Pharmacology Prep U Level 1-4 Chapter 47 Lipid Lowering Agents

Liver disease

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? Asthma Liver disease Renal disease Hypertension

Increased bleeding times, Vitamin A and D, E deficiencies, constipation due to fecal impaction

What are the adverse effects of Bile Acid Sequestrants? cutaneous flushing of the chest, neck, and face, nausea Flatulence, constipation, headache, Rhabdomylosis, liver failure Increased bleeding times, Vitamin A and D, E deficiencies, constipation due to fecal impaction tachycardia, hypertension, shallow respirations

Heart disease atherosclerotic heart disease

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 Diabetes Glaucoma Hypertension

Blood in urine or stool Warfarin levels increase with ezetimibe, increasing the patient's risk for bleeding.

A patient with atrial fibrillation is receiving warfarin therapy. The patient is also prescribed ezetimibe. The nurse would instruct the patient to watch for: Blood in urine or stool Abdominal pain Yellowing of the skin Blurred vision

Frequently monitor blood cholesterol.

A patient with hyperlipidemia is prescribed ezetimibe. Which ongoing assessment should the nurse perform during treatment? Take a dietary history of the patient. Inspect skin and eyelids for evidence of xanthomas. Obtain reports of fasting blood sugar levels. Frequently monitor blood cholesterol.

True Metabolic syndrome is a cluster of conditions that occur together, increasing your risk of heart disease, stroke and type 2 diabetes. These conditions include increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels

A patient with metabolic syndrome usually has increased plasminogen activator levels. True False

Cholesterol

Blood lipids are a category of fatty acids, which are substances used within the body to perform essential functions. Which category of blood lipids is involved in the formation of atherosclerotic plaques? Phospholipids Cholesterol Triglycerides Nitroglycerin

LFT Increased concentrations of liver enzymes commonly occur, and acute liver failure has been reported with the use of atorvastatin and fluvastatin. Liver function studies should be monitored at the onset of therapy, at 6 and 12 weeks, and intermittently during course of therapy.

The nurse is caring for a client who takes fluvastatin . Which laboratory value should be assessed regularly in this client? BUN LFT CBC aPTT

HMG-CoA reductase inhibitors

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? Bile acid sequestrants HMG-CoA reductase inhibitors Fibrates Niacin

Works in the brush border of the small intestine to inhibit the absorption of cholesterol and decrease the delivery of intestinal cholesterol to the liver

What is the mechanism of action of Cholesterol Absorption Inhibitors? Binds with bile acids in the small intestine, allowing excretion in the feces Inhibits the production of cholesterol Works in the brush border of the small intestine to inhibit the absorption of cholesterol and decrease the delivery of intestinal cholesterol to the liver inhibits peripheral breakdown of lipids, reduces production of triglycerides and LDLs, and increases HDL concentrations.

Inhibits the production of cholesterol

What is the mechanism of action of a statin? Binds with bile acids in the small intestine, allowing excretion in the feces Inhibits the production of cholesterol Works in the brush border of the small intestine to inhibit the absorption of cholesterol and decrease the delivery of intestinal cholesterol to the liver inhibits peripheral breakdown of lipids, reduces production of triglycerides and LDLs, and increases HDL concentrations.

Ezetimibe

What is the prototype Cholesterol Absorption Inhibitors? Colestipol Colesevelam Ezetimibe Evolocumab

Atorvastatin

What is the prototype HMG-CoA Reductase Inhibitors (statin)? Atorvastatin Fluvastatin Lovastatin Pravastatin

Statins

Which single class drug is known to be most effective in reducing the major types of dyslipidemia? Bile acid sequestrants Fibrates Statins Niacin

High High is rated at >240 mg/dL (6.2064 mmol/L).

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? Optimal Desirable High Very high

"This is an expected adverse effect of the drug. It should subside in time." Large doses of nicotinic acid produce peripheral vasodilation, mostly in the cutaneous vessels of the face, neck, and chest. Vasodilation results in flushing of the skin and is usually transient. The vasodilation is due to the histamine release caused by the medication.

A female client is taking a large dose of nicotinic acid to treat hyperlipidemia. She calls the clinic and reports that her face, neck, and chest are red. Which would be an appropriate response by the nurse? "This is an expected adverse effect of the drug. It should subside in time." "Don't worry about it. I'm sure it's not really noticeable." "You need to stop taking the medication immediately. I will notify the health care provider." "You need to decide if you want to take this medication. The flushing will be present as long as you take the medication."

