Lipid Lower Agents - CH 47 PrepU
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 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 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.
Which would be classified as a bile acid sequestrant?
Cholestyramine Cholestyramine is classified as a bile acid sequestrant. Lovastatin is a HMG-CoA reductase inhibitor. Ezetimibe is a cholesterol absorption inhibitor. Gemfibrozil is classified as a fibrate.
A client is taking cholestyramine. The nurse will assess for which common adverse effect of the drug?
Constipation Constipation is the most common adverse effect of cholestyramine. Abdominal pain, headache, and indigestion are less frequently experienced adverse effects of the drug.
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 High is rated at >240 mg/dL (6.2064 mmol/L). The other options are incorrect.
A client with moderately elevated lipid levels requests immediate pharmacotherapy for dyslipidemia. The nurse explains that a period of intensive diet therapy and lifestyle modification will be utilized before drug therapy is considered based on what rationale?
Therapeutic lifestyle changes are the preferred method for lowering blood lipids Nonpharmacologic interventions are always preferred to pharmacologic ones if there is potential for success. Medications are to be used only when nonpharmacologic efforts have proven unsuccessful. Appropriate lifestyle changes should be maintained, but adherence will not guarantee success. Many clients may find lifestyle changes (e.g., smoking cessation) challenging.
After teaching a group of students about metabolic syndrome, the instructor determines that the teaching was successful when the students identify which characteristic?
Triglyceride level above 150 mg/dL Characteristics of metabolic syndrome include fasting blood glucose levels greater than 110 mg/dL, waist measurement over 40 inches in men and over 35 inches in women, triglyceride levels greater than 150 mg/dL or HDL levels less than 40 mg/dL in men or less than 50 mg/dL in women, blood pressure greater than 130/85 mm Hg, increased macrophages, levels of interleukin-6 and TNF, and increased plasminogen activator levels.
A patient with metabolic syndrome usually has increased plasminogen activator levels.
True Metabolic syndrome involves increase plasminogen activator levels.
In addition to being synthesized in the liver and intestine, from where are blood lipids derived?
diet 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 will begin taking atorvastatin, and the nurse is conducting relevant health education. The nurse should emphasize the need to report any new onset of:
muscle pain. Myopathy is an important adverse effect of statins. Statins can injure muscle tissue, resulting in muscle ache or weakness; this should be reported promptly. Dry mouth, pruritus, and thirst are not reported adverse effects of statins.
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." 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 receives a prescription for niacin. The nurse is providing education about the medication and possible adverse effects. Which adverse affect would the nurse include?
"Some people get very flushed skin when they take this medication." Niacin is associated with intense cutaneous flushing, nausea, and abdominal pain, making its use somewhat limited. A full body rash should always be reported and self-limiting nausea is not expected. There is no need to avoid shellfish or contrast solution when taking niacin.
The nurse is providing education to an older adult client who has been prescribed atorvastatin. How should the nurse describe the common adverse effects of the drug?
"The most common side effects of atorvastatin include some mild gastrointestinal upset." Statins like atorvastatin are usually well tolerated. The most common adverse effects (nausea, constipation, diarrhea, abdominal cramps or pain, headache, skin rash) are usually mild and transient. Chest pain, joint stiffness, and bleeding are not common adverse effects.
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 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.
A nurse is caring for a client prescribed nicotinic acid for hyperlipidemia. The nurse would assess the client for which findings as a possibility?
Flushing of the skin The nurse should inform the client prescribed nicotinic acid that flushing of the skin is generally experienced by clients during this treatment. Weakness, tachycardia, and dyspnea are not adverse reactions associated with nicotinic acid.
A patient with hyperlipidemia is prescribed ezetimibe. Which ongoing assessment should the nurse perform during treatment?
Frequently monitor blood cholesterol. The nurse should frequently monitor blood cholesterol as part of the ongoing assessment for a patient receiving ezetimibe. Taking a dietary history of the patient and inspecting the skin and eyelids for evidence of xanthomas are the pre-administration assessments that a nurse should perform for a patient receiving ezetimibe. The nurse obtains the reports of fasting blood sugar for a diabetic patient.
