NU141- Chapter 47 Lipid-Lowering Agents
What drug or drug class decreases the delivery of intestinal cholesterol to the liver?
Cholesterol absorption inhibitor
Which would be classified as a bile acid sequestrant?
Cholestyramine
A nurse is preparing a teaching plan for a client who is prescribed cholestyramine. Which information would the nurse include as a possible adverse reaction associated with this drug? Select all that apply.
Constipation Abdominal cramping Bruising
The client has been prescribed nicotinic acid for treatment of hyperlipidemia. The nurse should teach about which common side effects with this medication?
Flushing of the skin
The physician is caring for a client who is a 2-year kidney transplant survivor. The nurse would expect the physician to order what drug for the client's hyperlipidemia?
Fluvastatin
The nurse instructs a client to take the prescribed pravastatin at bedtime based on understanding that:
Greater drug effectiveness is achieved at this time.
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 96 Cholesterol 178
The pharmacology instructor is discussing medications used in the treatment of dyslipidemia. Which drug class would the instructor identify as the most widely used dyslipidemia drugs?
HMG-CoA reductase inhibitors
A 54-year-old client has a cholesterol level of 240 mg/dL (6.2064 mmol/L). What serum concentration of cholesterol would this client have?
High
Which adverse effect would a nurse expect to assess in a client taking ezetimibe?
Mild abdominal pain
A 37-year-old woman with moderately elevated lipid levels requests immediate pharmacotherapy for her dyslipidemia. The nurse explains that a period of intensive diet therapy and lifestyle modification will be utilized before drug therapy is considered. The nurse explains the rationale for this regimen as:
Therapeutic lifestyle changes are the preferred method for lowering blood lipids.
Which activity increases high-density lipoproteins?
Weight loss, regular aerobic exercise, and smoking cessation (for those who smoke) all increase HDL cholesterol.
A nurse is caring for several clients. Which client would have the greatest chance of developing CAD as determined by total cholesterol?
a 62-year-old White client with total cholesterol of 260 mg/dl
Teaching a client who is prescribed an HMG-CoA reductase inhibitor to treat high cholesterol and high lipid levels should include which information? a. The importance of exercise b. The need for dietary changes to alter cholesterol levels c. That taking a statin will allow a full, unrestricted diet d. That drug therapy is always needed when these levels are elevated e. The importance of controlling blood pressure and blood glucose levels f. That stopping smoking may also help to lower lipid levels
a. The importance of exercise b. The need for dietary changes to alter cholesterol levels e. The importance of controlling blood pressure and blood glucose levels f. That stopping smoking may also help to lower lipid levels
Hyperlipidemia is considered to be a. a normal finding in adult males. b. related to stress levels. c. a treatable CAD risk factor. d. a side effect of cigarette smoking.
c. a treatable CAD risk factor
A nurse would caution a client receiving cholestyramine to avoid mixing the drug with:
carbonated beverages.
Chlyomicron
carrier for lipids in the bloodstream, consisting of proteins, lipids, cholesterol, and so forth
Risk factors
factors that have been identified as increasing the risk of the development of a disease; for coronary artery disease, risk factors include genetic predisposition, gender, age, high-fat diet, sedentary lifestyle, gout, hypertension, diabetes, and estrogen deficiency
Antihyperlipidemic agents
general term used for drugs used to lower lipid levels in the blood
An older adult client is being treated in the hospital for a stroke and is undergoing an extended stay on a rehabilitation unit. The client's spouse has been participating actively in the client's care and performs much of the feeding and hygiene needs. This evening, the client's spouse has brought in a number of healthy snacks to keep at the client's bedside. Knowing that the client's medication regimen includes simvastatin, the nurse would remove which item?
grapefruit juice
Hyperlipidemia
increased levels of lipids in the serum, associated with increased risk of coronary artery disease development
A client's serum cholesterol is 286 mg/dL. Lovastatin (Mevacor) is prescribed. The nurse plans care based on the fact that the action of lovastatin:
inhibits the production of cholesterol.
