CH 23: Drugs for Lipid Disorders
The patient is to begin taking atorvastatin (Lipitor) and the nurse is providing education about the drug. Which symptom related to this drug should be reported to the healthcare provider? A) Constipation B) Increasing muscle or joint pain C) Hemorrhoids D) Flushing or "hot flash"
Increasing muscle or joint pain
A patient asks why a very high dose of niacin has been prescribed for high cholesterol. Which response should the nurse make? a) "Higher doses of niacin decrease production of very low-density lipoproteins (VLDLs), which are the primary carrier of triglycerides, ultimately decreasing cholesterol." b) "Used at high levels, niacin is very effective at decreasing cholesterol and has few side effects." c) "Because you have diabetes, niacin is one of the safest drugs to use to decrease your cholesterol levels." d) "Because it is available over the counter and is tolerated well, niacin is the best drug to try first."
"Higher doses of niacin decrease production of very low-density lipoproteins (VLDLs), which are the primary carrier of triglycerides, ultimately decreasing cholesterol. *Niacin in doses higher than what is used as a vitamin decreases the production of VLDLs, which lowers serum triglyceride levels. Because low-density lipoprotein (LDL) is synthesized from VLDL, LDL cholesterol is also reduced. Niacin produces more adverse effects than statins. Niacin in the dose needed to lower cholesterol should not be used in patients with diabetes because it can increase fasting glucose levels. The statement that niacin's over-the-counter availability makes it the best drug to try first is not a valid statement; if used to lower cholesterol, it should be used under medical supervision.
A patient taking an antihyperlipidemic medication asks if the medication will be needed long term. Which response should the nurse make? a) "Not necessarily; if you implement healthier lifestyle choices, you may no longer need the drug." b) "Unfortunately, once you begin drug therapy for hyperlipidemia, it is highly unlikely you will ever be able to stop." c) "Yes, you will always need to take the drug. Stopping it would be dangerous." d) "If you make drastic lifestyle changes and follow a strict diet and exercise regimen, you should be able to stop taking the drug fairly soon."
"Not necessarily; if you implement healthier lifestyle choices, you may no longer need the drug." *Patients who implement healthy lifestyle strategies including a healthy diet, physical activity, and tobacco cessation can minimize the need for drug therapy. Stating that the patient will likely or always have to take the drug would not be accurate responses. Although some individuals may need to make drastic lifestyle changes, often only minor to moderate changes are necessary to achieve lower lipid levels.
A patient taking statins asks if a routine intake of pork needs to be altered. Which response should the nurse make? a) "Pork is rich in coenzyme Q10, which is decreased by statin use." b) "The nutrients in pork have a very strong antihyperlipidemic effect and supplement the statin effects." c) "Pork has less fat than other meats, helping to decrease fat intake." d) "Pork has an even balance between saturated and unsaturated fats, making it more heart healthy."
"Pork is rich in coenzyme Q10, which is decreased by statin use." *HMG-CoA reductase inhibitors (statins) decrease the synthesis of coenzyme Q10 (CoQ10). Patients taking this drug may benefit from enhancing the diet with CoQ10-rich foods such as pork. There is no evidence tht pork has stron antihyperlipidemic effects. There is no evidence that pork has less fat than other meats or that it has an even balance between saturated and unsaturated fats.
A patient taking digoxin is prescribed cholestyramine (Questran) for the treatment of hyperlipidemia. Which should the nurse instruct this patient? a) "Take the cholestyramine 2 hours before or 4 hours after the digoxin." b) "You may need to increase the dose of digoxin while taking the cholestyramine (Questran)." c) "Always make sure to take both medications with food." d) "Digoxin effects may be enhanced by the cholestyramine (Questran), so watch for signs of digitalis toxicity."
"Take the cholestyramine 2 hours before or 4 hours after the digoxin." *Cholestyramine (Questran) can bind to other drugs and interfere with their absorption, so it should be taken 2 hours before or 4 hours after other oral medications. Decreasing the dose of the digoxin would not be appropriate. Taking both medications with food would not alter the possible impact of the cholestyramine. Cholestyramine would decrease the effects of the digoxin.