After teaching a group of students about fats and biotransformation, the instructor determines that the teaching was successful when the students identify what as the storage location of bile acids?
Gallbladder The presence of fatty acids, lipids, and cholesterol in the duodenum stimulates contraction of the gallbladder and the release of bile, which contains bile acids. Once their action is completed, they are reabsorbed and recycled to the gallbladder, where they remain until the gallbladder is stimulated again.
The three major classes of drugs used to control blood lipids are statins, bile acid resins (or sequestrants), and fibrates. Which is a fibrate?
Gemfibrozil Gemfibrozil is a fibrate. Colestipol, colesevelam, and cholestyramine are bile acid resins.
After reviewing information about antihyperlipidemic drugs, a group of nursing students demonstrate understanding when they identify which medication as a fibric acid derivative (fibrate)?
Gemfibrozil Gemfibrozil is a fibric acid derivative. Colesevelam is a bile acid resin. Niacin is classified as a miscellaneous antihyperlipidemic. Ezetimibe is a miscellaneous antihyperlipidemic.
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 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 nurse is providing care to a client who has elevated levels of low-density lipoprotein (LDL). A review of the client's history reveals a sedentary lifestyle and a history of being overweight. The nurse understands that this combination of factors places the client at risk for which condition?
Heart disease Increased levels of LDL in combination with other risk factors, such as increased weight, diet high in saturated fats, and lack of physical activity, can lead to the development of atherosclerotic heart disease. In diabetes high levels of blood glucose as well as HbA1c are seen. In clients with glaucoma, increased eye pressure causes damage to the optic nerve. Clients with hypertension left untreated can lead to kidney failure and stroke.
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 Overall, the most effective blood lipid profile for prevention or management of metabolic syndrome and its sequelae is high HDL cholesterol, low LDL cholesterol, and low total cholesterol. A low triglyceride level is also desirable.
A client is taking lovastatin. Which are noted as the most common adverse effects?
Nausea, flatulence, and constipation 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.
HMG-CoA reductase inhibitors (statins) are classified as which pregnancy category?
Pregnancy Category X HMG-CoA reductase inhibitors (statins) are in pregnancy category X and contraindicated during any stage of pregnancy. Medications in pregnancy category A are considered safe. Medications classified as pregnancy category B, studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women. For pregnancy category C studies have shown adverse effects to the fetus, however, benefit may outweigh the potential harm---the risk has not been ruled out.
What should the nurse suggest to assist a client to improve his cholesterol levels?
Smoking cessation Lifestyle changes that can help improve cholesterol levels include a low-fat diet, regular aerobic exercise, losing weight, and not smoking.
Which single class drug is known to be most effective in reducing the major types of dyslipidemia?
Statins 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.
An instructor is describing the characteristics associated with metabolic syndrome. Which of the following would the instructor include in the description? (Select all that apply.)
Waist measurement over 40 inches in men Triglyceride levels greater than 150 mg/dL Characteristics of metabolic syndrome include waist measurement over 40 inches in men; triglyceride levels greater than 150 mg/dL or HDL levels less than 40 mg/dL in men or less than 50 mg/dL in women; fasting blood glucose levels greater than 110 mg/dL; blood pressure greater than 130/85 mm Hg; increased plasminogen activator levels; and increased macrophages, levels of interleukin-6, and tumor necrosis factor.
A nurse is conducting a presentation for a local community group about hyperlipidemia. When discussing the modifiable factors that individuals can work on to reduce their risk, which information would the nurse include? Select all that apply.
Weight Diet Modifiable risk factors for hyperlipidemia are weight, diet, and physical inactivity. Nonmodifiable risk factors for hyperlipidemia are age, gender, and family history.
The client has been taking rosuvastatin for hyperlipidemia. The client now presents with severe weakness and states barely being able to move the extremities. The nurse suspects the client has which?
rhabdomyolysis. An adverse reaction of rosuvastatin is muscle toxicity, which may cause rhabdomyolysis. Rhabdomyolysis is the breakdown of muscle that can cause pain, weakness, nausea, and even kidney damage. Gallbladder disorders are related to the use of fibric acid derivatives. Any medication can cause pruritis, however, it is not related to weakness manifested by the use of rosuvastatin.
