Chapter 47: Lipid-Lowering Agents PREPU

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?

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.

Which of the following activities increases high-density lipoproteins?

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

After teaching a group of students about fats and biotransformation, the instructor determines that the teaching was successful when the students identify which of the following as the storage location of bile acids?

Gallbladder The presence of fatty acids, lipids, and cholesterol in the duodenum stimulates contraction of the gallbladder and the release of bile, which contains bile acids. Once their action is completed, they are reabsorbed and recycled to the gallbladder, where they remain until the gallbladder is stimulated again.

A patient has an elevated total serum cholesterol of 260. Which of the following aspects of patient teaching of lifestyle changes is most important for the patient?

Stop smoking Therapeutic lifestyle changes to lower serum cholesterol, including exercise, smoking cessation, change in diet, and drug therapy, are recommended to lower serum cholesterol. The patient should increase dietary vegetables in a heart-healthy diet. The patient with an elevated serum cholesterol should increase exercise and not increase rest periods. The patient should consume low-fat dairy products and avoid whole milk.

A nurse is caring for a patient who has been prescribed lovastatin to control blood lipid levels. While teaching the patient about the medication, the nurse should caution the patient against consuming large amounts of:

grapefruit juice. Consumption of large amounts of grapefruit juice during lovastatin therapy can increase serum drug levels.

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.

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 he states which of the following?

"I will take the digoxin about an hour before the cholestyramine." The absorption of digoxin can be decreased or delayed with colestyramine, a bile acid sequestrant. Therefore, the digoxin should be taken 1 hour before for 4 to 6 hours after the colestyramine.

A patient with primary hypercholesterolemia has been prescribed 10 mg of ezetimibe per day by a physician. The physician has instructed the nurse to continue the drug therapy for 3 days. The drug is available in 10 mg capsules. How many capsules of the drug should the nurse administer the patient during the entire therapy?

3 capsules The nurse should administer 3 capsules of ezetimibe to the patient during the therapy.

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 of the following patients?

An obese male client who is a heavy alcohol user and who has cirrhosis of the liver Active liver disease is a contraindication to the use of statins. As well, heavy alcohol use increases the risk of liver dysfunction. Respiratory disease, recent surgery, and organic cognitive deficits do not preclude the use of statins for high cholesterol.

Which substance would a group of students identify as being responsible for breaking up dietary fats into smaller units?

Bile acids Bile acids act like a detergent in the small intestine and break up fats into small units. These small units are called micelles. High levels of cholesterol are part of bile acids. Chylomicrons are carriers for micelles.

A client with atrial fibrillation who is receiving oral anticoagulant therapy is receiving atorvastatin. The nurse would monitor this client for which of the following?

Bleeding Increased serum levels and resultant toxicity can occur if a statin is combined with warfarin, an oral anticoagulant. This would increase the client's risk for bleeding. Abdominal pain and cataract development are related to the use of atorvastatin alone. Liver failure also is associated with atorvastatin use alone.

When describing the action of atorvastatin, which of the following would the nurse include?

Blocking the enzyme that is involved in cholesterol synthesis 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 patient with atrial fibrillation is receiving warfarin therapy. The patient is also prescribed ezetimibe. The nurse would instruct the patient to watch for which of the following?

Blood in urine or stool Warfarin levels increase with ezetimibe increasing the patient's risk for bleeding. Abdominal pain is a common adverse effect of ezetimibe and is unrelated to the combination therapy. Yellowing of the skin suggest liver dysfunction, which is not associated with the combination therapy. Blurred vision is not associated with the combination therapy.

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.

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) Cholestyramine is administered to patients to reduce LDL cholesterol in patients 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.

Recommended treatments for patients with dyslipidemia are made according to their blood levels of total and LDL cholesterol and risk factors for cardiovascular disease. What does the impact of existing cardiovascular disease have on recommendations?

Decreases target serum LDL level Existing cardiovascular disease lowers the target LDL serum level in these patients.

Which of the following are examples of modifiable risk factors for hyperlipidemia? (Select all that apply)

Diet Weight Modifiable risks factors for hyperlipidemia are weight, diet, and physical inactivity. Non-modifiable risk factors for hyperlipidemia are age, gender, and family history.

A patient is taking cholestyramine (Questran) to reduce LDL cholesterol. Cholestyramine will cause a decrease in absorption of which of the following medications?

Digoxin (Lanoxin) Bile acid sequestrants may decrease absorption of digoxin (Lanoxin). Cholestyramine will not decrease the ibuprofen, aspirin, or acetaminophen.