A patient is receiving cholestyramine (Questran) for elevated low-density lipoprotein (LDL) levels. As the nurse completes the nursing care plan, which adverse effects will be included for continued monitoring? A) Abdominal pain B) Orange-red urine and saliva C) Decreased capillary refill time D) Sore throat and fever
Abdominal pain
A patient asks what it means to have elevated cholesterol and lipid levels. Which explanation should the nurse provide to this patient? a) "Cholesterol is a fat the body produces and is considered a lipid." b) "I'll ask your healthcare provider to explain this to you." c) "Cholesterol and lipids are two very different things, serving two very different functions in the body." d) "The term used really isn't important; it is most important to focus on how to decrease your levels."
Cholesterol is a fat the body produces and is considered a lipid. *Cholesterol, triglycerides, and phospholipids are all lipids. These terms are often used interchangeably and should be explained to the patient to reduce confusion. The nurse can explain these terms. Cholesterol is a lipid. Telling the patient to lower the levels misses an opportunity to teach the patient.
A patient with hyperlipidemia has biliary obstruction. Which medication should the nurse question before giving to this patient? a) Cholestyramine (Questran) b) Atorvastatin (Lipitor) c) Gemfibrozil (Lopid) d) Ezetimibe (Zetia)
Cholestyramine (Questran) *Cholestyramine (Questran) is contraindicated in biliary obstruction. It is not contraindicated in Clostridium difficile-related diarrhea, diabetes mellitus, or rheumatoid arthritis. Atorvastatin (Lipitor), gemfibrozil (Lopid), and ezetimibe (Zetia) are not contraindicated for those with biliary obstruction.
A patient continues to experience elevated cholesterol levels despite taking prescribed medication. Which drug should the nurse identify that is causing this patient's results? a) Ezetimibe (Zetia) b) Gemfibrozil (Lopid) c) Cholestyramine (Questran) d) Omega-3-acid ethyl esters (Lovaza)
Ezetimibe (Zetia) *Ezetimibe (Zetia) is the only drug in a class called cholesterol absorption inhibitors. Cholesterol is absorbed from the intestinal lumen by cells in the jejunum of the small intestine. Ezetimibe blocks this absorption by as much as 50%, causing less cholesterol to enter the blood. Unfortunately, the body responds by synthesizing more cholesterol; thus, a statin is usually administered concurrently. Gemfibrozil is indicated for patients with excessive triglyceride and VLDL levels. Cholestyramine binds with bile acids containing cholesterol in an insoluble complex that is excreted in the feces. Omega-3 fatty acid esters are found in fish oil. Fish oil has long been a natural therapy for lowering blood lipid levels and is approved as an adjunct to diet in the treatment of severe hypertriglyceridemia.
The nurse prepares dietary teaching for a patient who will be taking statins for the long term. Which nutrients should the nurse encourage the patient to increase because of possible depletion or diminished absorption? a) Fat-soluble vitamins and folic acid b) Phosphorus and non-fat-soluble vitamins c) Sodium and potassium d) Carbohydrates and protein
Fat-soluble vitamins and folic acid *Lipid-lowering drugs can deplete or diminish absorption of fat-soluble vitamins and folic acid. These drugs are not identified as impacting phosphorus, non-fat-soluble vitamins, sodium, potassium, carbohydrates, or protein.
A patient has been on long-term therapy with colestipol (Colestid). To prevent adverse effects related to the length of therapy and lack of nutrients, which supplements may be required? (Select all that apply.) A) Folic acid B) Vitamins A, D, E, and K C) Potassium, iodine, and chloride D) Protein E) B vitamins
Folic acid Vitamins A, D, E, and K
A patient has been ordered gemfibrozil (Lopid) for hyperlipidemia. The nurse will first validate the order with the healthcare provider if the patient reports a history of which disorder? A) Hypertension B) Angina C) Gallbladder disease D) Tuberculosis
Gallbladder disease
A patient is experiencing several adverse effects and minimal lipid level changes while taking a statin for hypertriglyceridemia. Which medication should the nurse anticipate being prescribed next for this patient? a) Gemfibrozil (Lopid) b) Lomitapide (Juxtapid) c) Colesevelam (Welchol) d) Simvastatin (Zocor)
Gemfibrozil (Lopid) *Gemfibrozil (Lopid) is the next drug of choice if statins are having minimal impact and are not tolerated well by the patient. Lomitapide (Juxtapid) is indicated only for familial hypercholesterolemia. Colesevelam (Welchol) is a bile acid sequestrant and is no longer considered a first-line drug for dyslipidemias, although they are sometimes combined with statins or as monotherapy for patients who have contraindications to the use of statins. Simvastatin (Zocor) is a statin and would not be considered as the next drug of choice for this patient.
