Pharm Exam 2 part 2

The nurse understands that cholesterol is carried through the blood by lipoproteins. Which lipoprotein is most closely associated with coronary atherosclerosis?

Low-density lipoprotein (LDL)

Niacin pt education:

-drink 2-3 liters of water/daily -administer aspirin 325 mg so mins before dose -avoid alcohol -take with food to avoid GI distress

HDLs

-major core lipid: cholesterol -transport of cholesterol from nonhepatic tissues back to the liver -PROTECT against atherosclerosis

LDLs

-major core lipid: cholesterol -delivery of cholesterol to nonhepatic tissues -DEFINITELY contribute to atherosclerosis -majority of cholesterol in the blood

VLDLs

-major core lipid: triglycerides -delivery of triglycerides to nonhepatic tissues -PROBABLY contribute to atherosclerosis

ASCVD

-begins as fatty streak in vessel wall -deposits of fibrous plaque -impediment of blood flow/anginal pain -encourages formation of thrombi

A patient is receiving a continuous heparin infusion for venous thromboembolism treatment. Which laboratory results should the nurse monitor?

-platelets -Activated partial thromboplastin time (aPTT)

re: HMG CoA reductase inhibitors, what to do?

-take in evening -avoid alcohol -monitor for muscle aches

myopathy

-unexplained muscle pain or tenderness that may be a serious AE of statin use hepatotoxicity -rare but serious AE of statin use -monitor LFTs

A patient with cardiovascular disease is taking rosuvostatin. The nurse is monitoring for adverse effects. Which finding indicates a potential adverse effect of this drug?

muscle pain and tenderness

atherosclerosis

-ASCVD -thickening of the coronary arteries, leading to chest pain, MI, & stroke -risk directly r/t blood cholesterol levels

A patient tells you they stopped taking niacin due to flushing. What do you recommend?

Aspirin

Heparin enhances the anticoagulant activity of what naturally occurring substance?

antithrombin

An adverse effect that may be seen with fibrate use is:

gall stones.

A patient taking gemfibrozil complains of bloating and abdominal pain. Which AE do you suspect?

gallstones

An adverse effect that may be seen with fibrate use is:

gallstones

HMG-CoA reductase inhibitor

atorvastatin (Lipitor)

Which of the following drugs is an antiplatelet agent?

clopidogrel (Plavix)

The nurse is evaluating the teaching done with a patient who has a new prescription for captopril. Which statement by the patient indicates a need for further teaching?

"I can take this medication with breakfast each morning."

The healthcare provider prescribes lovastatin for a patient discharged from the hospital for MI. Which instructions are most appropriate for the nurse to include in the patient's teaching plan?

-"Do not start any new medications without first talking to your healthcare provider." -"Before starting this medication, a blood test will be done to check your total cholesterol and measure liver enzymes." -Take your medication in the morning, with a full glass of water for best results." -"Lower the total fat and saturated fat in your diet by increasing your intake of fresh fruits and vegetables and whole grains."

An adult male patient is taking medication for blood pressure management. The patient states to the nurse," I'm not going to take these drugs anymore, because they are interfering with my sex life." What is the most appropriate response from the nurse?

"Let's discuss this with your provider. There are other drugs available to manage your blood pressure that may not have the same adverse effects."

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?

"Read food labels and reduce your intake of saturated fats." (the body uses dietary saturated fats to make cholesterol, an increase in saturated fat intake can produce a significant increase in blood cholesterol levels)

The nurse is teaching a patient prescribed captopril for the treatment of HTN. Which instructions should the nurse include?

-Avoid potassium salt substitutes -a persistent, dry cough may occur -report difficulty in breathing immediately

Which are beneficial effects that can be derived from the statin drug class?

-Reduction of LDLs -Elevation of HDLs -Stabilization of the plaque in coronary arteries ----Reduction of risk of cardiovascular events

The nurse is caring for a patient prescribed gemfibrozil. For which patient should the nurse question the use of this drug?

A patient with a history of gallstones and elevated triglycerides.

The nurse is caring for a patient prescribed gemfibrozil [Lopid]. For which patient should the nurse question the use of this drug?