As part of a routine physical examination, a 60-year-old patient's primary care provider has ordered blood work that includes cholesterol levels. What result would most strongly suggest the need for treatment with an antihyperlipidemic drug?

Elevated LDL levels 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.

A nurse is caring for a patient prescribed nicotinic acid for hyperlipidemia. Which of the following are experienced by patients taking nicotinic acid?

Flushing of the skin The nurse should inform the patient prescribed nicotinic acid that flushing of the skin is generally experienced by patients during this treatment. The nurse should not state weakness, tachycardia, or dyspnea are adverse reactions experienced by patients taking nicotinic acid. These are toxic reactions to flax.

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

Gemfibrozil Gemfibrozil is a fibrate. Colestipol, colesevelam, and cholestyramine are bile acid resins.

After reviewing the various agents used to lower lipid levels, the students demonstrate understanding of the information when they identify which agents as stimulating the breakdown of lipoproteins from the tissues and their removal from the plasma? Select all that apply.

Gemfibrozil Fenofibrate Fibrates stimulate the breakdown of lipoproteins from the tissues and their removal from the plasma. Examples include fenofibrate and gemfibrozil.

Which of the following medications is classified as a fibric acid derivative (fibrate)? (Choose one)

Gemfibrozil (Lopid) Lopid is a fibric acid derivative. Mevacor is a HMG-CoA reductase inhibitor. WelChol is a bile acid resin. Niaspan is a miscellaneous antihyperlipidemic. Zetia 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?

HDL 58 LDL 96 Cholesterol 178 Normal HDL should be less than 40 mg/dl, LDL should be less than 100 mg/dl, and total cholesterol should be less than 200 mg/dl.

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 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.

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

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

What is the most common reason for an elevated cholesterol level in a client who does not have a genetic disorder of lipid metabolism?

His dietary intake of saturated fat Unless a person has a genetic disorder of lipid metabolism, the amount of cholesterol in the blood is strongly related to dietary intake of saturated fat.

Which of the following lipid levels would the nurse interpret as being high?

LDL cholesterol of 190 mg/dL LDL level of 190 mg/dL would be considered high. A total cholesterol level of 200 mg/dL would be considered borderline high. A triglyceride level of 160 would be borderline high. HDL level of 48 would be considered low to optimal. Levels about 60 mg/dL would be considered high.

Your client appears to be a candidate for statin therapy. What laboratory value should be assessed prior to initiating therapy?

LFT Liver function tests (LFT) and serum cholesterol levels should be assessed prior to initiating statin therapy.

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

Pregnancy Category X HMG-CoA reductase inhibitors (statins) are in pregnancy category X and contraindicated during any stage of pregnancy.

What is the most serious side effect of lovastatin?

Rhabdomyolysis One adverse effect with potentially serious consequences is muscle damage, the exact cause of which is not known. The most serious skeletal muscle effect that may result from lovastatin is rhabdomyolysis, although it is very rare (occurring in 0.1% of patients on statins as monotherapy). Rhabdomyolysis is an acute, sometimes fatal disease, in which direct injury to the plasma membrane of the skeletal muscle occurs (manifested by increased levels of CK, also known as creatine phosphokinase [CPK]). The damage to the muscle causes leakage of the skeletal muscle components (myoglobin) into the blood or the urine; brown urine usually results.

The nurse is developing a plan of care for a patient who has been admitted to the hospital after a myocardial infarction. The patient begins lovastatin to lower his LDL levels and increase his HDL levels. Based on the adverse reaction of this medication, what would be the most appropriate nursing diagnosis?

Risk for injury to skeletal muscles related to adverse effects of drug therapy The only diagnosis that focuses on the risk factors associated with taking the medication is risk for injury to the skeletal muscles. The other diagnoses focus on the patient's risk factors prior to the medication or the problem associated with having a heart attack.

What should the nurse suggest to assist a client to improve his cholesterol levels?

Smoking cessation Lifestyle changes that can help improve cholesterol levels include a low-fat diet, regular aerobic exercise, losing weight, and not smoking.

A patient who has an elevated triglyceride level and reduced high-density lipoprotein cholesterol is seen by her primary care physician. What do these laboratory tests indicate in this patient?

The development of metabolic syndrome Metabolic syndrome is noted when the patient has elevated waist circumference, elevated triglycerides, reduced high-density lipoprotein cholesterol, elevated blood pressure, and elevated fasting glucose. Elevated triglyceride level and reduced high-density lipoprotein cholesterol are not indicative of arthritic syndrome. Reye's syndrome is marked by acute encephalopathy and seen in children under the age of 15 years after an acute viral infection. Tay-Sachs is a genetic disease characterized by neurological deterioration in the first year of life.