A patient with chronic kidney disease (CKD) has elevated lipid levels. Which medication should the nurse question before administering to this patient? a) Gemfibrozil (Lopid) b) Atorvastatin (Lipitor) c) Fluvastatin (Lescol) d) Pitavastatin (Livalo)
Gemfibrozil (Lopid) *Gemfibrozil is contraindicated in patients with chronic kidney disease (CKD). Atorvastatin (Lopid), fluvastatin (Lescol), and pitavastatin (Livalo) are not contraindicated for CKD.
A patient has an elevated low-density lipoprotein (LDL) level. Which medication should the nurse question before providing to the patient? a) Gemfibrozil (Lopid) b) Atorvastatin (Lipitor) c) Fuvastatin (Lescol) d) Pravastatin (Pravachol)
Gemfibrozil (Lopid) *Gemfibrozil is indicated for the treatment of hypertriglyceridemia and hypercholesterolemia. Effects of gemfibrozil include up to a 50% reduction in VLDL with an increase in HDL. The mechanism of achieving this action is unknown. Because it is less effective than the statins at lowering LDL, it is not a drug of first choice for reducing LDL levels. Atorvastatin, fluvastatin, and pravastatin are all HMG-CoA reductase inhibitors and increase the removal of LDL from the blood.
A patient is diagnosed with dyslipidemia. On which lifestyle factor should the nurse focus when teaching this patient? a) High amount of saturated fat in the diet b) Lack of adequate physical activity c) Limited amounts of soluble fiber in the diet d) Use of tobacco
High amount of saturated fat in the diet *To reduce LDL cholesterol, the patient must reduce saturated fat in the diet. A lack of physical activity and tobacco use also contribute to hyperlipidemia, but are not the highest contributors. Soluble fiber helps address hyperlipidemia. However, limited amounts of soluble fiber in the diet are not the highest contributor to hyperlipidemia.
A patient is prescribed a statin. For which patient statement should the nurse intervene? a) "I like to drink grapefruit juice each morning with breakfast." b) "I've been including more sardines and salmon in my diet." c) "I take this medication every evening with my meal." d) "I have been periodically having headaches and nausea."
I like to drink grapefruit juice each morning with breakfast. *Grapefruit and grapefruit juice interfere with the metabolism of statins, increasing the potential for toxicity. The patient should be encouraged to increase intake of foods rich in omega-3 fatty acids, such as sardines and salmon. Most statins should be taken in the evening. Nausea and headaches can be common minor adverse effects of statins.
The community health nurse is working with a patient taking simvastatin (Zocor). Which patient statement may indicate the need for further teaching about this drug? A) "I'm trying to reach my ideal body weight by increasing my exercise." B) "I didn't have any symptoms even though I had high lipid levels. I hear that's common." C) "I've been taking my pill before my dinner." D)"I take my pill with grapefruit juice. I've always taken my medications that way."
I take my pill with grapefruit juice. I've always taken my medications that way."
A patient is prescribed atorvastatin (Lipitor). Which information should the nurse provide about the mechanism of action? a) "It inhibits cholesterol production, leading to a reduction of cholesterol and low-density lipoprotein (LDL)." b) "It blocks the absorption of cholesterol from the intestine." c) "It increases the amount of cholesterol excreted in the stool." d) "It increases the breakdown of fatty acids and elimination of triglyceride-rich particles."
It inhibits cholesterol production, leading to a reduction of cholesterol and low-density lipoprotein (LDL)." *Atorvastatin (Lipitor) is an HMG-CoA reductase inhibitor, which interferes with HMG-CoA reductase, the critical enzyme in the biosynthesis of cholesterol. Ezetimibe (Zetia) blocks the absorption of cholesterol from the intestine. Bile acid-binding drugs increase the excretion of cholesterol in the stool. Fibric acid drugs increase the breakdown of fatty acids and elimination of triglyceride-rich particles.
