Ch. 27 - Antilipemic Drugs EAQ

When teaching the nursing student about coronary heart disease (CHD), which statement will the nurse include in the session? a. "CHD occurs due to the formation of atherosclerotic plaques." b. "CHD cannot be prevented by changing lifestyle modifications." c. "CHD is due to decreases in the cholesterol levels to below 200 mg/dL." d. "CHD is nonlethal and cannot be prevented by antilipemic medications."

a. "CHD occurs due to the formation of atherosclerotic plaques." Rationale CHD occurs due to the formation of atherosclerotic plaques inside the walls of the coronary arteries. The risk of CHD also increases with an unhealthy lifestyle, which should be modified. Cholesterol levels above 200 mg/dL increase the risk for developing coronary artery disease. CHD is lethal and can be prevented by antilipemic medications that lower the serum cholesterol levels if diagnosed early. Antilipemic therapy is used as primary prevention in patients with known risk factors for CHD.

Which patient's statement indicates a need for further medication instruction about colestipol? a. "I should sprinkle the powder on food to enhance absorption." b. "I might need to take fat-soluble vitamins to supplement my diet." c. "I should take this medication 1 hour after or 4 hours before my other medications." d. "The medication may cause constipation, so I will increase fluid and fiber in my diet."

a. "I should sprinkle the powder on food to enhance absorption." Rationale Colestipol is a powder that must be well diluted in fluids before administration to avoid esophageal irritation or obstruction and intestinal obstruction. The powder should be mixed well with 4 to 6 ounces of fluid. The other statements are true and are part of patient teaching.

A patient receiving atorvastatin therapy to reduce high cholesterol levels calls the clinic and reports, "I am experiencing severe pain in both my legs." Which response is appropriate by the nurse? a. "Stop taking the drug and visit the clinic immediately." b. "Continue taking the drug; leg pain is a common side effect." c. "Stop taking the drug if the symptoms persist for another week." d. "Continue taking the drug along with antilipemic drugs and a painkiller."

a. "Stop taking the drug and visit the clinic immediately." Rationale The patient may have pain in both legs due to myopathy, an adverse effect of atorvastatin. It progresses to a life-threatening condition called rhabdomyolysis, which involves the breakdown of muscle proteins, leading to renal failure and death. The nurse would instruct the patient to stop taking the drug and immediately visit the clinic. The nurse will not instruct the patient to continue the drug because myopathy is a life-threatening condition and requires immediate medical attention. The nurse will instruct the patient to watch for the symptoms; rhabdomyolysis further worsens the patient's condition, leading to renal failure. Administration of antilipemic drugs along with atorvastatin further increases the breakdown of muscle proteins and causes rhabdomyolysis. The nurse would ask the patient to stop taking the medication until the cause of the leg pain is confirmed.

Which instruction would the nurse provide for the patient to ensure proper administration of atorvastatin? a. "Take the drug in the evening." b. "Take the drug after breakfast." c. "Take the drug with an antacid." d. "Take the drug on an empty stomach."

a. "Take the drug in the evening." RationaleCholesterol production by the liver usually occurs at night; thus, statin drugs, such as atorvastatin, work by decreasing the cholesterol synthesis and are generally administered in the evening to reduce cholesterol production. All statins should be taken once daily, during the evening meal or at bedtime. The drug need not be administered after breakfast because cholesterol level production is lesser in the mornings. Antacids may not be administered along with the drug because it doesn't cause gastric irritation. The desired therapeutic effects may not be produced if the drug is administered on an empty stomach.

Which information would the nurse tell the patient who is on atorvastatin in preparation for a lipid profile? a. Fast for 12 hours before the sample collection. b. Keep the bladder full for the test and increase the water intake. c. Take the medication with a sip of water in the morning of sample collection. d. Get the liver function test performed a day before the sample collection for lipid profile.

a. Fast for 12 hours before the sample collection. Rationale The sample for a lipid profile is collected after the patient has fasted for 12 to 14 hours to help get accurate results. A lipid profile is a blood test, and the patient does not need a full bladder. The patient should not take any medications because they may interfere with the results of the lipid profile. A liver function test before a lipid profile is not needed.

