic and severe liver injury has been reported. Hepatotoxicity is more common with the sustained-release, controlled-release, or timed-released formulation.)

A patient with severe gout would be contraindicated with taking niacin because it causes which the following adverse effects? a. Hyperglycemia b. Flushing c. Hepatotoxicity d. Rhabdomylosis

D

Which of the following patients would be safe to take HMG-CoA Reductase Inhibitors, also known as statins? a. A patient with liver disease b. A patient in their 2nd trimester c. A patient with a disease of muscle tissue d. A patient with heart failure

D

Your patient has a deficiency of vitamin A, D, E, and K. They state they are on a lipid lowering drug but cannot remember which one. Which medication do you suspect this patient of taking? a. Lovaza b. Zetia c. Niacin d. A bile-acid sequestrant

D

The nurse is caring for a patient prescribed gemfibrozil [Lopid]. For which patient should the nurse question the use of this drug? a. A patient with cardiovascular disease and elevated triglycerides b. A patient with elevated very-low-density lipoprotein (VLDL) levels c. A patient with elevated triglycerides who has not responded to dietary changes d. A patient with history of gallstones and elevated triglycerides

D (Gemfibrozil is indicated to reduce elevated triglycerides and very-low-density lipoprotein levels primarily in patients who have not responded adequately to diet modification. It can also raise HDL 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.)

A patient with cardiovascular disease is taking rosuvastatin [Crestor]. The nurse is monitoring for potential adverse effects. Which finding indicates a potential adverse effect of this drug? a. Blood pressure of 140/90 mm Hg b. Wheezing and shortness of breath c. Platelet count of 100 × 103/mm3 d. Muscle pain and tenderness

D (The statins 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.)

What three lipid changes are expected with Niacin?

Decreased triglycerides, decreased LDLs, increased HDL

What are two severe adverse effects of statins?

Hepatoxicity and myopathy

When should statins be taken?

In the evening

Do fibrates increase or decrease the effect of warfarin?

Increase by displacing warfarin from the albumin.

Bile-acid sequestrants are taken to lower what?

LDL

Which lipoproteins are the "bad" lipoproteins?

LDL

What are two contraindications for statins?

Liver disease and pregnancy

How do HMG-CoA Reductase Inhibitors work?

Reduce synthesis of cholesterol by inhibiting the enzyme. And increasing the number of LDL receptors in the liver.

What major risk increases when fibrates are coadministered with statins?

Risk of myopathy. (Also liver injury and kidney disease)

What deficiencies can be caused by bile-acid sequestrants?

Vitamin A,D, E,K

How do bile-acid sequestrants lower cholesterol?

They inhibit reabsorption of bile and cause the liver to use LDLs in the blood to make more bile. The liver increases the number of LDL receptors in the liver.

Carbohydrates should be restricted to 50-60% of the caloric intake because they can form what?

Triglycerides

Fibrates (or fibric acid derivatives) are the most effective drug for lowering what?

Triglycerides