PrepU chapter 47 lipid-lowering Agents
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'll take the digoxin about 15 minutes before the cholestyramine." "I'll take the cholestyramine at 8 AM and the digoxin at 9 AM." "I will take the digoxin about an hour before the cholestyramine." "I need to take both drugs at the same time of the day."
"I will take the digoxin about an hour before the cholestyramine." The absorption of digoxin can be decreased or delayed with cholestyramine, a bile acid sequestrant. Therefore, the digoxin should be taken 1 hour before for 4 to 6 hours after the cholestyramine.
The client wants information about triglycerides and cholesterol. Which response by the nurse would be correct? "Triglycerides are found in your blood. Cholesterol is how the fat is transported." "Triglycerides transport cholesterol throughout the body." "Triglycerides and cholesterol are fatlike substances found in your blood." "Triglycerides are found in your blood. Cholesterol is found in the gallbladder."
"Triglycerides and cholesterol are fatlike substances found in your blood." Explanation: Triglycerides and cholesterol are lipids that are found in blood. Cholesterol is produced mostly by the liver.
A client is going home on cholestyramine (Questran). Client teaching should state that cholestyramine should be administered: with other medications. 1 hour before other medications. 1 hour after other medications. on an empty stomach.
1 hour after other medications. Explanation: Drugs that interact with cholestyramine should be administered 1 hour before or 4 to 6 hours after cholestyramine. Otherwise, cholestyramine may prevent the absorption of other drugs. Reference:
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 Calcium carbonate Digoxin Vitamin D
Cholestyramine Cholestyramine is administered to clients to reduce LDL cholesterol in clients who are already taking a statin drug. Digoxin is not given to lower LDL cholesterol. Vitamin D is not given to lower LDL cholesterol. Calcium carbonate is not given to lower LDL cholesterol.
Elevated blood lipids are a major risk factor for atherosclerosis and vascular disorders. From where are blood lipids derived? Exercise Diet Kidneys Medications
Diet Blood lipids, which include cholesterol, phospholipids, and triglycerides, are derived from the diet or synthesized by the liver and intestine. Medications, exercise, and the kidneys do not play a role in synthesis.
A male client's triglycerides are still elevated despite lifestyle changes. What does the nurse expect the health care provider to order for this client? Niacin Fenofibrate Cholestyramine Atorvastatin
Fenofibrate Fibrates are the most effective drugs for reducing serum triglyceride levels.
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? Trail mix (salted nuts and seeds) Purple grapes Cranberry cocktail Grapefruit juice
Grapefruit juice Explanation: It is important to avoid taking simvastatin with grapefruit juice. Grapefruit juice increases the level of simvastatin in the blood and makes side effects more likely. None of the other listed foods is contraind
The nurse instructs a client to take the prescribed pravastatin at bedtime based on understanding that: Lack of dietary intake during sleep increases absorption. Adverse effects are less likely during the night. Compliance is enhanced with nighttime administration. Greater drug effectiveness is achieved at this time.
Greater drug effectiveness is achieved at this time. 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 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? Fibrates Bile acid sequestrants Niacin HMG-CoA reductase inhibitors
HMG-CoA reductase inhibitors Explanation: HMG-CoA reductase inhibitors (or statins) are the most widely used dyslipidemia drugs. They are useful in treating most of the major types of dyslipidemia.
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? Desirable High Optimal Very high
High Explanation: High is rated at >240 mg/dL (6.2064 mmol/L). The other options are incorrect.
A client appears to be a candidate for statin therapy. What laboratory value should be assessed prior to initiating therapy? BUN aPTT LFT CBC
LFT Liver function tests (LFT) and serum cholesterol levels should be assessed prior to initiating statin therapy.
A client diagnosed with hyperlipidemia is prescribed a statin. The nurse is reviewing the client's history and would notify the client's health care provider if which condition was noted in the client's history? Renal disease Asthma Hypertension Liver disease
Liver disease Statins are contraindicated in clients with liver disorders. They are used cautiously in clients with a history of hypotension, infection, and myopathy.
