Prep U Karch ch 47 lipid lowering agents

A client is going home on cholestyramine (Questran). Client teaching should state that this medication should be administered:

1 hour after other medications. Explanation: Drugs that interact with cholestyramine should be administered 1 hour before or 4 to 6 hours after cholestyramine. Otherwise, cholestyramine may prevent the absorption of other drugs.

A client diagnosed with metabolic syndrome is encouraged to implement nonpharmacologic measures to improve existing risk factors. What actions demonstrate an understanding of appropriate measures? Select all that apply.

Adhering to a low-fat diet Walking for 30 minutes several times a week Eating a high-fiber diet Avoiding tobacco products Maintaining a healthy weight Explanation: Metabolic syndrome is a cluster of risk factors that includes central adiposity, elevated triglycerides, reduced HDL cholesterol, elevated blood pressure, and elevated fasting glucose. All the options will decrease weight, increase cardiovascular health, and reduce risk factors of metabolic syndrome

A client with atrial fibrillation who is receiving oral anticoagulant therapy is receiving atorvastatin. The nurse would monitor this client for:

Bleeding Explanation: 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

A client is taking cholestyramine. The nurse will assess for which common adverse effect of the drug?

Constipation Explanation: Constipation is the most common adverse effect of cholestyramine. Abdominal pain, headache, and indigestion are less frequently experienced adverse effects of the drug.

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?

Decrease the dosage of his medication Explanation: Cholesterol absorption inhibitors as monotherapy (without statins) require dosage reduction in clients with mild hepatic impairment.

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?

Decrease the dosage of his medication Explanation: Cholesterol absorption inhibitors as monotherapy (without statins) require dosage reduction in clients with mild hepatic impairment.

Treatments for clients with dyslipidemia are determined according to blood levels of total and LDL cholesterol and risk factors for cardiovascular disease. What does the impact of existing cardiovascular disease have on treatment recommendations?

Decreases target serum LDL level Explanation: Existing cardiovascular disease lowers the target LDL serum level in these clients.

A male client presents to the health care provider's office for his annual visit. He takes statins to control his hyperlipidemia. When the provider reviews the client's laboratory results and notes that there is an unexplained elevation in the serum aspartate, what would the nurse expect the provider to do?

Discontinue the statin Explanation: Statins are metabolized in the liver and may accumulate in clients with impaired hepatic function. They are contraindicated in clients with active liver disease or unexplained elevations of serum aspartate or alanine aminotransferase.

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 Explanation: 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.

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 Explanation: 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

A 54-year-old client has a cholesterol level of 240 mg/dL (6.2064 mmol/L). What serum concentration of cholesterol would this client have?

High Explanation: High is rated at >240 mg/dL (6.2064 mmol/L). The other options are incorrect

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 Explanation: 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 lipid level would the nurse interpret as being high?

LDL cholesterol of 190 mg/dL Explanation: 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.

A client diagnosed with hyperlipidemia is prescribed a statin. The nurse is reviewing the client's history and would notify the client's health care provider if which condition was noted in the client's history?

Liver disease Explanation: Statins are contraindicated in clients with liver disorders. They are used cautiously in clients with a history of hypotension, infection, and myopathy

A client is taking lovastatin. Which are noted as the most common adverse effects?

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

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 LDL cholesterol levels Explanation: Cholestyramine, the prototype bile acid sequestrant, has the ability to reduce LDL cholesterol. It has little or no effect on HDL cholesterol and either no effect or an increased effect on triglyceride levels.

Which single class drug is known to be most effective in reducing the major types of dyslipidemia?

Statins Explanation: For single-drug therapy, a statin is preferred for the treatment of dyslipidemia. To lower cholesterol and triglycerides, a statin, a cholesterol absorption inhibitor, gemfibrozil, a fibrate, or the vitamin niacin may be used. To lower triglycerides, gemfibrozil, ezetimibe, a cholesterol absorption inhibitor, or niacin may be given.

A nurse is conducting a presentation for a local community group about hyperlipidemia. When discussing the factors that individuals can work on to reduce their risk, which information would the nurse include? Select all that apply.

Weight Diet Explanation: Modifiable risk factors for hyperlipidemia are weight, diet, and physical inactivity. Nonmodifiable risk factors for hyperlipidemia are age, gender, and family history.

A 62-year-old man has been prescribed extended-release lovastatin. The nurse will instruct the patient to take the medication:

at bedtime. Explanation: Patients who are prescribed extended-release lovastatin should take the medication at bedtime, without food, to be most effective. This is because most cholesterol synthesis occurs during this time. Immediate-release lovastatin should be taken after the evening meal. It would not be appropriate to take lovastatin in the afternoon or the early morning.

A nurse would caution a client receiving cholestyramine to avoid mixing the drug with:

carbonated beverages. Explanation: Cholestyramine should not be mixed with carbonated beverages. Soups, fruit juices, cereals, liquids, or pulpy fruit are acceptable alternatives.

Which category of blood lipids is involved in the formation of atherosclerotic plaques?

cholesterol Explanation: Blood lipids are a category of fatty acids, which are substances used within the body to perform essential functions. Cholesterol is the portion of blood lipids involved in the formation of atherosclerotic plaques. Triglycerides and phospholipids are not involved in the formation of plaque. Nitroglycerin is not a blood lipid.