Which adverse effect does the nurse expect to find in a patient who is taking niacin antilipemic drugs? a. Flushing b. Diarrhea c. Belching or bloating d. Increased risk for gallstones

a. Flushing Rationale Niacin antilipemic drugs may cause flushing and pruritus. If the patient is taking fibric acid derivatives or hydroxymethylglutaryl-coenzyme A reductase inhibitors, the patient may experience diarrhea. The patient will experience belching or bloating if he or she is taking bile acid sequestrant medication. The patient may have an increased risk of gallstones if he or she is taking fibric acid derivative medication.

The nurse is caring for a patient who has coronary heart disease (CHD). The nurse tells the patient, "Your cholesterol levels are abnormal; you are at a high risk of having a heart attack." Which laboratory finding did the nurse discover regarding the lipoprotein levels in the patient's blood report? a. High levels of low-density lipoproteins (LDL) b. High levels of high-density lipoproteins (HDL) c. Low levels of very-low-density lipoproteins (VLDL) d. Low levels of intermediate-density lipoproteins (IDL)

a. High levels of low-density lipoproteins (LDL) Rationale High levels of LDL refer to high cholesterol levels in the blood because LDL is almost entirely composed of cholesterol. This cholesterol is bad cholesterol, which promotes the formation of atherosclerotic plaque, resulting in CHD. HDL is good cholesterol, which has a cardioprotective action. Low levels of VLDL are due to a low-fat diet; however, these do not cause high cholesterol levels. Low levels of IDL do not increase the risk of CHD; they are useful for the production of bile acids.

The nurse would question an order for colesevelam if the patient has which condition in the medical history? a. Impaction b. Glaucoma c. Renal disease d. Hepatic disease

a. Impaction Rationale Colesevelam binds with bile in the intestinal tract to form an insoluble complex. It can also bind to other substances and lead to intestinal obstruction. Glaucoma, renal disease, and hepatic disease are not contraindications for taking colesevelam.

Which side effect is common with fenofibrate, a fibric acid derivative? Select all that apply. One, some, or all responses may be correct. a. Impotence b. Constipation c. Cutaneous flushing d. Nausea and abdominal pain e. Increase in gallstone formation

a. Impotence d. Nausea and abdominal pain e. Increase in gallstone formation RationaleImpotence, nausea, abdominal pain, and an increase in gallstone formation are the adverse effects produced by fenofibrate. Diarrhea, not constipation, is a common side effect of fibric acid derivatives. Cutaneous flushing is an adverse effect produced by niacin. Constipation and cutaneous flushing are not associated with fenofibrate.

A patient with hyperlipidemia has been prescribed simvastatin. While caring for the patient, the nurse unknowingly administers niacin along with simvastatin. Which complication may the patient have due to the drug interaction? a. Myopathy b. Blurred vision c. Bowel obstruction d. Hepatic dysfunction

a. Myopathy Rationale The drug interactions between niacin and a hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor, such as simvastatin, could result in myopathy, which could progress to rhabdomyolysis. Blurred vision is the adverse effect produced by statins when administered alone. Colesevelam may cause bowel obstruction because it binds with bile and other substances in the intestinal tract to form an insoluble complex. Simvastatin can cause hepatic dysfunction in patients who have pre-existing liver disease by increasing the liver enzymes. Blurred vision, bowel obstruction, and hepatic dysfunction are not caused by the coadministration of niacin and simvastatin.

Which symptom would he nurse assess for while caring for a patient prescribed niacin (nicotinic acid) for hyperlipidemia? a. Pruritus b. Muscle pain c. Constipation d. Nausea and vomiting

a. Pruritus Rationale The nurse would monitor the patient for adverse effects of niacin (nicotinic acid), such as abdominal discomfort, cutaneous flushing, and pruritus. Muscle pain is the most serious adverse effect of statins. Constipation is an adverse effect produced by HMG- CoA reductase inhibitors and bile acid sequestrants. Nausea and vomiting are adverse effects of HMG-CoA reductase inhibitors and bile acid sequestrants.

