Chapter 47: Lipid-Lowering Agents

angina pectoris

-"suffocation of the chest" -pain caused by the imbalance between oxygen being supplied to the heart muscle and demand for oxygen by the heart muscle

Lipid-Lowering Agents Nursing Considerations

-Assess lab tests: triglyceride, total cholesterol, LDL, HDL levels -Collect patient's height and weight -Provide education

Low-Density Lipoproteins (LDL)

-Bad -You want low levels

Bile Acid Sequestrants contraindications

-Complete biliary obstruction -Abnormal intestinal function

Bile Acid Sequestrants side effects

-Direct GI irritation -Vitamin A and E deficiencies

Cholesterol Absorption Inhibitors caution

-Elderly patients -Liver disease

HMG-CoA Reductase Inhibitors drug interactions

-Estrogen (oral birth control) -Grapefruit juice

High-Density Lipoproteins (HDL)

-Good -You want high levels

HMG-CoA Reductase Inhibitors aide effects

-Liver failure -Rhabdomyolysis

nitrates

-drugs used to cause direct relaxation of smooth muscle leading to vasodilation and decreased venous return to the heart with decreased resistance to blood flow -this rapidly decreases oxygen demand in the heart and can restore the balance between blood delivered and blood needed in the heart muscle of patients with angina

normal LDL

<100 mg/dL

Normal serum triglycerides

<150

normal total cholesterol

<200 mg/dL

high LDL

>190

High serum triglycerides

>500

high HDL

>60 mg/dL

A nurse is providing teaching to a client who is starting simvastatin. Which of the following information should the nurse include in the teaching? A. Take this medication in the evening. B. Change position slowly when rising from a chair. C. Maintain a steady intake of green leafy vegetables. D. Consume no more than 1 L/day of fluid.

A. Take this medication in the evening.

A nurse is caring for a client who has a new prescription for niacin to reduce cholesterol. The nurse should monitor for which of the following findings as an adverse effect of niacin? (Select all that apply.) A. Muscle aches B. Hyperglycemia C. Hearing loss D. Flushing of the skin E. Jaundice

B. Hyperglycemia D. Flushing of the skin E. Jaundice

Bile Acid Sequestrants pregnancy class

C

A nurse is completing a nursing history for a client who takes simvastatin. The nurse should identify which of the following disorders as a contraindication to adding ezetimibe to the client's medications? A. History of severe constipation B. History of hypertension C. Active hepatitis C D. Type 2 diabetes mellitus

C. Active hepatitis C

A nurse is teaching a client who is taking digoxin and has a new prescription for colesevelam. Which of following instructions should nurse include in the teaching? A. "Take digoxin with your morning dose of colesnvelam B. "Your sodium and potassium levels will be monitored periodically while taking colesevelam. C. "Watch for bleeding or bruising while taking colesnvelam. D. "Take colesevelam with food at least one glass of water.

D. "Take colesevelam with food at least one glass of water.

A client asks the nurse what the atorvastatin (Lipitor) prescribed for the client will do. What is an expected outcome for this client? Decrease in sitosterol and serum cholesterol Decrease in campesterol and LDL levels Decrease in serum cholesterol only Decrease in serum cholesterol and LDL levels

Decrease in serum cholesterol and LDL levels

Which would be classified as a cholesterol absorption inhibitor? Gemfibrozil Cholestyramine Lovastatin Ezetimibe

Ezetimibe

Which agents stimulate the breakdown of lipoproteins from the tissues and their removal from the plasma? (Select all that apply.) Cholestyramine Fenofibrate Atorvastatin Niacin Gemfibrozil

Fenofibrate Gemfibrozil

What is the first med of choice to reduce blood-lipid levels?