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

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? A 72-year-old man who has emphysema and a long history of cigarette smoking An obese male client who is a heavy alcohol user and who has cirrhosis of the liver A female client who had a laparoscopic cholecystectomy (gall bladder removal) earlier this year A resident of a long-term care facility whose Alzheimer disease is being treated with donepezil (Aricept)

HDLs HDLs are loosely packed lipids that are used for energy and to pick up remnants of fats and cholesterol left in the periphery by the breakdown of LDLs.

After reviewing information about lipoproteins, a group of students demonstrate understanding of the information when they identify which of the following as being loosely packed? LDLs HDLs Triglycerides Lipids

headache and flatulence. 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.

The client is diagnosed with hyperlipidemia and prescribed lovastatin. Which is the most common adverse effects of lovastatin? increased appetite and blood pressure. headache and flatulence. fatigue and mental disorientation. hiccups, sinus congestion, and dizziness.

Flatulence, constipation, headache, Rhabdomylosis, liver failure

What are the adverse effects of HMG-CoA Reductase Inhibitors? cutaneous flushing of the chest, neck, and face, nausea Flatulence, constipation, headache, Rhabdomylosis, liver failure Increased bleeding times, Vitamin A and D, E deficiencies, constipation due to fecal impaction tachycardia, hypertension, shallow respirations

cutaneous flushing of the chest, neck, and face, nausea

What are the adverse effects of Niacin? cutaneous flushing of the chest, neck, and face, nausea Flatulence, constipation, headache, Rhabdomylosis, liver failure Increased bleeding times, Vitamin A and D, E deficiencies, constipation due to fecal impaction tachycardia, hypertension, shallow respirations

Pravastatin Dyslipidemic drugs are not recommended for children younger than 10 years of age, except for pravastatin, which has dosing recommendations for children as young as 8 years.

An 8-year-old male client requires treatment for dyslipidemia. What would the nurse expect the health care provider to order? Niacin Pravastatin Fenofibrate Cholestyramine

Digoxin

A client is taking cholestyramine to reduce LDL cholesterol. Cholestyramine will cause a decrease in absorption of which medication? Ibuprofen Aspirin Acetaminophen Digoxin

Cholestyramine

A client who has been taking a statin has seen an improvement in his cholesterol laboratory values; however, the low-density lipoprotein remains elevated. What medication will be added to the medical regime? Digoxin Vitamin D Cholestyramine Calcium carbonate

Binds with bile acids in the small intestine, allowing excretion in the feces

What is the mechanism of action of Bile Acid Sequestrants? Binds with bile acids in the small intestine, allowing excretion in the feces Inhibits the production of cholesterol Works in the brush border of the small intestine to inhibit the absorption of cholesterol and decrease the delivery of intestinal cholesterol to the liver inhibits peripheral breakdown of lipids, reduces production of triglycerides and LDLs, and increases HDL concentrations.

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

"I will take the digoxin about an hour before the cholestyramine." The absorption of digoxin can be decreased or delayed with cholestyramine, a bile acid sequestrant. Therefore, the digoxin should be taken 1 hour before for 4 to 6 hours after the cholestyramine.

A client who is receiving cholestyramine also takes digoxin. The nurse teaches the client about the drug and administration. The client demonstrates understanding of the teaching when stating: "I need to take both drugs at the same time of the day." "I'll take the cholestyramine at 8 AM and the digoxin at 9 AM." "I'll take the digoxin about 15 minutes before the cholestyramine." "I will take the digoxin about an hour before the cholestyramine."

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.

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 Blood pressure below 130/85 mm Hg Fasting blood glucose below 110 mg/dL Waist measurement over 35 inches in men

LFTs Niacin may cause hepatotoxicity, especially with doses greater than 2 g daily, with timed-release preparations, and if given in combination with a statin or a fibrate.

The health care provider prescribes fibrate for a client with elevated triglycerides. The client begins to self-administer niacin approximately 3 mg daily. What would the nurse expect the provider to order? LFTs CBC Electrolyte panel Fibrate level

Gemfibrozil

The three major classes of drugs used to control blood lipids are statins, bile acid resins (or sequestrants), and fibrates. Which is a fibrate? Cholestyramine Colesevelam Colestipol Gemfibrozil

LDL cholesterol of 190 mg/dL 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.

Which lipid level would the nurse interpret as being high? LDL cholesterol of 190 mg/dL Total cholesterol of 200 mg/dL Triglyceride level of 160 mg/dL HDL cholesterol of 48 mg/dL