A patient with history of gallstones and elevated triglycerides

The nurse is caring for a patient who takes warfarin for the prevention of DVT. The patient has an international normalized ration (INR) of 2.7. What action by the nurse is most appropriate?

Administer the dose. (An INR range of 2.0 to 3.0 is generally an effective therapeutic range for people taking warfarin for disorders such as atrial fibrillation or a blood clot in the leg or lung.)

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?

Alanine aminotransferase (ALT)

A patient with an elevated triglyceride level is prescribed a sustained-release form of nicotinic acid. Which laboratory value is most important for the nurse to monitor for this patient?

Alanine transferase (ALT)

Aminocaproic acid (Amicar) can be used for severe, life-threatening bleeding caused by which drug?

Alteplase (Activase)

Which drug is the most effective (and the most commonly prescribed for lowering LDL cholesterol)?

Atorvastatin

Which 2 cholesterol meds are more effective in treating high LDL levels?

Atorvastatin (Lipitor) and Ezetemibe (Zetia)

Which drug is the most effective for lowering LDL cholesterol?

Atorvastatin [Lipitor]

Required nursing action when administering colesevelam?

give other meds 1 hr prior or 4 hours post

The nurse is caring for a patient prescribed a cholesterol-lowering drug. Which drug is least likely to cause systemic side effects?

Colesevelam

The nurse is caring for a patient prescribed a cholesterol-lowering drug. Which drug is least likely to cause systemic side effects?

Colesevelam [Welchol]

High levels of _________, which helps to remove cholesterol from peripheral tissues (extrahepatic tissue) and returns it to the liver, is thought to be cardioprotective.

HDL

A patient is prescribed rivaroxaban (Xarelto) and the nurse is providing patient education. What are some things for the patient to look out for?

I should: -watch closely for discolored urine or stool, bruises persistent headache or faintness. -inform all health care professionals I am taking this medication -not double my dose when I forget to take it the day before -know that drug interactions are common with this drug

The nurse knows which truth about enoxaparin?

It reduces the activity of factor Xa more than the activity of thrombin.

main carrier of blood cholesterol from the liver to peripheral tissues

LDL Cholesterol

An 89-year old patient is status post a prosthetic mitral valve replacement. He is on warfarin (Coumadin) daily and his most recent INR is 4.5. The nurse has notified the provider of the lab results. Which of the following is the best nursing intervention for patient at this point?

Monitor for Bleeding

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?

Muscle pain and tenderness

Which of the following tests is used to monitor the effects of warfarin?

PT/INR

Which patients should not be prescribed ezetimibe?

Severe liver dysfxn

Which medication is likely to cause the side effect of constipation?

Verapamil

What medication can be used to reverse the effects of warfarin?

Vitamin K

inhibits the SYNTHESIS of clotting factors, including factor X and thrombin

Warfarin (decreases production of vitamin K-dependent clotting-factors II, VII, IX, X)

homozygous familial hypercholestremia

an inherited genetic disorder that affects the body's ability to manage cholesterol. The result is very high levels of LDL, or "bad" cholesterol, from birth.

Which of the anti-platelet drugs has no specific reversal agent available?

clopidogrel (Plavix)

Which of the following drugs has no specific reversal agent available?

clopidogrel (Plavix)

Warfarin works by which of the following mechanisms:

competitively blocks vitamin k at its sites of action

The nurse is monitoring a patient receiving a heparin infusion for the treatment of pulmonary embolism. Which assessment finding most likely relates to an adverse effect of heparin?

discolored urine

What would you include in pt ed for a pt prescribed a statin?

drinking GF juice can lead to serious side effects

What is the drug of choice for pregnant patient's who require anticoagulation?

heparin

What is the drug of choice for pregnant patients who require anticoagulation?

heparin

MOA of ezetimide

inhibits absorption of dietary cholesterol

A patient who takes warfarin for atrial fibrillation undergoes hip replacement surgery. On the second postoperative day, the nurse assesses the patient and notes an oxygen saturation of 83%, pleuritic chest pain, shortness of breath, and hemoptysis. The nurse will contact the provider to report possible ____ and request an order for ____

pulmonary embolism; heparin

Which of the following patients should not be prescribed ezetimibe?

severe liver dysfunction