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?

decreases target serum LDL level Explanation: Existing cardiovascular disease entails a lower target LDL serum level in these clients. Such existing conditions are not considered in treating abnormal triglyceride or HDL levels.

In addition to being synthesized in the liver and intestine, from where are blood lipids derived?

diet Explanation: Blood lipids, which include cholesterol, phospholipids, and triglycerides, are derived from the diet or synthesized by the liver and intestine. None of the remaining options are capable of synthesizing or even stimulating the synthesis of blood lipids.

A client with a diagnosis of cardiovascular disease is taking atorvastatin calcium to reduce serum cholesterol. What is the goal of therapy for LDL cholesterol for a client taking atorvastatin calcium? You Selected:

less than 130 mg/dL (3.37 mmol/L) Explanation: In clients with a diagnosis of cardiovascular disease, the goal of therapy is an LDL below 130

The nurse is reviewing the results of a client's lipid profile. Which of the following would the nurse identify as borderline high?

A triglyceride level of 180 mg/dL is considered borderline high (normal or desirable would be less than 150 mg/dL). A total cholesterol of 160 mg/dL and an LDL cholesterol of 110 mg/dL would be considered normal or desirable. An HDL level of 45 mg/dL would be considered normal; levels above 60 mg/dL would be considered high.

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

Elevated LDL levels Explanation: 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.

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

HMG-CoA reductase inhibitors Explanation: 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.

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?

Liver panel Explanation: Because of the risk for hepatotoxicity, clients taking fenofibrate require serial testing of liver enzyme levels. There is no specific need for follow-up with CBCs, coagulation tests, or reticulocyte counts.

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

The administration of ezetimibe is 1 hour before cholestyramine. Explanation: Ezetimibe should be taken 1 hour before or 4 to 6 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 resulting in reduced hepatic cholesterol stores and increased clearance of cholesterol from the blood. Cholestyramine binds bile acids in the intestinal lumen, causing the bile acids to be excreted in feces, preventing recirculation to the liver. Cholestyramine should not be administered 1 hour after ezetimibe.

The nurse instructs a client to take the prescribed pravastatin at bedtime based on understanding that:

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 39-year-old nulliparous woman has been taking atorvastatin for 2 years and has now decided that she would like to become pregnant. What health education should the nurse provide to this client?

"It's important that you stop taking atorvastatin before you stop using contraception." Explanation: Statins like atorvastatin are potentially teratogenic (pregnancy category X). In a very few cases, potential benefits warrant use of these drugs in pregnant women, but this is exceptional. It is also contraindicated during breastfeeding. None of the other statements describe accurate educational information about atorvastatin and conception

The client is diagnosed with hyperlipidemia and prescribed lovastatin. Which is the most common adverse effects of lovastatin? You Selected:

headache and flatulence. Explanation: 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. Hiccups, sinus congestion, dizziness, fatigue, mental disorientation, increased appetite or hypertension are not common adverse effects of statin drugs.

A nurse is aware of the high incidence and prevalence of hyperlipidemia and the consequent need for antihyperlipidemics. Treatment of high cholesterol using statins would be contraindicated in which client?

An obese male client who is a heavy alcohol user and who has cirrhosis of the liver Explanation: 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.

The nurse is reviewing the results of a client's lipid profile. Which of the following would the nurse identify as borderline high?

Explanation: A triglyceride level of 180 mg/dL is considered borderline high (normal or desirable would be less than 150 mg/dL). A total cholesterol of 160 mg/dL and an LDL cholesterol of 110 mg/dL would be considered normal or desirable. An HDL level of 45 mg/dL would be considered normal; levels above 60 mg/dL would be considered high.

Which agent would the nurse identify as inhibiting triglyceride synthesis in the liver, resulting in a reduction of LDL levels.

Fenofibrate Explanation: Fenofibrate inhibits triglyceride synthesis in the liver resulting in a reduction of LDL levels. Gemfibrozil inhibits the peripheral breakdown of lipids, reduces production of triglycerides and LDLs, and increases HDL concentrations. Niacin acts to inhibit the release of free fatty acids from adipose tissue, increases the rate of triglyceride removal from the plasma, and generally reduces LDL and triglyceride levels and increases HDL levels. Fenofibric acid activates a specific hepatic receptor that results in increased breakdown of lipids, elimination of triglyceride-rich particles from the plasma, and reduction in the production to an enzyme that naturally inhibits lipid breakdown.

The client is diagnosed with hyperlipidemia and prescribed lovastatin. Which is the most common adverse effects of lovastatin?

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. Hiccups, sinus congestion, dizziness, fatigue, mental disorientation, increased appetite or hypertension are not common adverse effects of statin drugs.

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?

Brownish colored urine Explanation: 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.

Which agent would the nurse identify as inhibiting the release of free fatty acids from adipose tissue?

Niacin Niacin acts to inhibit the release of free fatty acids from adipose tissue, increases the rate of triglyceride removal from the plasma, and generally reduces LDL and triglyceride levels and increases HDL levels. Fenofibrate inhibits triglyceride synthesis in the liver, resulting in a reduction of LDL levels. Gemfibrozil inhibits the peripheral breakdown of lipids, reduces the production of triglycerides and LDLs, and increases HDL concentrations. Fenofibric acid activates a specific hepatic receptor that results in increased breakdown of lipids, elimination of triglyceride-rich particles from the plasma, and reduction in the production to an enzyme that naturally inhibits lipid breakdown.