PHARM 201 CH 34 ANTIHYPERLIPIDEMIC DRUGS

A patient who is receiving cholestyramine also takes digoxin. The nurse teaches the patient about the drug and administration. The patient demonstrates understanding of the teaching when stating:

"I will take the digoxin about an hour before the cholestyramine." Page 359

A patient is taking cholestyramine. The nurse will assess for which common adverse effect of the drug?

Constipation Page 358

What intervention may help the client increase HDL levels?

Exercise Page 357

The nurse is teaching a client about nicotinic acid, which the physician has prescribed for treatment of hyperlipidemia. What common adverse effect should the nurse mention to the client?

Flushing of the skin

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. Page 359-360

Statins (HMG_CoA reductase inhibitors)

common name for drugs that inhibit the manufacture or promote breakdown of cholesterol

Cholelithiasis

stones in the gallbladder

A 58-year-old man has recently been prescribed atorvastatin (Lipitor) in an effort to reduce his cholesterol levels. The man has acknowledged the potentially harmful effects of hyperlipidemia and is motivated to make changes to resolve this health problem. What advice should the nurse give to this patient?

"It's a good idea to keep your intake of saturated fat to a bare minimum." Page 357

A female patient is taking a large dose of nicotinic acid to treat hyperlipidemia. She calls the clinic and reports that her face, neck, and chest are red. Which would be an appropriate response by the nurse?

"This is an expected adverse effect of the drug. It should subside in time." Large doses of nicotinic acid produce peripheral vasodilation, mostly in the cutaneous vessels of the face, neck, and chest. Vasodilation results in flushing of the skin and is usually transient. The vasodilation is due to the histamine release caused by the medication. A nurse would never tell a patient not to worry and to stop taking the medication, unless the prescriber told her to. The flushing should subside and will not be present for the duration of the course of the drug. Page 360

The client wants to know the difference between triglycerides and cholesterol. Which response by the nurse would be correct?

"Triglycerides and cholesterol are fatlike substances found in your blood." Page 355

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 patient? Page 358

An obese male client who is a heavy alcohol user and who has cirrhosis of the liver

The client is admitted with hyperglycemia. The nurse evaluates the client for which of the following medications?

Atorvastatin Page 358

A nurse is caring for a female patient who breastfeeds her 3 month old infant. The patient tells the nurse that she has been taking garlic to reduce serum cholesterol levels. Which of the following is an adverse effect of garlic that the nurse should inform the patient of?

Can cause colic in infants The nurse should inform the patient who is breastfeeding her 3 month old infant that garlic can cause colic in infants as it is excreted in breast milk. Garlic could cause increased risk of bleeding if taken along with warfarin. Mild stomach upset or irritations are adverse effects of garlic. Garlic does not increase blood pressure, instead it is known to lower blood pressure. Page 360

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 Cholesterol is the portion of blood lipids involved in the formation of atherosclerotic plaques. Page 356

A patient who has been taking lovastatin (Mevacor) 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?

Cholestyramine (Questran) Page 358

A nurse is caring for a client receiving cholestyramine to improve his blood lipid profile at a home care setting. What adverse reactions to cholestyramine should the nurse monitor in the client? You Selected:

Constipation The nurse should monitor for constipation in the client receiving cholestyramine. Rash, vertigo, and cholelithiasis should be monitored by the nurse when caring for a client receiving gemfibrozil. Page 358

The three major classes of drugs used to control blood lipids are statins, bile acid resins (or sequestrants), and fibrates. Which is a fibrate?

Gemfibrozil Page 364

Increased levels of low-density lipoprotein (LDL) combined with certain risk factors can lead to the development of which medical condition? Page 356

Heart disease Increased levels of LDL in combination with other risk factors can lead to the development of atherosclerotic heart disease.

A 54-year-old patient has a cholesterol level of 240 mg/dL. What serum concentration of cholesterol would this patient have?

High Page 357

A client asks how ezetimibe will help to treat high lipid levels. The nurse explains that: Page 359-360

It decreases the absorption of cholesterol in the small intestine. 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 patient who takes fluvastatin (Lescol). Which laboratory value should be assessed regularly in this patient?