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? INR and aPTT Complete blood count (CBC) Liver panel Reticulocyte count
Liver panel Because of the risk for hepatotoxicity, clients taking fenofibrate require serial testing of liver enzyme levels. There is no specific need for follow-up with CBCs, coagulation tests, or reticulocyte counts.
What should the nurse review about an antihyperlipidemic medication with the client when completing discharge counseling? (Select all that apply.) Correct dose Drug name Reason for taking the prescribed drug Frequency of administration Dosage form
Reason for taking the prescribed drug Drug name Correct dose Frequency of administration Dosage form The nurse should review the reasons for the drug and prescribed therapy, including drug name, form and method of preparation, correct dose, and frequency of administration as part of a client's discharge counseling.
What should the nurse suggest to assist a client to improve his cholesterol levels? Smoking cessation Weight lifting Diet high in polysaturated fats Limit exercise to the weekends
Smoking cessation Lifestyle changes that can help improve cholesterol levels include a low-fat diet, regular aerobic exercise, losing weight, and not smoking.
Which single class drug is known to be most effective in reducing the major types of dyslipidemia? Fibrates Niacin Statins Bile acid sequestrants
Statins 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.
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 a 26-year-old Native American client with total cholesterol of 150 mg/dl a 32-year-old Asian American with total cholesterol of 120 mg/dl a 48-year-old Black client with total cholesterol of 198 mg/dl
a 62-year-old White client with total cholesterol of 260 mg/dl Explanation: White clients have the highest incidence of CAD. This client has total cholesterol of 260 mg/dl, which is considered high according to the Third Report of the National Cholesterol Education Program Expert Panel. The other three clients could be at risk due to cultural risk factors such as hypertension, diabetes, high (HDL) and low density lipoprotein (LDL) levels, and HDL level to cholesterol ratio. However, their total cholesterol levels fall within normal or desirable range.
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 increased first-pass effect increased metabolism faster excretion
decreased absorption Cholestyramine may decrease absorption of thiazide diuretics. None of the other options are associated with cholestyramine's effect on other medications.
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? has no effect on either LDL or HDL levels decreases target serum LDL level decreases target serum triglyceride level increases target serum high-density lipoproteins (HDL) level
decreases target serum LDL level Existing cardiovascular disease entails a lower target LDL serum level in these clients. Such existing conditions are not considered in treating abnormal triglyceride or HDL levels.
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. decrease in LDL. increase in the statin tolerance level. decrease in plasma concentration of lovastatin.
increase in plasma concentration of lovastatin. Explanation: 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. Reference:
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. is a hormone. consists of a fibric acid derivative. is a bile-acid resin.
inhibits cholesterol syntheses. Lovastatin belongs to a group of drugs classified as statins. These drugs work by inhibiting cholesterol synthesis in the liver. Fibric acid derivatives and bile-acid resins also decrease cholesterol levels but they work at different sites. Fibric acid derivatives work on lipoproteins and triglycerides to reduce cholesterol, and bile-acid resins work in the gastrointestinal tract and bind bile salts in the intestine. Lovastatin is not a hormone.
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: pruritus (itching) increased thirst. muscle pain. dry mouth.
muscle pain.
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? 2 capsules 1 capsule 4 capsules 3 capsules
3 capsules The nurse should administer 3 capsules of ezetimibe to the client during the therapy.
What nonpharmacologic measures should the nurse include when educating a client about the management of metabolic syndrome? select all that apply begin a low fat diet begin a regular walking program
Begin a low-fat diet. Begin a regular walking program. Decreasing dietary fat intake and instituting regular aerobic exercise will decrease weight, increase cardiovascular health, and reduce risk factors of metabolic syndrome. Increased protein and adequate sleep do not address the risk factors for metabolic syndrome.
Which would be classified as a bile acid sequestrant? Gemfibrozil Ezetimibe Lovastatin Cholestyramine
Cholestyramine Cholestyramine is classified as a bile acid sequestrant. Lovastatin is a HMG-CoA reductase inhibitor. Ezetimibe is a cholesterol absorption inhibitor. Gemfibrozil is classified as a fibrate.
