Pharmacology Ch 47 (2)

A client who is receiving colestipol is also taking a thiazide diuretic. Which instruction would be most appropriate for the nurse to give?

"Take the thiazide diuretic about 1 hour before the colestipol." Rationale: The absorption of thiazide diuretic can be decreased or delayed with colestipol, a bile acid sequestrant. Therefore, the diuretic should be taken 1 hour before or 4 to 6 hours after the colestipol.

An older adult client's most recent physical assessment and diagnostic workup reveal the presence of dyslipidemia. The woman is a candidate for monotherapy with a statin, and she will soon begin treatment with atorvastatin. The nurse should anticipate what prescription from the health care provider?

"atorvastatin 10 mg PO OD" Rationale: Atorvastatin is normally administered PO 10 to 80 mg daily in a single dose.

A client asks the nurse about herbal products that can help to lower serum cholesterol and triglycerides. Which herbal product would the nurse include in the response?

Garlic Rationale: Research has shown that garlic is helpful in lowering serum cholesterol and triglyceride levels. Ginseng is used to enhance memory. Feverfew is used in the herbal treatment of migraine headaches. Black cohosh is beneficial in the menopause and hot flashes.

A nurse is caring for a male patient who has a diagnosis of coronary artery disease (CAD). His drug therapy includes lovastatin. Because the patient has a history of severe renal disease, the nurse will assess for a(n):

Increase in plasma concentration of lovastatin Rationale: Patients with severe renal disease may have an increased plasma concentration of lovastatin because 10% of the drug is eliminated in the urine. Patients with renal disorders are not likely to experience a decrease in LDL or an increase in the statin tolerance level.

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

at bedtime. Rationale: 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.

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

cholesterol Rationale: Cholesterol is the portion of blood lipids involved in the formation of atherosclerotic plaques.

A client has had cholestyramine added to his or her treatment plan for dyslipidemia. What effect will cholestyramine have on the pharmacokinetics of the thiazide diuretic that the client is currently prescribed?

decreased absorption Rationale: Cholestyramine may decrease absorption of thiazide diuretics.

What factor determines the "preferred" density of the cholesterol?

higher amount of protein Rationale: The "preferred" or healthier configuration for a lipoprotein is to have a higher density of protein than lipids.

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 Rationale: Because of the risk for hepatotoxicity, clients taking fenofibrate require serial testing of liver enzyme levels.

Several months of treatment with a statin accompanied by lifestyle modifications have failed to appreciably improve a patient's cholesterol levels. Consequently, the patient has been prescribed cholestyramine. The nurse should recognize that this drug achieves its therapeutic effect by:

oxidizing cholesterol to bile acids. Rationale: Bile acid sequestrants, such as cholestyramine, promote the oxidation of cholesterol to bile acids.

A client with metabolic syndrome is encouraged to implement nonpharmacologic measures improve his risk factors. What do those non-pharmacologic measures include? (Select all that apply.)

- Begin a low-fat diet - Walk regularly Rationale: Decreasing dietary fat intake and instituting regular aerobic exercise will decrease weight, increase cardiovascular health, and reduce risk factors of metabolic syndrome.

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 Rationale: 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 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 Rationale: 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.

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

Greater drug effectiveness is achieved at this time. Rationale: 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.

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 115 Cholesterol 210 - HDL 78 LDL 115 Cholesterol 189 - HDL 82 LDL 96 Cholesterol 240 - HDL 58 LDL 96 Cholesterol 178

HDL 58 LDL 96 Cholesterol 178 Rationale: 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.

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 Rationale: Existing cardiovascular disease lowers the target LDL serum level in these patients.

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." Rationale: 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 nurse would never tell a client not to worry and to stop taking the medication, unless the prescriber told her to. The flushing should subside and will not be present for the duration of the course of the drug.

When describing the action of atorvastatin, which would the nurse include?

Blocking the enzyme that is involved in cholesterol synthesis Rationale: HMG-CoA reductase inhibitors, such as atorvastatin, block the enzyme involved in cholesterol synthesis.

A nurse is caring for a client receiving cholestyramine to improve his blood lipid profile at a home care setting. What adverse reactions to cholestyramine should the nurse monitor in the client?

Constipation Rationale: The nurse should monitor for constipation in the client receiving cholestyramine. Rash, vertigo, and cholelithiasis should be monitored by the nurse when caring for a client receiving gemfibrozil, which is a fibrate that reduces the production of triglycerides.

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 Rationale: Cholesterol absorption inhibitors as monotherapy (without statins) require dosage reduction in clients with mild hepatic impairment.