Chapter 50 Pharm Evolve

The healthcare provider prescribes lovastatin [Mevacor] for a patient discharged from the hospital post-myocardial infarction. Which instructions are most appropriate for the nurse to include in the patient's teaching plan?

"Do not start any new medications without first talking to your healthcare provider." "Before starting this medication a blood test will be done to check your total cholesterol level and to measure liver enzymes." "Lower the total fat and saturated fat in your diet by increasing your intake of fresh fruits and vegetables and whole grains." Lovastatin, simvastatin, and atorvastatin levels may be elevated when these drugs are combined with other drugs that inhibit CYP3A4. If these drugs are combined, caution is warranted. Before starting a statin, obtain a baseline lipid profile that includes total cholesterol and obtain baseline LFTs. The statins are taken once daily with food. It is recommended to take them with the evening meal because endogenous cholesterol synthesis increases during the night. The statins do not typically cause flushing and itching; that effect occurs with niacin. A diet low in total fat and saturated fat is recommended when antilipemic drugs are prescribed.

The nurse is teaching a group of patients about dietary approaches to reduce cholesterol levels. Which statement is most important to include in the teaching?

"Read food labels and reduce your intake of saturated fats An increase in dietary cholesterol intake does not produce a large increase in blood cholesterol because of the body's feedback system. When cholesterol intake increases, endogenous production decreases. However, because the body uses dietary saturated fats to make cholesterol, an increase in saturated fat intake can produce a significant increase in blood cholesterol levels. To lower blood cholesterol, it is most important to lower saturated fat intake. Although red meat and pork should be limited, it is not necessary to eliminate them from the diet. Sodium intake is not directly related to lowering cholesterol levels.

The nurse is caring for a patient prescribed gemfibrozil [Lopid]. For which patient should the nurse question the use of this drug?

A patient with history of gallstones and elevated triglycerides Gemfibrozil is indicated to reduce elevated triglycerides and very-low-density lipoprotein levels primarily in patients who have not responded adequately to diet modification. It can also raise HDL but does not reduce LDL to a significant degree. Gemfibrozil increases the risk of gallstone formation and should not be used in patients with preexisting gallbladder disease.

A patient with an elevated triglyceride level is prescribed a sustained-release form of nicotinic acid [Slo-Niacin]. Which laboratory value is most important for the nurse to monitor for in this patient?

Alanine aminotransferase (ALT) The alanine aminotransferase (ALT or SGPT) would receive priority, because nicotinic acid is hepatotoxic and severe liver injury has been reported. Hepatotoxicity is more common with the sustained-release, controlled-release, or timed-released formulation.

Which drug is the most effective for lowering LDL cholesterol?

Atorvastatin [Lipitor] The statin drugs, such as atorvastatin, are the most effective drugs for lowering LDL cholesterol. They are better tolerated, have fewer adverse effects, and produce better clinical outcomes than any other agents available for lowering LDL.

The nurse is caring for a patient prescribed a cholesterol-lowering drug. Which drug is least likely to cause systemic side effects?

Colesevelam [Welchol] Colesevelam, a bile acid sequestrant, is a nonabsorbable resin that works directly in the gastrointestinal tract. Because it and other bile acid sequestrants (eg, cholestyramine [Questran] and colestipol [Colestid]) are not absorbed, they do not have systemic effects. The bile acid sequestrants' most common complication is constipation. The other agents have potential systemic adverse effects.

The nurse understands that cholesterol is carried through the blood by lipoproteins. Which lipoprotein is most closely associated with coronary atherosclerosis?

Low-density lipoprotein (LDL) Cholesterol is the primary core lipid of LDLs, which are responsible for carrying cholesterol to tissues outside the liver. Of all the lipoproteins, LDLs are the most significant contributors to coronary atherosclerosis. When pharmacologic agents are used to lower cholesterol, the primary goal is to reduce elevated LDL levels.

Which discharge instructions should the nurse include for a patient prescribed cholestyramine ?

Mix the drug with water or juice. Cholestyramine [Questran] is supplied in powdered form. Mix the powder with liquids that include water, fruit juices, and soups because swallowing it can cause esophageal irritation. Certain oral medications should be administrated 1 hour before the sequestrant or 4 hours after. Flushing can occur with niacin and can be reduced by taking 325 mg of aspirin 30 minutes before each dose. Gemfibrozil and fenofibrate increase the risk of gallstones manifested with symptoms such as upper abdominal discomfort.

A patient with cardiovascular disease is taking rosuvastatin [Crestor]. The nurse is monitoring for potential adverse effects. Which finding indicates a potential adverse effect of this drug?

Muscle pain and tenderness The statins typically are well tolerated; however, in rare cases they can cause the serious adverse effect of myopathy and rhabdomyolysis. If unexplained muscle pain and tenderness develop, the prescriber should be notified. The other effects would not likely be caused by rosuvastatin.

Which are beneficial effects that can be derived from simvastatin [Zocor] and other drugs in this class?

Reduction of LDLs Elevation of HDLs Stabilization of the plaque in coronary arteries Reduction of risk of cardiovascular events The statin drugs have many benefits, the most important being reduction of LDLs. They also promote an increase in HDLs, stabilization of atherosclerotic plaque, and reduced inflammation at the plaque site. Among other benefits, they also slow progression of coronary artery calcification. The statins reduce the overall risk of cardiovascular events. They can have serious adverse effects on the liver, but these are relatively rare.