High-density lipoprotein (HDL)
loosely packed chylomicron-containing fats, able to absorb fats and fat remnants in the periphery; thought to have a protective effect, decreasing the development of coronary artery disease
A client has begun taking cholestyramine. Which are noted as the most common adverse effects?
nausea, flatulence, and constipation
How does the nurse providing medication education describe how the drug atorvastatin achieves its desired therapeutic effect?
reducing the amount of cholesterol synthesized by the liver
An obese client who has an elevated triglyceride level and reduced high-density lipoprotein cholesterol is seen by the primary care provider. What do these data suggest in this client?
the development of metabolic syndrome
A 39-year-old nulliparous woman has been taking atorvastatin for 2 years and has now decided that she would like to become pregnant. What health education should the nurse provide to this client?
"It's important that you stop taking atorvastatin before you stop using contraception."
When describing the action of atorvastatin, which would the nurse include?
Blocking the enzyme that is involved in cholesterol synthesis
A patient with atrial fibrillation is receiving warfarin therapy. The patient is also prescribed ezetimibe. The nurse would instruct the patient to watch for:
Blood in urine or stool
Recommended treatments for patients with dyslipidemia are made according to their blood levels of total and LDL cholesterol and risk factors for cardiovascular disease. What does the impact of existing cardiovascular disease have on recommendations?
Decreases target serum LDL level
What intervention may help the client increase HDL levels?
Exercise
Which would the nurse expect the healthcare provider to prescribe for a patient who has high lipid levels and cannot take fibrates or HMG-CoA reductase inhibitors? a. Nicotine b. Vitamin C c. PCSK9 inhibitor d. Nitrates
c. PCSK9 inhibitor
Which category of blood lipids is involved in the formation of atherosclerotic plaques?
cholesterol
The client receives a prescription for niacin. The nurse is providing education about the medication and possible adverse effects. Which adverse affect would the nurse include?
"Some people get very flushed skin when they take this medication."
What should the nurse teach an older adult client about the potential adverse effects of atorvastatin?
"The most common side effects of atorvastatin involve some mild gastrointestinal upset."
The client wants to know the difference between triglycerides and cholesterol. Which response by the nurse would be correct?
"Triglycerides and cholesterol are fatlike substances found in your blood."
A client with primary hypercholesterolemia has been prescribed 10 mg of ezetimibe per day by a health care provider. The provider has instructed the nurse to continue the drug therapy for 3 days. The drug is available in 10-mg capsules. How many capsules of the drug should the nurse administer to the client during the entire therapy?
3 capsules
A nurse is aware of the high incidence and prevalence of hyperlipidemia and the consequent need for antihyperlipidemics. Treatment of high cholesterol using statins would be contraindicated in which client?
An obese male client who is a heavy alcohol user and who has cirrhosis of the liver
A client is taking atorvastatin calcium to reduce serum cholesterol. Which aspect of client teaching is most important?
Call the health care provider if muscle pain develops.
Blood lipids are a category of fatty acids, which are substances used within the body to perform essential functions. Which category of blood lipids is involved in the formation of atherosclerotic plaques?
Cholesterol
A client is taking cholestyramine. The nurse will assess for which common adverse effect of the drug?
Constipation
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
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
Which of the following best reflects the action of ezetimibe?
Decreases the absorption of dietary cholesterol from the small intestine
As part of a routine physical examination, a 60-year-old client's primary care provider has ordered blood work that includes cholesterol levels. What result would strongly suggest the need for an antihyperlipidemic drug?
Elevated LDL levels
A patient with hyperlipidemia is prescribed ezetimibe. Which ongoing assessment should the nurse perform during treatment?
Frequently monitor blood cholesterol.
After teaching a group of students about fats and biotransformation, the instructor determines that the teaching was successful when the students identify what as the storage location of bile acids?
Gallbladder
Which drug is most effective in reducing most major types of dyslipidemia in patients at risk or who have already developed CAD?
HMG-CoA reductase inhibitors
A nurse is providing care to a client who has elevated levels of low-density lipoprotein (LDL). A review of the client's history reveals a sedentary lifestyle and a history of being overweight. The nurse understands that this combination of factors places the client at risk for which condition?
Heart disease
A client is taking lovastatin (Mevacor). Which are noted as the most common adverse effects?
Nausea, flatulence, and constipation
A female client presents to the health care provider's office with recurrence of her "hot flashes." The nurse understands that the client is taking what drug to treat her dyslipidemia?