The nurse is caring for a patient who has hyperlipidemia and who has been prescribed gemfibrozil. On reviewing the medical history of the patient, the nurse learns that the patient is taking warfarin. Which problem would the nurse anticipate after reviewing the patient's medical history? a. The patient has an increased risk of bleeding. b. The patient has an increased risk of infection. c. The patient has an increased risk of bowel obstruction. d. The patient has an increased risk of vitamin K toxicity.

a. The patient has an increased risk of bleeding. Rationale Gemfibrozil can bind with vitamin K in the intestinal tract, reducing the absorption of vitamin K. Vitamin K is the antidote for warfarin, so the lack of vitamin K increases the anticoagulant effect of warfarin, causing an increased risk of bleeding. Hyperlipidemic drugs do not cause immune suppression; the patient would not have an increased risk of infection. There may be an increased risk of bowel obstruction when bile acid sequestrants bind to other substances in the intestinal tract, but not with this combination of drugs. Because the hyperlipidemic drug gemfibrozil reduces absorption of vitamin K, the patient may have a vitamin K deficiency rather than a vitamin K toxicity.

A patient is prescribed simvastatin. During medication reconciliation, the presence of which drug in the prescription would raise concern? Select all that apply. One, some or all responses may be correct. a. Warfarin b. Colestipol c. Gemfibrozil d. Cyclosporine e. Erythromycin

a. Warfarin c. Gemfibrozil d. Cyclosporine e. Erythromycin Rationale Simvastatin inhibits the metabolism of warfarin, which may increase the risk of clotting. If the patient has taken gemfibrozil, it may lead to potentiation of the drug and cause myopathy. If the patient takes cyclosporine while on simvastatin medication, the patient may experience myopathy because it inhibits the metabolism of simvastatin. Erythromycin should not be taken by patients who are also taking simvastatin. The patient can take colestipol, a bile acid sequestrant that can be used with hydroxymethylglutaryl-coenzyme A reductase inhibitors, such as simvastatin.

The nurse is assessing a patient with diabetes who has hyperlipidemia. The patient asks the nurse to suggest either an herbal medication or a dietary modification to reduce cholesterol levels. Which suggestion given by the nurse would be beneficial to the patient? a. "Include flaxseeds in your food." b. "Eat foods rich in omega-3 fatty acids." c. "Consume excessive amounts of garlic." d. "Take 20 mg of St. John's wort regularly."

b. "Eat foods rich in omega-3 fatty acids." Rationale The patient has diabetes and hyperlipidemia; therefore, the nurse would suggest that the patient include foods rich in omega-3 fatty acids, such as fish oil, in her diet. They are also available as fish oil products under the brand name Lovaza. This reduces cholesterol levels without altering blood glucose levels. Flax intake should not be suggested to a diabetic patient because it may have potential hypoglycemic effects due to drug interactions. Because garlic is contraindicated in diabetic patients, the nurse would not suggest that the patient eat an excessive amount of garlic. St. John's wort is an herb used to treat depression and the symptoms associated with depression, such as anxiety, loss of appetite, and insomnia. This is not helpful in reducing the cholesterol level.

Which information would the nurse instruct the patient with high serum cholesterol who has been on treatment with antilipemics for 6 months to do to ensure safe drug administration? a. "You should decrease your fluid intake." b. "You should include fiber-rich foods in your diet." c. "You may need supplements of vitamins B and C." d. "We need to run a renal function test during your next visit."

b. "You should include fiber-rich foods in your diet." Rationale Antilipemics tend to cause changes in the gastrointestinal system and may result in constipation. Therefore, foods rich in fiber should be included in the diet to promote regular bowel movements and prevent constipation. Fluid intake should be increased to prevent constipation. Antilipemics may disrupt the balance of fat-soluble vitamins, and the patient may need supplementation of vitamins A, D, and E. Antilipemics affect the portal system and may cause liver dysfunction. Therefore, liver function tests should be performed routinely to assess the liver function. A renal test may not be needed.

