Chapter 47: Lipid-Lowering Agents

A client calls the clinic and talks to the nurse. The client tells the nurse the client has been taking colesevelam (Welchol) for six months and that the client is having small amounts of bright red rectal bleeding and is concerned. What would an appropriate response from the nurse be?

"The bleeding may be coming from hemorrhoids. We should check this out." Colesevelem is a bile acid sequestrant and these drugs can aggravate hemorrhoids and cause bright, red bleeding. This is not a serious adverse effect and can be treated.

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." Triglycerides and cholesterol are lipids that are found in blood. Cholesterol is produced mostly by the liver.

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?

Bile acid resins can decrease the gastrointestinal absorption of several medications

What drug or drug class decreases the delivery of intestinal cholesterol to the liver?

Cholesterol absorption inhibitor, The cholesterol absorption inhibitors (e.g., ezetimibe), the newest class of dyslipidemic drugs, act in the small intestine to inhibit absorption of cholesterol and decrease the delivery of intestinal cholesterol to the liver, resulting in reduced hepatic cholesterol stores and increased clearance of cholesterol from the blood.

A nurse is preparing a teaching plan for a client who is prescribed cholestyramine. Which information would the nurse include as a possible adverse reaction associated with this drug?

Cholestyramine is a bile acid resin that can cause constipation, which can be severe; abdominal cramping; and increased bleeding tendencies as evidenced by bruising.

Which would a nurse identify as a carrier for small units of fats?

Chylomicrons are carriers for micelles. Micelles are the small units of broken down fats.

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

Constipation is the most common adverse effect of cholestyramine.

Which agent would the nurse identify as inhibiting triglyceride synthesis in the liver, resulting in a reduction of LDL levels.

Fenofibrate inhibits triglyceride synthesis in the liver resulting in a reduction of LDL levels.

The physician is caring for a client who is a 2-year kidney transplant survivor. The nurse would expect the physician to order what drug for the client's hyperlipidemia?

Fluvastatin is cleared hepatically, and less than 6% of the dose is excreted in urine; therefore, dosage reduction for mild to moderate renal impairment is unnecessary. Use caution with severe impairment. Recent randomized, controlled clinical trials have demonstrated the drug's safety in kidney transplant recipients.

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?

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.

After reviewing information about lipoproteins, a group of students demonstrate understanding of the information when they identify which of the following as being loosely packed?

HDLs... are loosely packed lipids that are used for energy and to pick up remnants of fats and cholesterol left in the periphery by the breakdown of LDLs. LDLs are tightly packed cholesterol, triglycerides, and lipids that are carried by proteins that enter the circulation to be broken down for energy or stored for future use as energy

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?

In clients with a diagnosis of cardiovascular disease, the goal of therapy is an LDL below 130 mg/dL (3.37 mmol/L).

Statin drugs help lower cholesterol, LDL, and triglycerides by which mechanisms?

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

What factor determines the "preferred" density of the cholesterol?

The "preferred" or healthier configuration for a lipoprotein is to have a higher density of protein than lipids. None of the other factors are relevant.