Cholesterol Perfusin EAQ
The nurse is caring for a patient who has coronary heart disease (CHD). The nurse tells the patient, "Your cholesterol levels are abnormal; you are at a high risk of having a heart attack." What did the nurse discover regarding the lipoprotein levels in the patient's blood report? 1 High levels of low-density lipoproteins (LDL) 2 High levels of high-density lipoproteins (HDL) 3 Low levels of very-low-density lipoproteins (VLDL) 4 Low levels of intermediate-density lipoproteins (IDL)
1 High level of low-density lipoproteins (LDL) refers to high cholesterol levels in the blood, as LDL is almost entirely composed of cholesterol. This cholesterol is bad cholesterol, which promotes the formation of atherosclerotic plaque resulting in CHD. High-density lipoproteins (HDL) are good cholesterol, which has a cardioprotective action. Low levels of very-low-density lipoproteins (VLDL) are due to a low fat diet; however, it does not cause high cholesterol levels. Low levels of intermediate-density lipoproteins (IDL) do not increase the risk of CHD; they are useful for the production of bile acids.
When will the nurse administer hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins)? 1 In the evening 2 With breakfast 3 With an antacid 4 On an empty stomach
1 The liver produces the majority of cholesterol during the night. Thus, it is best to give HMG-CoA reductase inhibitors (statins), which work to decrease this synthesis, during the evening so that blood levels are highest coinciding with this production. Since this drug has a tendency to elevate the liver enzyme level, it may not be advisable to take the drug on an empty stomach. Since the liver produces the majority of cholesterol during the night, it is not ideal to give the drug during breakfast. An antacid is generally given to prevent stomach upset.
A patient receiving atorvastatin [Lipitor] therapy to reduce high cholesterol levels calls the clinic and reports, "I am experiencing severe pain in both my legs." What is the nurse's best response? 1 "Stop taking the drug and visit the clinic immediately." 2 "Continue taking the drug; leg pain is a common side effect." 3 "Stop taking the drug if the symptoms persist for another week." 4 "Continue taking the drug along with niacin [Niaspan] and a pain killer."
1 The patient may have pain in both legs due to myopathy, an adverse effect of atorvastatin [Lipitor]. It progresses to a life-threatening condition called rhabdomyolysis, which involves the breakdown of muscle proteins leading to renal failure and death. The nurse should instruct the patient to stop taking the drug and immediately visit the clinic. The nurse will not instruct the patient to continue the drug as it is a life-threatening condition and requires immediate medical attention. The nurse will instruct the patient to watch for the symptoms; rhabdomyolysis further worsens the patient's condition, leading to renal failure. Administration of niacin [Niaspan], along with atorvastatin [Lipitor], further increases the breakdown of muscle proteins and causes rhabdomyolysis. The nurse should ask the patient to stop taking the medication until confirming the cause of the leg pain.
A patient with cardiovascular disease is taking rosuvastatin [Crestor]. Which finding would indicate a potential adverse effect of this drug? 1 Muscle pain and tenderness 2 Platelet count of 100 × 103/mm3 3 Blood pressure of 140/90 mm Hg 4 Wheezing and shortness of breath
1 The statins, such as rosuvastatin [Crestor], 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 [Crestor].
The nurse understands that cholesterol is carried through the blood by lipoproteins. Which lipoprotein is most closely associated with coronary atherosclerosis? 1 Apolipoprotein B-100 2 Low-density lipoprotein (LDL) 3 High-density lipoprotein (HDL) 4 Very-low-density lipoprotein (VLDL)
2 Cholesterol is the primary core lipid of low-density lipoproteins (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.
The nurse is assessing a patient who has been prescribed atorvastatin [Lipitor]. What instruction should the nurse provide for the patient to ensure proper administration of the medication? 1 "Take the drug after breakfast." 2 "Take the drug in the evening." 3 "Take the drug with an antacid." 4 "Take the drug on an empty stomach."
2 Cholesterol production by the liver usually occurs at night; thus, statin drugs such as atorvastatin [Lipitor] work by decreasing the cholesterol synthesis and are generally administered in the evening to reduce cholesterol production. All statins should be taken once daily during the evening meal or at bedtime. The drug need not be administered after breakfast because cholesterol level production is lesser in the mornings. Antacids may not be administered along with the drug as it doesn't cause gastric irritation. The desired therapeutic effects may not be produced if the drug is administered on an empty stomach.