A patient asks why the low-density lipoprotein (LDL) to high-density lipoprotein (HDL) ratio is more important than the cholesterol level. Which information should the nurse include about this ratio? a) It provides a more accurate profile of risk for cardiovascular disease." b) "It provides a better picture of what is occurring with all of the lipids." c)"It reflects cholesterol levels as well as lipid levels." d) "It helps to differentiate which type of dyslipidemia is present."
It provides a more accurate profile of risk for cardiovascular disease *The LDL to HDL ratio provides the most accurate profile for cardiovascular disease risk because some cholesterol is always being transported for destruction, making the total cholesterol level a less accurate predictor of risk. It does not provide a picture of what is going on with all lipids. Although LDL and HDL do carry cholesterol, this does not address why this result is preferred. This test alone will not differentiate between the different types of dyslipidemias.
A patient asks why periodic liver function studies are needed while being treated for dyslipidemia. Which response should the nurse make to this patient? a) Most of the antihyperlipidemic drugs are broken down mainly by the liver, so we need to monitor your liver function to make sure no damage is occurring." b) "Because cholesterol is synthesized in the liver, it is important for us to monitor liver studies for the impact on cholesterol synthesis." c)"Liver function is monitored for all drugs, not just those to treat hyperlipidemia." d) "Unfortunately, liver damage is a common adverse effect of these types of drugs, so we monitor these results closely."
Most of the antihyperlipidemic drugs are broken down mainly by the liver, so we need to monitor your liver function to make sure no damage is occurring *Most drugs for dyslipidemia are heavily metabolized by the liver. Routine monitoring of liver function studies can help to detect elevations early and possibly avoid liver damage. These studies are not done to monitor the drugs' impact on cholesterol. Liver function is not monitored periodically for all drugs. Liver damage can occur, but it is not a common adverse effect of drugs for dyslipidemia.
A patient taking statins reports unexplained muscle or joint pain. Which action should the nurse take first for this patient? a) Report the information to the healthcare provider. b) Contact the healthcare provider for a prescription to discontinue the drug. c) Send the patient to the laboratory for liver function tests. d) Tell the patient to reduce the dose of statins by half.
Report the information to the healthcare provider *Myopathy and rhabdomyolysis are rare, but serious, adverse effects of statin therapy. Any patient taking statins who reports unexplained muscle or joint pain should be reported immediately to the healthcare provider. The drug may be stopped if the patient's creatine kinase level is elevated, but asking the healthcare provider for this order would not be the first action to take. The patient may be prescribed a creatine kinase test because of the complaints of muscle and joint pain, but this would not be the first action to take. It is beyond the nurse's scope of practice to have the patient reduce the dose. The information needs to be immediately reported to the healthcare provider for appropriate evaluation and follow-up.
The nurse is reviewing a patient's laboratory values. Which lipid value should the nurse consider desirable? a) Serum triglyceride: 140 mg/dL b) Low-density lipoprotein (LDL): 120 mg/dL c) Total cholesterol: 210 mg/dL d) High-density lipoprotein (HDL): 30 mg/dL
Serum triglyceride: 140 mg/dL *A serum triglyceride level of less than 150 mg/dL is considered desirable. An LDL level of 120 mg/dL would be considered near or above optimal. A total cholesterol level of 210 mg/dL would be considered borderline high risk. An HDL level of 30 mg/dL would be considered low risk, but not optimal.
A patient taking a steroid for another health problem is prescribed a statin with a short half-life for treatment of hypertriglyceridemia. Which should the nurse instruct the patient about this medication? a) "Take the medication in the evening for optimal results." b) "It is safe to take this drug with immunosuppressants." c) "A fibric acid agent may be prescribed in addition to the statin." d) "The medication must be taken with food."
Take the medication in the evening for optimal results. *Short half-life statins should be taken in the evening because cholesterol biosynthesis is higher at night. An immunosuppressant such as a steroid should be avoided with statin therapy due to a higher risk for severe myopathy. Fibric acid drugs are generally not combined with statins due to an increased risk of adverse events. Although taking statins with food may help reduce gastrointestinal discomfort, it is not required for some patients.
