Pharmacology Cardiac

Which agent is in the category of drugs considered most effective for lowering LDL cholesterol? A) Atorvastatin (Lipitor) B) Cholestyramine (Questran) C) Gemfibrozil (Lopid) D) Ezetimibe (Zetia)

Correct: A The statin drugs, such as atorvastatin, are the most effective drugs available for lowering LDL cholesterol. They are better tolerated, have fewer adverse effects, and produce better clinical outcomes than any other agents available for lowering LDL.

Which are beneficial effects that can be derived from simvastatin (Zocor) and other agents in this class? (Select all that apply.) A) Reduction of LDLs B) Elevation of HDLs C) Stabilization of the plaque in coronary arteries D) Reduction of risk of cardiovascular events E) Improvement of liver function

Correct: A,B,C,D The statin drugs have many benefits, the most important being reduction of LDLs. They also promote an increase in HDLs, stabilization of atherosclerotic plaque, and reduced inflammation at the plaque site. Among other benefits, they also slow progression of coronary artery calcification. The statins reduce the overall risk of cardiovascular events. They can have adverse effects on the liver.

A 68-year-old woman with a history of myocardial infarction is beginning a new prescription for lovastatin (Mevacor). Which statements by the nurse are appropriate to include in the teaching plan? (Select all that apply.) A) "Call if you get new prescriptions from other providers, because several medications can interact with lovastatin." B) "Return to the clinic every 6 to 12 months so we can run blood tests for possible side effects." C) "Take your medication once a day, first thing in the morning, with a full glass of water for best results." D) "Take one 325-mg aspirin 30 minutes before your dose to lessen the problem of flushing and itching that can occur with this drug." E) "Lower the total fat and saturated fat in your diet by increasing your intake of fresh fruits and vegetables and whole grains."

Correct: A,B,E

The nurse is caring for a group of patients who take cholesterol-lowering drugs. Which agent is least likely to cause systemic side effects and is considered safer than other lipid-lowering drugs? A) Simvastatin (Zocor) B) Colesevelam (Welchol) C) Nicotinic acid (Niaspan) D) Gemfibrozil (Lopid)

Correct: B Colesevelam, a bile acid sequestrant, is a nonabsorbable resin that works directly in the gastrointestinal tract. Because it and other bile acid sequestrants (e.g., cholestyramine [Questran] and colestipol [Colestid]) are not absorbed, they do not have systemic effects. The bile acid sequestrants' most common complication is constipation. The other agents have potential systemic 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? A) "Lower your cholesterol to 300 mg/day." B) "Eliminate red meat and pork from your diet." C) "Read food labels and reduce your intake of saturated fats." D) "Reduce salt consumption to keep your sodium intake to 2400 mg/day."

Correct: C An increase in dietary cholesterol intake does not produce a large increase in blood cholesterol because of the body's feedback system. When cholesterol intake increases, endogenous production decreases. However, because the body uses dietary saturated fats to make cholesterol, an increase in saturated fat intake can produce a significant increase in blood cholesterol levels. To lower blood cholesterol, it is most important to lower saturated fat intake. Although red meat and pork should be limited, it is not necessary to eliminate them from the diet. Sodium intake is not directly related to lowering cholesterol levels.

The nurse understands that cholesterol is carried through the blood by means of lipoproteins. Which lipoprotein is most closely associated with coronary atherosclerosis? A) Very-low-density lipoprotein (VLDL) B) Apolipoprotein B-100 C) Low-density lipoprotein (LDL) D) High-density lipoprotein (HDL)

Correct: C Cholesterol is the primary core lipid of 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.

A 60-year-old man with an elevated triglyceride level is prescribed a pharmacologic dose of an extended-release form of nicotinic acid (Slo-Niacin). Which laboratory value takes priority for assessment when this patient is seen in the clinic? A) Blood urea nitrogen (BUN) B) Complete blood count (CBC) C) Alanine aminotransferase (ALT) D) Creatine kinase (CK)

Correct: C The alanine aminotransferase (ALT or SGPT) would receive priority, because nicotinic acid is hepatotoxic and severe liver injury has been reported. Hepatotoxicity is more common with the extended-release formulation.

The nurse is caring for patients who have been prescribed gemfibrozil (Lopid). For which patient should the nurse question the use of this drug? A) A 78-year-old man with cardiovascular disease and elevated triglycerides B) A 50-year-old woman with elevated very-low-density lipoprotein (VLDL) levels C) A 68-year-old man with elevated triglycerides who has not responded to dietary changes D) A 58-year-old woman with history of gallstones and elevated triglycerides

Correct: D Gemfibrozil is indicated to reduce elevated triglycerides and very-low-density lipoprotein levels primarily in patients who have not responded adequately to diet modification. It can also raise HDL but does not reduce LDL to a significant degree. Gemfibrozil increases the risk of gallstone formation and should not be used in patients with pre-existing gallbladder disease.

A 79-year-old man with cardiovascular disease is taking rosuvastatin (Crestor). The nurse is monitoring for potential adverse effects. Which symptom, if found, indicates a potential adverse effect of this drug? A) Blood pressure of 140/90 mm Hg B) Wheezing and shortness of breath C) Platelet count of 100 × 103/mm3 D) Muscle pain and tenderness

Correct: D The statins 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.