HMG-CoA Reductase Inhibitors

HMG-CoA Reductase Inhibitors MOA

Inhibits HMG-CoA

Cholesterol Absorption Inhibitors contraindications

Pregnancy or lactation if combined with a statin

Cholesterol Absorption Inhibitors MOA

Works in small intestine to inhibit absorption of cholesterol

HMG-CoA Reductase Inhibitors pregnancy class

X

HMG-CoA Reductase Inhibitors prototype

atorvastatin (Lipitor)

coronary artery disease (CAD)

characterized by progressive narrowing of coronary arteries leading to a decreased delivery of oxygen to cardiac muscle cells

Bile Acid Sequestrants prototype

cholestyramine (Questran)

Rhabdomyolysis

dissolution of striated muscle

Prinzmetal angina

drop in blood flow through the coronary arteries caused by a vasospasm in the artery

Bile Acid Sequestrants indications

elevated serum cholesterol in patients with primary hypercholesterolemia

unstable angina

episode of myocardial ischemia with pain due to the imbalance of myocardial oxygen supply and demand when the person is at rest and/or at unpredictable times

Cholesterol Absorption Inhibitors prototype

ezetimibe (Zetia)

Niacin side effects

flushing, hot flashes

Fenofibrates contraindications

gout

Fenofibrates nursing considerations

watch for bleeding with patients on anticoagulants

myocardial infarction

-end result of vessel blockage in the heart -leads to ischemia and then necrosis of the area cut off from the blood supply -dead cells replaced by scar tissue

atherosclerosis

-narrowing of the arteries caused by buildup of atheromas, swelling, and accumulation of platelets -leads to a loss of elasticity and responsiveness to normal stimuli

stable angina

-pain due to the imbalance of myocardial oxygen supply and demand -the pain is relieved by rest or stoppage of activity

atheroma

-plaque in the endothelial lining of arteries; contains fats, blood cells, lipids, inflammatory agents, and platelets -leads to narrowing of the lumen of the artery, stiffening of the artery, and loss of distensibility and responsiveness

HMG-CoA Reductase Inhibitors all end in what?

-statin

pulse pressure

-the systolic blood pressure minus the diastolic blood pressure -reflects the filling pressure of the coronary arteries

high cholesterol levels

>240 mg/dL

high total cholesterol

>240 mg/dL

HMG-CoA Reductase Inhibitors contraindications

Active liver disease or history of alcoholic liver disease

Bile Acid Sequestrants MOA

Binds bile acids in intestine, allows excretion in feces instead of reabsorption

A nurse is collecting data from a client who is taking gemfibrozil Which of the following assessment findings should the nurse identify as an adverse reaction to the medication? A. Mental status changes B. Tremor C. Jaundice D. Pneumonia

C. Jaundice

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

Colestipol Colesevelam Cholestyramine

From where are blood lipids derived? Diet Exercise Kidneys Medications

Diet

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

Digoxin

The client has been prescribed nicotinic acid for treatment of hyperlipidemia. The nurse should teach about which common side effects with this med? Flushing of the skin Drowsiness Fever Facial tics

Flushing of the skin

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

Gemfibrozil

Fenofibrates

Inhibits triglyceride synthesis in liver to lower LDL

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

LDL cholesterol of 190 mg/dL

Which would be classified as a HMG-CoA reductase inhibitor? Gemfibrozil Cholestyramine Lovastatin Ezetimibe

Lovastatin

A client has begun taking cholestyramine. Which are noted as the most common adverse effects? Increased appetite and blood pressure Hiccups, nasal congestion, and dizziness Fatigue and mental disorientation Nausea, flatulence, and constipation

Nausea, flatulence, and constipation

A client is taking lovastatin. Which are noted as the most common adverse effects? Increased appetite and blood pressure Hiccups, nasal congestion, and dizziness Nausea, flatulence, and constipation Fatigue and mental disorientation

Nausea, flatulence, and constipation

Cholesterol Absorption Inhibitors side effects

Upper Respiratory Infection

Niacin

Vitamin B3, inhibits release of free fatty acids from adipose tissue

Bile Acid Sequestrants drug interactions

fat-soluble vitamins

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

headache and flatulence.

Hyperlipidemia

high cholesterol

normal HDL

men <40 women <50