Pharmacology Ch 47 (3)

HMG-CoA reductase inhibitors (statins) are classified as which pregnancy category?

Pregnancy Category X Rationale: HMG-CoA reductase inhibitors (statins) are in pregnancy category X and contraindicated during any stage of pregnancy. Medications in pregnancy category A are considered safe. Medications classified as pregnancy category B, studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women. For pregnancy category C studies have shown adverse effects to the fetus, however, benefit may outweigh the potential harm---the risk has not been ruled out.

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." Rationale: Niacin, or nicotinic acid, inhibits the release of free fatty acids from adipose tissue, increases the rate of triglyceride removal from plasma, and generally reduces LDL and triglyceride levels and increases HDL levels. Niacin is associated with intense cutaneous flushing, cause, and abdominal pain, making its use somewhat limited.

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." Rationale: Statins like atorvastatin are usually well tolerated; the most common adverse effects (nausea, constipation, diarrhea, abdominal cramps or pain, headache, skin rash) are usually mild and transient.

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 Rationale: High levels of low-density lipoproteins increase the risk of heart disease and stroke.

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 Rationale: The presence of fatty acids, lipids, and cholesterol in the duodenum stimulates contraction of the gallbladder and the release of bile, which contains bile acids. Once their action is completed, they are reabsorbed and recycled to the gallbladder, where they remain until the gallbladder is stimulated again.

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 Rationale: Gemfibrozil is a fibrate. Colestipol, colesevelam, and cholestyramine are bile acid resins.

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 Rationale: Provastatin, lovastatin, and simvastatin are indicated for patients with documented CAD to slow progression of the disease.

Which lipid level would the nurse interpret as being high?

LDL level of 190 mg/dL Rationale: A total cholesterol level of 200 mg/dL would be considered borderline high. A triglyceride level of 160 would be borderline high. HDL level of 48 would be considered low to optimal. Levels about 60 mg/dL would be considered high.

A patient with metabolic syndrome usually has increased plasminogen activator levels.

True Rationale: Lipid and triglyceride levels play a role in metabolic syndrome, a collection of factors including insulin resistance, abdominal obesity, low high-density lipoprotein, high triglyceride levels, hypertension, and proinflammatory and prothrombotic states, which has been shown to increase the incidence of CAD. Increased plasminogen activator levels are also present in metabolic syndrome, which also increases the risk for thrombosis and atherosclerosis.

In addition to being synthesized in the liver and intestine, from where are blood lipids derived?

diet Rationale: Blood lipids, which include cholesterol, phospholipids, and triglycerides, are derived from the diet or synthesized by the liver and intestine. None of the remaining options are capable of synthesizing or even stimulating the synthesis of blood lipids.

A patient is taking cholestyramine to reduce LDL cholesterol. Cholestyramine will cause a decrease in absorption of which medication?

digoxin Rationale: Bile acid sequestrants decrease or delay the absorption of thiazide diuretics, digoxin, warfarin, thyroid hormones, and corticosteroids. Consequently, any of these drugs should be taken 1 hour before or 4 to 6 hours after the bile acid sequestrant.

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 Rationale: Myopathy is an important adverse effect of statins. Statins can injure muscle tissue, resulting in muscle ache or weakness; this should be reported promptly. Dry mouth, pruritus, and thirst are not reported adverse effects of statins.

A client has been largely unsuccessful in achieving adequate control of dyslipidemia through lifestyle changes and the use of a statin. As a result, the client has been prescribed cholestyramine. What change in this client's lipid profile will the nurse identify as the mostlikely goal of therapy?

reduction in LDL cholesterol levels Rationale: Cholestyramine, the prototype bile acid sequestrant, has the ability to reduce LDL cholesterol. It has little or no effect on HDL cholesterol and either no effect or an increased effect on triglyceride levels.

Which single class drug is known to be most effective in reducing the major types of dyslipidemia?

statins Rationale: For single-drug therapy, a statin is preferred for the treatment of dyslipidemia. To lower cholesterol and triglycerides, a statin, a cholesterol absorption inhibitor, gemfibrozil, a fibrate, or the vitamin niacin may be used. To lower triglycerides, gemfibrozil, ezetimibe, a cholesterol absorption inhibitor, or niacin may be given.

An 8-year-old male client requires treatment for dyslipidemia. What would the nurse expect the health care provider to order?

Pravastatin Rationale: Dyslipidemic drugs are not recommended for children younger than 10 years of age, except for pravastatin, which has dosing recommendations for children as young as 8 years.

A patient with hyperlipidemia is prescribed ezetimibe. Which ongoing assessment should the nurse perform during treatment?

Frequently monitoring blood cholesterol Rationale: The nurse should frequently monitor blood cholesterol as part of the ongoing assessment for a client receiving ezetimibe. Taking a dietary history of the client and inspecting the skin and eyelids for evidence of xanthomas are the preadministration assessments that a nurse should perform for a client receiving ezetimibe. The nurse obtains the reports of fasting blood sugar for a client with diabetes.

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 Rationale: Increased levels of LDL in combination with other risk factors, such as increased weight, diet high in saturated fats, and lack of physical activity, can lead to the development of atherosclerotic heart disease. In diabetes high levels of blood glucose as well as HbA1c are seen. In clients with glaucoma, increased eye pressure causes damage to the optic nerve. Clients with hypertension left untreated can lead to kidney failure and stroke.

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 Rationale: Gemfibrozil is a fibric acid derivative. Colesevelam is a bile acid resin. Niacin is classified as a miscellaneous antihyperlipidemic. Ezetimibe is a miscellaneous antihyperlipidemic.

Which substance would a group of students identify as being responsible for breaking up dietary fats into smaller units?

Bile acids Rationale: Bile acids act like a detergent in the small intestine and break up fats into small units. These small units are called micelles. High levels of cholesterol are part of bile acids. Chylomicrons are carriers for micelles.

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." Rationale: Statins like atorvastatin are potentially teratogenic (pregnancy category X). In a very few cases, potential benefits warrant use of these drugs in pregnant women, but this is exceptional. It is also contraindicated during breastfeeding. None of the other statements describe accurate educational information about atorvastatin and conception.