Initial monitoring for the maximum effect of simvastatin 20 mg will occur within which time period of starting the medication? a. A week b. 6 to 8 weeks c. 12 weeks d. Six months

b. 6 to 8 weeks Rationale Lipid levels may not be lowered to the maximum extent until six to eight weeks after the start of therapy. Changes in a week will not be the maximum effects and will most likely not be monitored. Lipid levels are monitored at 6 to 8 weeks for the first 6 months and then every 3 to 6 months to monitor continued response.

Which assessment finding in a patient taking a hydroxymethylglutaryl- coenzyme A (HMG-CoA) reductase inhibitor will the nurse act on immediately? a. Decreased hemoglobin b. Elevated liver function tests c. Elevated low-density lipoprotein (LDL) d. Elevated high-density lipoprotein (HDL)

b. Elevated liver function tests Rationale HMG-CoA reductase inhibitors (statins) can cause hepatic toxicity; thus, it is necessary to monitor liver function tests. The nurse would act on this finding immediately. Decreased hemoglobin should be addressed but not immediately. It is most likely not related to the administration of the HMG-CoA reductase inhibitor. Also, although an elevated LDL level must be addressed, it is not as high a priority as the elevated liver function test results. An elevated HDL is a positive finding and an encouraging result.

The nurse provides teaching to a patient who will take atorvastatin at home. Which patient teaching is likely to help maintain the antilipemic medication dosage at the lowest level possible? a. Take atorvastatin at bedtime. b. Engage in moderate exercise. c. Avoid all alcoholic beverages. d. Adhere to the blood test schedule.

b. Engage in moderate exercise. Rationale The nurse instructs the patient to engage in moderate-intensity exercise to improve cardiovascular conditioning. Exercise helps increase metabolism and promote collateral circulation. Taking atorvastatin at bedtime, avoiding alcoholic beverages, and adhering to the blood test schedule all help manage adverse effects and aid in the early detection of serious adverse effects; however, these reasonable nursing interventions for patient teaching are less likely to affect the dosage of atorvastatin.

Which antilipemic medication reduces serum cholesterol by inhibiting its absorption in the small intestine? a. Niacin b. Ezetimibe c. Rosuvastatin d. Cholestyramine

b. Ezetimibe Rationale Ezetimibe, the only cholesterol absorption inhibitor on the US market, is effective in lowering total cholesterol, low-density lipoprotein (LDL) cholesterol, apolipoprotein B, and triglyceride levels. Niacin is a vitamin administered in large doses to lower serum cholesterol levels. Rosuvastatin is a hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor that lowers serum cholesterol levels. Cholestyramine is a bile acid sequestrant.

Which risk factor contributes to coronary heart disease (CHD)? Select all that apply. One, some, or all responses may be correct. a. Blood pressure of 130/85 mm Hg b. Family history of premature CHD c. Blood pressure higher than 140/90 mm Hg d. Serum triglyceride level of 150 mg/dL or more e. High-density lipoprotein level of 60 mg/dL or higher

b. Family history of premature CHD c. Blood pressure higher than 140/90 mm Hg Rationale The positive risk factors for CHD include a family history of premature CHD, such as myocardial infarction. The sudden death of a patient's father before 55 years of age or the sudden death of the patient's mother before 65 years of age, also indicates a CHD risk. Hypertension is characterized by an increase in blood pressure, which may be higher than 140/90 mm Hg, indicating that the individual has a CHD risk. A blood pressure of 130/85 mm Hg and a serum triglyceride level of 150 mg/dL or more are identifying features of metabolic syndrome but are not risk factors for CHD. A high- density lipoprotein (HDL) cholesterol level of 60 mg/dL or higher is a negative risk factor for CHD.

Which response would the nurse monitor when caring for a patient on atorvastatin? a. Complaints of constipation b. Increase in liver enzyme levels c. Complaints of cutaneous flushing d. Consumption of less than 1 quart of grapefruit juice

b. Increase in liver enzyme levels Rationale One of the main adverse effects of atorvastatin is the elevation in liver enzyme levels. The patient needs to be monitored on a regular basis for excessive elevations of these enzymes. The patient may experience constipation with bile acid sequestrants. The patient may experience cutaneous flushing with niacin. The patient should consume less than 1 quart of grapefruit juice daily. If the patient is drinking more than 1 quart, it may lead to rhabdomyolysis.

