Pharmacology Prep U Level 5-8 Chapter 47 Lipid Lowering Agents

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.

What drug or drug class decreases the delivery of intestinal cholesterol to the liver? Statin Fibrate Cholesterol absorption inhibitor Bile acid sequestrant

higher amount of protein The "preferred" or healthier configuration for a lipoprotein is to have a higher density of protein than lipids.

What factor determines the "preferred" density of the cholesterol? higher amount of protein higher amount of plasma higher amount of lipids higher amount of carbohydrates

Headache Insomnia Constipation

What might a client report of during treatment with an atorvastatin (Lipitor)? (Select all that apply.) Headache Sedation Insomnia Diarrhea Constipation

Bleeding

A client with atrial fibrillation who is receiving oral anticoagulant therapy is receiving atorvastatin. The nurse would monitor this client for: Abdominal pain Cataract development Liver failure Bleeding

Triglycerides 180 mg/dL

The nurse is reviewing the results of a client's lipid profile. Which of the following would the nurse identify as borderline high? Total cholesterol 160 mg/dL Low-density lipoprotein (LDL) cholesterol 110 mg/dL High-density lipoprotein (HDL) cholesterol 45 mg/dL Triglycerides 180 mg/dL

Cholestyramine

Which would be classified as a bile acid sequestrant? Lovastatin Ezetimibe Cholestyramine Gemfibrozil

decreased absorption

A client has had cholestyramine added to his or her treatment plan for dyslipidemia. What effect will cholestyramine have on the pharmacokinetics of the thiazide diuretic that the client is currently prescribed? increased first-pass effect increased metabolism decreased absorption faster excretion

Liver panel Because of the risk for hepatotoxicity, clients taking fenofibrate require serial testing of liver enzyme levels.

An elderly client with dyslipidemia has had fenofibrate added to the existing medication regimen. In addition to having the lipid profile drawn on a regular basis, the nurse should educate the client about the need for what ongoing laboratory testing during therapy? Complete blood count (CBC) Liver panel INR and aPTT Reticulocyte count

Reduction of the intake of saturated fats Weight loss Increased physical activity

The nurse knows that part of the education plan for a client with the diagnosis of hyperlipidemia needs to include which lifestyle changes? (Select all that apply.) Reduction in the intake of carbohydrates Reduction of the intake of saturated fats Weight loss Increased physical activity

Brownish colored urine Prolonged use of lovastatin may damage skeletal muscle; the increased bilirubin from the dead cells changes the color of the urine from amber to brown. Tanned and reddish color skin indicates photosensitivities caused by the drug and are general adverse effects.

A nurse is caring for a patient who is receiving lovastatin. Which assessment by the nurse would indicate that there is possible damage to the patient's skeletal muscle as a result of the drug therapy? Amber colored urine Brownish colored urine Tanned colored skin Reddish colored skin

1 to 2 hours

A patient is receiving atorvastatin. The nurse would anticipate that the maximum effectiveness of the drug would occur within which time frame? 1 to 2 hours 2 to 3 hours 3 to 4 hours 4 to 5 hours

decreases target serum LDL level

Recommended treatments for clients with dyslipidemia are made according to their blood levels of total and low-density lipoproteins (LDL) cholesterol and risk factors for cardiovascular disease. What does the impact of existing cardiovascular disease have on recommendations? increases target serum high-density lipoproteins (HDL) level decreases target serum LDL level has no effect on either LDL or HDL levels decreases target serum triglyceride level

Low triglycerides High HDL cholesterol Low LDL cholesterol

To effectively prevent or manage metabolic syndrome, what should the desired blood lipid profile include? (Select all that apply.) Low triglycerides High HDL cholesterol Low LDL cholesterol High total cholesterol High VLDL cholesterol

Reduction in LDL cholesterol levels

A client has been largely unsuccessful in achieving adequate control of dyslipidemia through lifestyle changes and the use of a statin. As a result, the client has been prescribed cholestyramine. What change in this client's lipid profile will the nurse identify as the most likely goal of therapy? Reduction in triglycerides Reduction in total serum cholesterol levels Increase in HDL levels Reduction in LDL cholesterol levels

95 mg/dL In conjunction with an acceptable total cholesterol-to-HDL ratio, it is also important for the LDL reading to be between 80 and 100 mg/dL to further decrease the risk of coronary artery disease.

A client who had a total cholesterol-to-HDL cholesterol ratio of 5.3 has been losing weight and participating in an exercise program. His total cholesterol-to-HDL ratio is now 3.9. What LDL reading is also important to further decrease his risk of coronary artery disease? 140 mg/dL 120 mg/dL 95 mg/dL 105 mg/dL

"Take the thiazide diuretic about 1 hour before the colestipol." The absorption of thiazide diuretic can be decreased or delayed with colestipol, a bile acid sequestrant. Therefore, the diuretic should be taken 1 hour before or 4 to 6 hours after the colestipol.

A client who is receiving colestipol is also taking a thiazide diuretic. Which instruction would be most appropriate for the nurse to give? "Take the colestipol at the same time as the thiazide diuretic." "Take the thiazide diuretic about 4 hours before the colestipol." "Take the colestipol first and then take the diuretic a half hour later." "Take the thiazide diuretic about 1 hour before the colestipol."

inhibits the production of cholesterol.

A client's serum cholesterol is 286 mg/dL. Lovastatin (Mevacor) is prescribed. The nurse plans care based on the fact that the action of lovastatin: inhibits the production of cholesterol. promotes the breakdown of HDL. promotes excretion of cholesterol in the feces. decreases absorption of cholesterol.

Decrease the dosage of his medication

A male client takes cholesterol absorption inhibitors as a monotherapy without statins. He develops mild hepatic insufficiency. What would the nurse expect the health care provider to do? Increase the dosage of his medication Decrease the dosage of his medication Maintain the current dosage of his medication Discontinue his medication

Constipation

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? Rash Vertigo Constipation Cholelithiasis

Fluvastatin 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 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? Atorvastatin Fluvastatin Lovastatin Pravastatin

HMG-CoA reductase inhibitors HMG-CoA reductase inhibitors are the first drug of choice in the treatment of hypercholesterolemia in patients who are at risk for, or who have already developed, coronary artery disease. HMG-CoA reductase inhibitors (statins) lower LDL cholesterin within 2 weeks and reach maximal effects in approximately 4 to 6 weeks.

Which drug is most effective in reducing most major types of dyslipidemia in patients at risk or who have already developed CAD? HMG-CoA reductase inhibitors Bile acid sequestrants Fibrates Niacin

Vitamin A deficiency With cholestyramine, malabsorption of fat soluble vitamins may occur, leading to deficiencies of vitamins A, D, E, and K. Subsequently, the client is at risk for increased bleeding due to decreased absorption of vitamin K and decreased production of clotting factors.

Which might occur in a client receiving colestipol? Vitamin A deficiency Thrombosis Increased vitamin K absorption Fecal incontinence