A patient with hypercholesterolemia is prescribed lovastatin [Mevacor]. After reviewing the patient's medical history, the nurse discovers that the medication is not safe to prescribe for the patient and reports this finding to the healthcare provider. What did the nurse find in the patient's medical history? 1 The patient has leukemia. 2 The patient has renal disease. 3 The patient has hepatic disease. 4 The patient has chronic pulmonary disease.
3 Lovastatin [Mevacor] can cause an increase in liver enzymes and should not be prescribed to patients with preexisting liver disease. Statins induce cell death in malignant cells. Cell death occurs via apoptosis and lovastatin [Mevacor] concentrations are used in the treatment of leukemia. Statins slow down the progress of chronic kidney disease by reducing kidney inflammation or improving the function of kidney tissues. Statins reduce chronic obstructive pulmonary disease (COPD).Lovastatin [Mevacor] can be prescribed to the patient with leukemia, renal disease and COPD.
The nurse is caring for a patient with hypercholesterolemia who is taking 20 mg of simvastatin [Zocor] as prescribed. After a few days, the patient's urinalysis reports indicated the presence of myoglobin. What instruction would the nurse receive from the primary healthcare provider? 1 "Give 10 mg of medication daily." 2 "Give the medication before meals." 3 "Discontinue administering the medication." 4 "Give the medication with 250 mL of water."
3 The presence of myoglobin in the urine indicates that the patient has rhabdomyolysis, an adverse effect of statins such as simvastatin [Zocor]. Rhabdomyolysis is characterized by the breakdown of muscle proteins and can be fatal. The primary healthcare provider would instruct the nurse to discontinue the medication. Reducing the dose of the medication to 10 mg, giving the medication before meals, or administering the medication with high amounts of fluids does not prevent rhabdomyolysis.
A patient with a serum cholesterol level of 275 mg/dL is prescribed simvastatin [Zocor]. What instructions should the nurse provide to the patient? Select all that apply. A "Avoid taking the drug with grapefruit juice." B "Notify your healthcare provider if your urine becomes discolored." C "Notify your healthcare provider if muscle pain occurs within 1 day." D "Notify your healthcare provider if muscle pain occurs after 3 days." E "Take aspirin [Ecotrin] 30 minutes before taking simvastatin [Zocor]."
A B D Simvastatin [Zocor] is a HMG Co-A reductase inhibitor that causes rhabdomyolysis as an adverse effect. Grapefruit juice inhibits the enzyme CYP3A4 that is required for the metabolism of simvastatin [Zocor]. This will increase levels of the drug in the body, resulting in rhabdomyolysis. Rhabdomyolysis is associated with the breakdown of muscle proteins that are excreted in the urine, changing the color of the urine. Simvastatin [Zocor] starts acting after 3 days of administration and can cause muscle pains. These should be reported to the healthcare provider as it may progress to rhabdomyolysis if simvastatin [Zocor] administration is not stopped. Muscle pain after one day may be due to some other cause and not the drug. Taking a small dose of aspirin [Ecotrin] is suggested before taking niacin [Nicobid] to reduce the incidence of cutaneous flushing.
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 "Take your medication in the morning, with a full glass of water, for best results." B "Do not start any new medications without first talking to your healthcare provider." C "Before starting this medication a blood test will be done to check your total cholesterol level and to measure liver enzymes." D "Lower the total fat and saturated fat in your diet by increasing your intake of fresh fruits and vegetables and whole grains." E "Take one 325-mg aspirin 30 minutes before your dose to lessen the problem of flushing and itching that can occur with this drug."
B C D Lovastatin [Mevacor], simvastatin [Zocor], and atorvastatin [Lipitor] levels may be elevated when these drugs are combined with other drugs that inhibit CYP3A4. Caution is warranted if these drugs are combined,. Before starting a statin, obtain a baseline lipid profile that includes total cholesterol and obtain baseline liver function tests (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 [Niacor]. A diet low in total fat and saturated fat is recommended when antilipemic drugs are prescribed.