A patient with hypercholesterolemia has been prescribed simvastatin. Which action would the nurse perform while caring for the patient? a. Instruct the patient to take aspirin for pain relief. b. Inform the patient that this drug may cause nausea. c. Inform the patient that allergies are a side effect of the drug. d. Instruct the patient to discontinue the drug in case of muscle pain.

b. Inform the patient that this drug may cause nausea. Rationale Patients who are treated with simvastatin may have adverse effects, such as nausea, vomiting, and fever. The nurse would teach the patient about the possible adverse effects of the drug therapy and instruct him or her to immediately report any signs of toxicity, including muscle soreness, changes in urine color, fever, malaise, nausea, or vomiting. The nurse would not instruct the patient to administer aspirin for pain relief. Any pain should be reported because it can indicate rhabdomyolysis, which may cause renal failure and even death. Simvastatin is contraindicated in patients with a known drug allergy. The nurse would not advise the patient to discontinue the medication without consulting the health care provider.

A patient is taking pravastatin sodium. Which assessment finding requires immediate action by the nurse? a. Headache b. Muscle pain c. Constipation d. Slight nausea

b. Muscle pain Rationale Patients who experience severe muscle pain while taking pravastatin sodium need to report the findings right away because this may be indicative of rhabdomyolysis, a muscle disintegration that can become fatal. Headache and nausea are not common side effects. Constipation is a possible adverse effect but does not warrant immediate action.

Which laboratory data is considered a risk factor for coronary heart disease? a. Serum triglyceride level of 90 mg/dL b. Total cholesterol level of 300 mg/dL c. High-density lipoprotein (HDL) cholesterol level of 55 mg/dL d. Low-density lipoprotein (LDL) cholesterol level 60 mg/dL

b. Total cholesterol level of 300 mg/dL Rationale The risk for coronary heart disease in patients with cholesterol levels of 300 mg/dL or more is three to four times greater than that in patients with levels of less than 200 mg/dL. Serum triglyceride levels of 150 mg/dL or more and HDL cholesterol levels of less than 40 mg/dL in men or less than 50 mg/dL in women are considered a feature of metabolic syndrome associated with cardiovascular disease. LDL cholesterol of 190 mg/dL or greater without current cardiac disease is still hyperlipidemia and a risk factor for cardiovascular disease.

A patient eats large amounts of garlic for its cardiovascular benefits. Which drug in the patient's medication history would prompt the nurse to ask the patient to stop consuming garlic? a. Digoxin b. Warfarin c. Colestipol d. Fenofibrate

b. Warfarin Rationale Warfarin has potential drug interactions with garlic. There is a possible interaction between garlic and warfarin that could increase the risk of bleeding in people taking blood-thinning medication. Digoxin is a cardiac glycoside drug that has no potential interactions with garlic. Colestipol and fenofibrate are used to treat elevated blood lipid and cholesterol concentrations and do not have any potential interactions with garlic.

At which time will the nurse instruct a patient to self-administer prescribed niacin to lower cholesterol levels? a. One hour before food b. With food at mealtime c. Two hours after a meal d. An hour before other medications

b. With food at mealtime Rationale Niacin can cause flushing, pruritus, and gastrointestinal distress. These undesirable effects can be minimized by having patients take the drug with meals. Prior to mealtime or 2 hours after a meal may increase these side effects. Small doses of aspirin or a nonsteroidal antiinflammatory drug may be taken 30 minutes before the niacin dose to minimize flushing. Drug interactions associated with niacin are minimal.