A patient reports headache, abdominal cramping, and heartburn since beginning a statin for dyslipidemia. Which response should the nurse make? a) "These are common side effects of statins. You should be able to tolerate them better as time goes on." b) "We will need to get you in to see your healthcare provider because these can indicate a serious response to the statin." c) "Stop taking the statin immediately and go to the emergency department because these are signs of rhabdomyolysis." d) "I will speak with your healthcare provider. You will probably need to try another medication for your high cholesterol."
These are common side effects of statins. You should be able to tolerate them better as time goes on." *Minor side effects of statins include headache, fatigue, muscle or joint pain, and heartburn. Often, patients are able to tolerate them over time. They do not indicate a serious response to the statin, such as rhabdomyolysis. It would not be necessary to immediately see the healthcare provider nor go to the emergency department. Changing the medication would not be appropriate at this point.
The nurse is instructing a patient on lipid levels. Which should the nurse explain as the primary carrier of triglycerides that is reduced in size to become a low-density lipoprotein (LDL)? a) VLDL b) HDL c) lipoprotein d) intermediate density lipoprotein (IDL)
VLDL *VLDL is the primary carrier of triglycerides in the blood; through a series of steps, VLDL is reduced in size to become an LDL. HDL, lipoprotein (a), and IDL are not the primary carriers of triglycerides in the blood.
A patient takes gemfibrozil (Lopid) to control lipid levels. Which medication should the nurse anticipate being prescribed at a lower dose for this patient? a) Warfarin (Coumadin) b) Digoxin (Lanoxin) c) Phenytoin (Dilantin) d) Penicillin
Warfarin (Coumadin) *Because gemfibrozil (Lopid) can increase the risk of bleeding in patients taking warfarin (Coumadin), the warfarin dose should be reduced when administered concomitantly with gemfibrozil. Digoxin (Lanoxin), phenytoin (Dilantin), and penicillin dosages would not need to be reduced when taken with gemfibrozil.
A patient has a triglyceride level of 450 mg/dL. Which drug should the nurse anticipate being prescribed for this patient? a) Fibric acid b) Bile acid resins c) Statins d) Niacin
fibric acid
The nurse is instructing a patient on home use of niacin and will include important instructions on how to take the drug and about its possible adverse effects. Which of the following may be expected adverse effects of this drug? (Select all that apply.) A) Fever and chills B) Intense flushing and hot flashes C) Tingling of the fingers and toes D) Hypoglycemia E) Dry mucous membranes
intense flushing and hot flashes tingling of fingers and toes
The nurse interviews a patient taking statin medication. Which information should the nurse immediately report to the healthcare provider? a) headache b) muscle pain c) abdominal cramping d) pruritus
muscle pain *Any patient taking statins who experiences unexplained muscle or joint pain should be reported immediately to the healthcare provider because this may indicate myopathy or rhabdomyolysis. Headache, abdominal cramping, and pruritus are common adverse effects of statin therapy and do not need to be immediately reported to the healthcare provider.
A patient has a serum triglyceride level of 140 mg/dL. Which risk level for heart disease should the nurse identify for this patient? a) borderline high risk b) high risk c) normal risk d) very high risk
normal risk *A level less than 150 mg/dL is considered desirable or normal. A serum triglyceride level of 188 mg/dL would be considered borderline high risk. A level between 200 mg/dL and 499 mg/dL would be considered high risk. A level of 500 mg/dL or higher is considered very high risk.
The nurse instructs a patient taking a statin to increase the intake of coenzyme Q10 (CoQ10) in the diet. Which food should the nurse recommend to this patient? a) pork b) strawberries c) green beans d) milk
pork
A patient has a low-density lipoprotein (LDL) level of 100 mg/dL. Which factor should the nurse identify that increases this patient's risk of developing heart disease in 10 years? a) smoking b) low basal metabolic index (BMI) c) hypotension d) steroid use
smoking *Primary prevention of atherosclerotic cardiovascular disease (ASCVD) for those without diabetes who have LDL levels between 70 and 189 mg/dL and an estimated 7.5% or greater 10-year risk of ASCVD. In determining the 10-year risk for a cardiovascular event, risk factors include the presence of dyslipidemia, diabetes, hypertension, and smoking. Low BMI, hypotension, and steroid use are not risk factors for the development of ASCVD in this patient.