Niacin
HMG-CoA reductase inhibitors (statins) are classified as which pregnancy category?
Pregnancy Category X
What should the nurse suggest to assist a client to improve his cholesterol levels?
Smoking cessation
A client has an elevated total serum cholesterol of 260 mg/dL (14.4 mmol/L). Which aspect of client teaching of lifestyle changes is most important for the client?
Stop smoking.
What is the basis for a nurse's recommendation of a period of intensive diet therapy and lifestyle modification before initiation of drug therapy for a client newly diagnosed with dyslipidemia?
Therapeutic lifestyle changes are the preferred method for lowering blood lipids.
What information would be included in a lipoprotein profile? Select all that apply:
Total cholesterol Triglycerides LDL
An instructor is describing the characteristics associated with metabolic syndrome. Which of the following would the instructor include in the description? (Select all that apply.)
Waist measurement over 40 inches in men Triglyceride levels greater than 150 mg/dL
A bile acid sequestrant is the drug of choice for a client who has which conditions? a. A high LDL concentration b. A high triglyceride concentration c. Biliary obstruction d. Vitamin K deficiency e. A high HDL concentration f. Intolerance to statins
a. A high LDL concentration f. Intolerance to statins
The formation of atheromas in blood vessels precedes the signs and symptoms of a. hepatitis. b. CAD. c. diabetes mellitus. d. chronic obstructive pulmonary disease (COPD).
b. CAD
A nurse is responsible for patient education for a 48-year-old woman who has been prescribed colestipol. The nurse will instruct the patient to take the medication
before a meal.
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
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
In addition to being synthesized in the liver and intestine, from where are blood lipids derived?
diet
hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase
enzyme that regulates the last step in cellular cholesterol synthesis
The client is diagnosed with hyperlipidemia and prescribed lovastatin. Which is the most common adverse effects of lovastatin?
headache and flatulence.
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.
The nurse should be cognizant that niacin therapy is the most effective method of achieving which cardiac-related goal?
increased concentration of HDL cholesterol
A client has been prescribed lovastatin for high cholesterol. The nurse's teaching plan will include a basic explanation of how the drug produces its therapeutic effect. The nurse will explain that lovastatin lowers cholesterol levels in which manner?
inhibits cholesterol syntheses.
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
The client has been taking rosuvastatin for hyperlipidemia. The client now presents with severe weakness and states barely being able to move the extremities. The nurse suspects the client has which?
rhabdomyolysis.
Which single class drug is known to be most effective in reducing the major types of dyslipidemia?
statins
Low-density lipoprotein (LDL)
tightly packed fats that are thought to contribute to the development of coronary artery disease when remnants left over from the LDL are processed in the arterial lining
The three major classes of drugs used to control blood lipids are statins, bile acid resins (or sequestrants), and fibrates. Which is a fibrate?
Gemfibrozil
Which would the nurse include when teaching a patient about HMG-CoA reductase inhibitors? a. The patient will not have a heart attack. b. The patient will not develop CAD. c. The patient might develop cataracts as a result. d. The patient might stop absorbing fat-soluble vitamins.
c. The patient might develop cataracts as a result
Bile acids
cholesterol-containing acids found in the bile that act like detergents to break up fats in the small intestine
A client who has been taking a statin has seen an improvement in his cholesterol laboratory values; however, the low-density lipoprotein remains elevated. What medication will be added to the medical regime?
cholestyramine
Which would alert the nurse to suspect that a patient receiving HMG-CoA reductase inhibitors is developing rhabdomyolysis? a. Flatulence and abdominal bloating b. Increased bleeding and bruising c. The development of cataracts and blurred vision d. Muscle pain and weakness
d. Muscle pain and weakness
The bile acid sequestrants a. are absorbed into the liver. b. take several weeks to show an effect. c. have no associated adverse effects. d. prevent bile salts from being reabsorbed.
d. prevent bile salts from being reabsorbed
A patient is taking cholestyramine to reduce LDL cholesterol. Cholestyramine will cause a decrease in absorption of which medication?
digoxin
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
A patient with metabolic syndrome usually has increased plasminogen activator levels.