The nurse is caring for a patient with hypercholesterolemia who is taking 20 mg of simvastatin as prescribed. After a few days, the patient's urinalysis reports indicate the presence of myoglobin. Which instruction would the nurse receive from the primary health care provider? a. "Give 10 mg of medication daily." b. "Give the medication before meals." c. "Discontinue administering the medication." d. "Give the medication with 250 mL of water."

c. "Discontinue administering the medication." Rationale The presence of myoglobin in the urine indicates that the patient has rhabdomyolysis, an adverse effect of statins, such as simvastatin. Rhabdomyolysis is characterized by the breakdown of muscle proteins and can be fatal. The primary health care provider would instruct the nurse to discontinue the medication. Reducing the dosage of the medication to 10 mg, giving the medication before meals, or administering the medication with high amounts of fluids does not prevent rhabdomyolysis.

Which statement made by the patient indicates an understanding of discharge instructions on antihyperlipidemic medications? a. "I will stop taking the medication if it causes nausea and vomiting." b. "It is important to double my dose if I miss one in order to maintain therapeutic blood levels." c. "I will continue my exercise program to help increase my high-density lipoprotein serum levels." d. "Antihyperlipidemic medications will replace the other interventions I have tried to decrease my cholesterol."

c. "I will continue my exercise program to help increase my high-density lipoprotein serum levels." Rationale Antihyperlipidemic medications are an addition to, not a replacement for, the therapeutic regimen used to decrease serum cholesterol levels. Patients should not stop taking the medication without consulting the provider. The dose should never be doubled if one is missed or stopped because of the risk of side effects.

The nurse plans which intervention to decrease flushing associated with niacin? a. Administer niacin with an antacid. b. Apply cold compresses to the head and neck. c. Administer aspirin 30 minutes before nicotinic acid. d. Administer diphenhydramine hydrochloride with the niacin.

c. Administer aspirin 30 minutes before nicotinic acid. Rationale Administration of an anti-inflammatory agent, such as aspirin, has been shown to decrease the flushing reaction associated with niacin. Antacids do not prevent cutaneous flushing. Applying cold compresses to the patient's head and neck may not diminish flushing. Histamine 1 antagonists, including such drugs as diphenhydramine hydrochloride, are of greatest value in the treatment of nasal allergies, particularly seasonal hay fever.

Which side effect may be seen with cholestyramine? a. Pruritus b. Myopathy c. Constipation d. Risk of gallstones

c. Constipation Rationale Constipation is a common adverse effect of cholestyramine. Pruritus is an adverse effect associated with niacin. Myopathy is a clinically important adverse effect of hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors. If a patient is on fibric acid derivatives, the patient has an increased risk for gallstones.

Which condition included in a patient's medical history requires provider notification regarding a recent addition of a flax supplement? a. Hypercholesterolemia b. Atherosclerosis c. Diabetes d. Constipation

c. Diabetes Rationale Flax supplements may alter antidiabetic drugs. The health care provider would need to be aware of the possible drug interaction. Flax is commonly used for hypercholesteremia, atherosclerosis, and constipation. While these conditions require management, diabetic control is the most concerning since blood glucose levels may be out of the normal range.

Which additional therapy is included for the plan of care for a patient prescribed atorvastatin 10 mg daily? a. Social services b. Genetic counseling c. Dietary referral d. Cardiac rehabilitation

c. Dietary referral Rationale The use of antilipemic therapy is an adjunct to dietary therapy in patients with elevated cholesterol. When receiving antilipemic therapy, patients remain on a low-fat, low- cholesterol diet as an integrated part of a change in lifestyle. There is data to suggest social services is indicated at this point unless there are additional difficulties securing resources for therapy. Cholesterol levels and family history guide initial therapy without genetic counseling. There is not enough data to support cardiac rehabilitation; however, a preventative program for an active lifestyle may benefit the patient.

A patient diagnosed with hypercholesterolemia is prescribed lovastatin. Based on this medication order, the nurse will contact the health care provider about which reported condition in the patient's history? a. Leukemia b. Renal disease c. Hepatic disease d. Chronic pulmonary disease

c. Hepatic disease Rationale Lovastatin can cause an increase in liver enzymes and thus should not be used in patients with pre-existing liver disease. Leukemia, renal disease, and pulmonary disease are not contraindications for taking lovastatin.