LFT

HMG-CoA reductase inhibitors (statins) are in which pregnancy category? Page 358

Pregnancy Category X

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

Pregnancy Category X Page 358

A 37-year-old woman with moderately elevated lipid levels requests immediate pharmacotherapy for her dyslipidemia. The nurse explains that a period of intensive diet therapy and lifestyle modification will be utilized before drug therapy is considered. The nurse explains the rationale for this regimen as:

Therapeutic lifestyle changes are the preferred method for lowering blood lipids. 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. Page 357

What are examples of modifiable risk factors for hyperlipidemia? (Select all that apply.) Page 357

Weight Diet

Which activity increases high-density lipoproteins? Page 357

Weight loss Regular aerobic Exercise Smoking cessation

Which activity increases high-density lipoproteins?

Weight loss Regular aerobic exercise Smoking cessation Weight loss, regular aerobic exercise, and smoking cessation (for those who smoke) all increase HDL cholesterol. Page 357

The nurse is taking a health history on a 38-year-old male 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:

alcohol. Page 358

Rhabdomyolysis

condition in which muscle damage results in the release of muscle cell contents into the bloodstream

Artherosclerosis

disease characterized by deposits of fatty plaques on the inner walls of arteries

The nurse is caring for a patient who has high levels of total cholesterol and triglycerides. When discussing management of dyslipidemia with the patient, the nurse will describe the desired blood lipid profile as

high HDL cholesterol, low LDL cholesterol, low total cholesterol, and low triglyceride. The desired blood lipid profile is high HDL cholesterol, low LDL cholesterol, low total cholesterol, and a low triglyceride level. Page 357

Hyperlipidemia

increase in the lipids in the blood

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:

increases HDL and decreases triglycerides. Page 357

Cholecystitis

inflammation of the gallbladder

A patient has been prescribed lovastatin for a high cholesterol level. 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 because it: Page 357

inhibits cholesterol syntheses.

A patient has been prescribed lovastatin for a high cholesterol level. 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 because it:

inhibits cholesterol syntheses. Page 357

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. 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. Page 357

The nurse is taking care of a patient with high cholesterol and triglyceride values. In teaching the patient about therapeutic lifestyle changes such as diet and exercise, the nurse realizes that the desired goal for cholesterol levels is:

low LDL values and high HDL values. Page 357

Lipoprotein

macromolecule consisting of lipid (fat) and protein; how fats are transported in the blood

Low-density lipoproteins (LDLs)

macromolecules that carry cholesterol from the liver to the body cells

Catalyst

substance that accelerates a chemical reaction without itself undergoing a change

Triglycerides

types of lipids that circulate in the blood

Xanthomas

yellow deposits of cholesterol in tendons and soft tissues

Which of the following herbal products have shown in studies to lower serum cholesterol and triglycerides? (Choose one)

Garlic Page 360

The nursing instructor is discussing common adverse effects of dyslipidemia drugs. Which of the following would the instructor identify as adverse effects of statins? Page 358

Headache and nausea Although statins are generally well tolerated, adverse effects can include GI disturbances(e.g., nausea, constipation, flatulence), central nervous system effects (e.g., headache, dizziness), blurred vision, muscle aches, and rash.

A patient is taking lovastatin (Mevacor). Which are noted as the most common adverse effects?

Nausea, flatulence, and constipation Page 358

When administering a lipid-lowering agent, the nurse would anticipate administering the drug by which route?

Oral Page 363

A 45-year-old man who is a construction worker has been diagnosed with hyperlipidemia and has been prescribed lovastatin. The nurse will advise the patient to Page 362

avoid prolonged exposure to sunlight.

A 45-year-old man who is a construction worker has been diagnosed with hyperlipidemia and has been prescribed lovastatin. The nurse will advise the patient to

avoid prolonged exposure to sunlight. Page 362

Cholesterol

fat-like substance produced mostly in the liver of animals

Lipids

group of fats or fat-like substances

The most common adverse effects of lovastatin include:

headache and flatulence. 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. Page 358

High-density lipoproteins (HDLs)

macro (big) molecules that carry cholesterol from the body cells to the liver to be excreted