True
A client will begin taking atorvastatin, and the nurse is conducting relevant health education. The nurse should emphasize the need to report any new onset of:
muscle pain.
A client with atrial fibrillation who is receiving oral anticoagulant therapy is receiving atorvastatin. The nurse would monitor this client for:
Bleeding
What is the most common reason for an elevated cholesterol level in a client who does not have a genetic disorder of lipid metabolism?
His dietary intake of saturated fat
Which lipid level would the nurse interpret as being high?
LDL cholesterol of 190 mg/dL
Which way that the body uses cholesterol stated by a community group indicates that the group has understood teaching about cholesterol? a. The production of water-soluble vitamins b. The formation of steroid hormones c. The mineralization of bones d. The development of dental plaques
b. The formation of steroid hormones
A client who is receiving cholestyramine also takes digoxin. The nurse teaches the client about the drug and administration. The client demonstrates understanding of the teaching when stating:
"I will take the digoxin about an hour before the cholestyramine."
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 serum cholesterol and LDL levels
The nurse is developing a plan of care for a male client who has been admitted to the hospital after a myocardial infarction. The client begins lovastatin to lower his LDL levels and increase his HDL levels. Based on the adverse reaction of this medication, what would be the most appropriate nursing diagnosis?
Risk for injury to skeletal muscles related to adverse effects of drug therapy
A nurse is conducting a presentation for a local community group about hyperlipidemia. When discussing the factors that individuals can work on to reduce their risk, which information would the nurse include? Select all that apply.
Weight Diet
Cholesterol
necessary component of human cells that is produced and processed in the liver and then stored in the bile until stimulus causes the gallbladder to contract and send the bile into the duodenum via the common bile duct; a fat that is essential for the formation of steroid hormones and cell membranes; it is produced in cells and taken in by dietary sources
After teaching a client about prescribed statin therapy, the nurse determines that additional teaching is needed when the client makes which statement?
"I can take the drug with grapefruit juice."
A 58-year-old man has recently been prescribed atorvastatin (Lipitor) in an effort to reduce his cholesterol levels. The man has acknowledged the potentially harmful effects of hyperlipidemia and is motivated to make changes to resolve this health problem. What advice should the nurse give to this client?
"It's a good idea to keep your intake of saturated fat to a bare minimum."
A nurse is caring for a client prescribed nicotinic acid for hyperlipidemia. The nurse would assess the client for which findings as a possibility?
Flushing of the skin
When administering a lipid-lowering agent, the nurse would anticipate administering the drug by which route?
Oral
The nurse is providing teaching to a client who is at risk for hyperlipidemia. The nurse knows that which risk factors can be controlled or modified?
Obesity, inactivity, diet, and smoking
What should the nurse review about an antihyperlipidemic medication with the client when completing discharge counseling? (Select all that apply.)
Reason for taking the prescribed drug Drug name Correct dose Frequency of administration Dosage form
The nurse knows that part of the education plan for a client with the diagnosis of hyperlipidemia needs to include which lifestyle changes? (Select all that apply.)
Reduction of the intake of saturated fats Weight loss Increased physical activity
After reviewing information about antihyperlipidemic drugs, a group of nursing students demonstrate understanding when they identify which medication as a fibric acid derivative (fibrate)?
Gemfibrozil
A nurse is caring for a client who has been prescribed lovastatin to control blood lipid levels. While teaching the client about the medication, the nurse should caution against consuming large amounts of which?
grapefruit juice.
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."
Elevated blood lipids are a major risk factor for atherosclerosis and vascular disorders. From where are blood lipids derived?
Diet
Metabolic syndrome
a collection of factors, including insulin resistance, abdominal obesity, low high-density lipoprotein and high triglyceride levels, hypertension, and proinflammatory and prothrombotic states, that increase the incidence of coronary artery disease
proprotein convertase subtilisin/kexin type 9
an enzyme that binds to LDL receptor on liver cells, which causes higher LDL levels in the blood
HMG-CoA reductase inhibitors work in the a. process of bile secretion. b. process of cholesterol formation in the cell. c. intestinal wall to block fat absorption. d. kidney to block fat excretion.
b. process of cholesterol formation in the cell
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