Which mechanism of action takes place with ezetimibe? a. Inhibiting the biosynthesis of cholesterol in the liver b. Decreasing the adhesion of cholesterol on the arterial walls c. Inhibiting absorption of dietary and biliary cholesterol in the small intestine d. Inhibiting the absorption of bile and thus causing the liver to produce bile from cholesterol

c. Inhibiting absorption of dietary and biliary cholesterol in the small intestine Rationale Ezetimibe works by selectively inhibiting the absorption of cholesterol and related sterols in the small intestine. The mechanism of action of ezetimibe does not involve the liver or arterial walls.

The nurse is caring for a patient who is prescribed simvastatin. Which medication in the prescription would need a replacement? a. Verapamil b. Ranolazine c. Ketoconazole d. Acetaminophen

c. Ketoconazole RationaleKetoconazole may have harmful drug interactions with simvastatin and may need to be replaced. Ranolazine and verapamil may not need replacement, but the dose would need to be reduced. Acetaminophen can be safely administered with simvastatin.

A patient will be discharged to continue treatment with simvastatin. The nurse will teach the patient to report which symptom? a. Fatigue b. Headache c. Muscle pain d. Nausea and vomiting

c. Muscle pain Rationale Muscle pain must be reported because it could signify rhabdomyolysis, the uncommon but serious adverse effect that is associated with statin drugs like simvastatin. Fatigue, headache, and nausea and vomiting are also adverse effects of statin drugs, but they are generally not severe.

The nurse is teaching a patient about the safe administration of niacin (nicotinic acid). Which instruction would the nurse give to the patient to minimize the adverse effects of the drug? a. Take the drug before going to bed. b. Take the drug on an empty stomach. c. Take aspirin 30 minutes before taking the drug. d. Consume a large amount of fiber while taking the drug.

c. Take aspirin 30 minutes before taking the drug. Rationale Niacin (nicotinic acid) may cause flushing of the face. Taking a small dose of aspirin or other nonsteroidal anti-inflammatory drugs 30 minutes before the drug, or titrating the drug dosage, may help to minimize flushing of the skin. The medication does not have sedative effects; it is not mandatory to take the medication before going to bed. Niacin (nicotinic acid) should not be taken on an empty stomach because it may produce gastrointestinal upset. Because niacin (nicotinic acid) does not cause constipation, taking the drug with large amounts of fiber may not be necessary.

A patient with hypercholesterolemia is prescribed lovastatin. After reviewing the patient's medical history, the nurse discovers that the medication is not safe to prescribe for the patient and reports this finding to the health care provider. Which health condition did the nurse find in the patient's medical history? a. The patient has leukemia. b. The patient has renal disease. c. The patient has hepatic disease. d. The patient has chronic pulmonary disease.

c. The patient has hepatic disease. Rationale Lovastatin can cause an increase in liver enzymes and should not be prescribed to patients with pre-existing liver disease. Statins induce cell death in malignant cells. Cell death occurs via apoptosis, and lovastatin concentrations are used in the treatment of leukemia. Statins slow down the progress of chronic kidney disease by reducing kidney inflammation or improving the function of kidney tissues. Statins reduce chronic obstructive pulmonary disorder (COPD). Lovastatin can be prescribed to the patient with leukemia, renal disease, and COPD.

Which statement by the patient indicates a need for further explanation regarding the safe administration of colestipol? a. "I might need to include food rich in fat-soluble vitamins to prevent the deficiency." b. "The medication may cause constipation, so I will increase fluid and fiber in my diet." c. "I should take this medication 1 hour before or 4 hours after taking other medications." d. "I should mix the powder in a small amount of fluid to maintain potency of the medication."

d. "I should mix the powder in a small amount of fluid to maintain potency of the medication." Rationale Colestipol is a bile acid sequestrant. It often comes in powdered form and must be mixed thoroughly with food or fluids (at least 4 to 6 ounces of fluid). The powder may not mix completely at first, but patients must be sure to mix the dose as much as possible, diluting any undissolved portion with additional fluid. The patient should avoid mixing the drug in small amounts of fluids. The drug must be well diluted in fluid before administration to avoid esophageal irritation or obstruction and intestinal obstruction. Because the colestipol decreases the cholesterol level, the patient should take fat-soluble vitamins to supplement the diet. Constipation may be prevented with a high-fiber diet and an increase in fluid intake. Colestipol should be taken 1 hour before or 4 to 6 hours after any other oral medication or meals because of the high risk for drug-drug and drug-food interactions and to facilitate proper absorption.