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.

What information would be included in a lipoprotein profile? Select all that apply:

Total cholesterol LDL Triglycerides A lipoprotein profile is a laboratory test which reports total cholesterol, LDL, HDL, and triglycerides. AST and ALT are values that would be found reported from liver function test.

Cholesterol is the base unit for the formation of steroid hormones.

True

A patient with metabolic syndrome usually has increased plasminogen activator levels.

True Metabolic syndrome involves increase plasminogen activator levels.

A nurse should be aware that use of statin drugs is contraindicated in clients with which of the following conditions? Select all that apply:

• Pregnancy • Serious hepatic disease • Lactation Statin drugs are contraindicated in individuals with known hypersensitivity to the drugs, serious liver disease, and during pregnancy (Category X), and lactation.

What should the nurse review about an antihyperlipidemic medication with the client when completing discharge counseling? Select all that apply:

• Reason for taking the prescribed drug • Dosage form • Correct dose • Frequency of administration • Drug name The nurse should review the reasons for the drug and prescribed therapy, including drug name, form and method of preparation, correct dose, and frequency of administration as part of a client's discharge counseling.

The administration of cholestyramine (Questran) with warfarin (Coumadin) would most likely cause a client to present with which of the following? Select all that apply:

• Subtherapeutic INR • Calf pain and warmth Co-administration of warfarin and cholestyramine can result in decreased anticoagulant effect leading to subtherapeutic INR and increase chance of clotting (signs and symptoms of DVT or PE).

During ongoing assessment of a client receiving an antihyperlipidemic drug, the nurse should collect the following? Select all that apply:

• Vital signs • Assessment of bowel function Clients on antihyperlipidemic medications should have vital signs checked and bowel function assessed.

A patient with hyperlipidemia is prescribed ezetimibe. Which of the following ongoing assessments should the nurse perform during treatment?

Frequently monitor blood cholesterol. The nurse should frequently monitor blood cholesterol as part of the ongoing assessment for a patient receiving ezetimibe. Taking a dietary history of the patient and inspecting the skin and eyelids for evidence of xanthomas are the pre-administration assessments that a nurse should perform for a patient receiving ezetimibe. The nurse obtains the reports of fasting blood sugar for a diabetic patient.

Which drug will be most effective in reducing the major types of dyslipidemia?

HMG-CoA reductase inhibitors For single-drug therapy, a statin is preferred. Statins are used for types IIa, IIb, IV, and V. Bile acid sequestrants primarily lower LDL. Fibrates decrease VLDL and increase HDL. Niacin decreases LDL cholesterol.

The pharmacology instructor is discussing medications used in the treatment of dyslipidemia. Which of the following drug classes would the instructor identify as the most widely used dyslipidemia drugs?

HMG-CoA reductase inhibitors HMG-CoA reductase inhibitors (or statins) are the most widely used dyslipidemia drugs. They are useful in treating most of the major types of dyslipidemia.

A client is taking cholestyramine (Questran) and ezetimibe (Zetia). What administration guideline is most important to teach this client?

The administration of ezetimibe (Zetia) is four hours after cholestyramine. 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.

Prior to administering an antihyperlipidemic to a client, what information does the nurse need to gather? Select all that apply:

• Dietary history • Vital signs • Weight The pre-administration assessment for antihyperlipidemic drugs includes a lipid profile, liver function tests, dietary history, vital signs, weight, and an inspection for xanthomas.

The nurse instructs a client to take the prescribed pravastatin at bedtime based on the understanding about which of the following?

Greater drug effectiveness is achieved at this time. The drug is administered at bedtime because the highest rates of cholesterol synthesis occur between 12 and 5 AM, and the drug should be taken when it will be most effective.

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

Nausea, flatulence, and constipation The most common adverse effects of statins are nausea, constipation, diarrhea, abdominal cramps or pain, headache, and skin rash. The patient will not experience increased appetite and blood pressure as adverse effects of statins. The patient will not experience fatigue and mental disorientation as adverse effects of statins. The patient will not experience hiccups, nasal congestion, and dizziness as adverse effects of statins.

The client has been taking rosuvastatin for hyperlipidemia. The client now presents with severe weakness. The client states barely being able to move the extremities because of weakness. The nurse suspects the client has:

rhabdomyolysis. 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.

Which of the following would be classified as a bile acid sequestrant?

Cholestyramine Cholestyramine is classified as a bile acid sequestrant. Lovastatin is a HMG-CoA reductase inhibitor. Ezetimibe is a cholesterol absorption inhibitor. Gemfibrozil is classified as a fibrate.