The nurse is teaching a group of nursing students about statin drugs and asks about the mechanism of action of lovastatin. Which response from the students indicates effective learning? a. "It inhibits the absorption of dietary cholesterol in the small intestine." b. "It stimulates the biliary system to increase the excretion of dietary cholesterol." c. "It binds to bile in the intestinal tract, forming an insoluble complex that is excreted in the feces." d. "It inhibits hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase to reduce the biosynthesis of cholesterol in the liver."

d. "It inhibits hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase to reduce the biosynthesis of cholesterol in the liver." Rationale Lovastatin is an HMG-CoA reductase inhibitor, decreasing the synthesis of cholesterol in the liver. Lovastatin does not inhibit the absorption of dietary cholesterol in the small intestine. Lovastatin does not stimulate the biliary system to increase the excretion of dietary cholesterol. Bile acid sequestrants bind bile and prevent the resorption of the bile acids from the small intestine.

Which mechanism of action occurs with simvastatin? a. By inhibiting lipolysis in the adipose tissue b. By activating the lipoprotein lipase enzyme c. By preventing the reabsorption of bile acids d. By inhibiting the enzyme hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase

d. By inhibiting the enzyme hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase Rationale Simvastatin exerts its action by inhibiting the enzyme HMG-CoA reductase, reducing the rate of cholesterol production. Antilipemic drugs are known to inhibit lipolysis in the adipose tissue, decrease esterification of the triglycerides in the liver, and increase the activity of lipoprotein lipase. Fibric acid drugs are believed to work by activating the lipoprotein lipase, an enzyme responsible for the breakdown of cholesterol. Bile acid sequestrants bind to bile salts and prevent the resorption of bile acids from the small intestine.

A patient with hyperlipidemia has been prescribed simvastatin. The nurse instructs the patient to undergo a liver function test and kidney function test every 3 to 6 months. Which drug therapy-related complication in the patient is the nurse trying to prevent? a. Hepatitis b. Cirrhosis c. Nephritis d. Rhabdomyolysis

d. Rhabdomyolysis Rationale Simvastatin may cause rhabdomyolysis, characterized by the breakdown of muscle protein. The elimination of myoglobin from the body may impair kidney functioning and cause acute renal failure. The nurse would monitor the levels of liver enzymes that indicate liver function. To prevent the development of rhabdomyolysis, the nurse would suggest that the patient undergo liver and renal function testing every 3 to 6 months. Simvastatin does not cause hepatitis, cirrhosis, or nephritis. Cirrhosis is caused by chronic alcohol consumption. Nephritis is caused by aminoglycosides.

The nurse is teaching a medication regimen to a patient who has type II hyperlipoproteinemia and who has been prescribed cholestyramine. Which information will the nurse give the patient during the teaching? a. Include milk in the diet while taking this medication. b. Avoid doing deep breathing exercises after taking the medication. c. Avoid taking vitamin A supplements while taking the medication. d. Take other medications 1 hour before the administration of cholestyramine.

d. Take other medications 1 hour before the administration of cholestyramine. Rationale Bile acid sequestrants, such as cholestyramine, should not be taken along with other medications because of reduced absorption. Other drugs must be taken at least 1 hour before or 4 to 6 hours after taking the bile acid sequestrant. Milk reduces peristalsis and is therefore not included in the diet. Cholestyramine does not impair pulmonary function, so the patient does not need to avoid practicing deep breathing exercises. Cholestyramine reduces the absorption of fat-soluble vitamins (A, D, E, and K); therefore, to prevent a vitamin A deficiency, the nurse suggests that the patient take vitamin A supplements.