A client is taking cholestyramine. The nurse will assess for which common adverse effect of the drug? Headache Abdominal pain Indigestion Constipation
Constipation Constipation is the most common adverse effect of cholestyramine. Abdominal pain, headache, and indigestion are less frequently experienced adverse effects of the drug.
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? Rash Constipation Cholelithiasis Vertigo
Constipation Explanation: 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.
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? A high ratio of HDL to LDL Elevated LDL levels Low VLDL levels Elevated HDL levels
Elevated LDL levels Elevated LDL levels are considered a risk factor for coronary artery disease. Elevated HDL levels, low VLDL levels, and a high ratio of HDL to LDL are associated with a decreased risk of heart disease.
After reviewing information about antihyperlipidemic drugs, a group of nursing students demonstrate understanding when they identify which medication as a fibric acid derivative (fibrate)? Colesevelam Niacin Ezetimibe Gemfibrozil
Gemfibrozil Explanation: Gemfibrozil is a fibric acid derivative. Colesevelam is a bile acid resin. Niacin is classified as a miscellaneous antihyperlipidemic. Ezetimibe is a miscellaneous antihyperlipidemic. Reference:
The nurse is evaluating the effectiveness of drug therapy in a client with hyperlipidemia. Effective therapy is best demonstrated by which laboratory values? HDL 78 LDL 115 Cholesterol 189 HDL 58 LDL 96 Cholesterol 178 HDL 82 LDL 96 Cholesterol 240 HDL 58 LDL 115 Cholesterol 210
HDL 58 LDL 96 Cholesterol 178 Normal HDL should be greater than 40 mg/dl, LDL should be less than 100 mg/dl, and total cholesterol should be less than 200 mg/dl.
The nurse is evaluating the effectiveness of drug therapy in a client with hyperlipidemia. Effective therapy is best demonstrated by which laboratory values? HDL 82 LDL 96 Cholesterol 240 HDL 78 LDL 115 Cholesterol 189 HDL 58 LDL 115 Cholesterol 210 HDL 58 LDL 96 Cholesterol 178
HDL 58 LDL 96 Cholesterol 178 Explanation: Normal HDL should be greater than 40 mg/dl, LDL should be less than 100 mg/dl, and total cholesterol should be less than 200 mg/dl.
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 His waist size His alcohol intake His sedentary lifestyle
His dietary intake of saturated fat Unless a person has a genetic disorder of lipid metabolism, the amount of cholesterol in the blood is strongly related to dietary intake of saturated fat.
A client asks how ezetimibe will help to treat high lipid levels. The nurse explains that: It reduces the production of triglycerides by the liver. Its mechanism of action is not understood. It stimulates the breakdown of triglycerides. It decreases the absorption of cholesterol in the small intestine.
It decreases the absorption of cholesterol in the small intestine. Ezetimibe inhibits the absorption of cholesterol by the small intestine. Fibric acid derivatives work by stimulating catabolism of triglyceride-rich proteins. Gemfibrozil reduces the production of triglycerides by the liver.
HMG-CoA reductase inhibitors (statins) are classified as which pregnancy category? Pregnancy Category A Pregnancy Category X Pregnancy Category C Pregnancy Category B
Pregnancy Category X 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.
Which single class drug is known to be most effective in reducing the major types of dyslipidemia? Bile acid sequestrants Fibrates Statins Niacin
Statins Explanation: 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.
What information would be included in a lipoprotein profile? Select all that apply: AST ALT Triglycerides LDL Total cholesterol
Total cholesterol Triglycerides LDL A lipoprotein profile is a laboratory test which reports total cholesterol, LDL, HDL, and triglycerides. AST and ALT are values that would be found reported from liver function test.
After teaching a group of students about metabolic syndrome, the instructor determines that the teaching was successful when the students identify which characteristic? Fasting blood glucose below 110 mg/dL Blood pressure below 130/85 mm Hg Triglyceride level above 150 mg/dL Waist measurement over 35 inches in men
Triglyceride level above 150 mg/dL Characteristics of metabolic syndrome include - fasting blood glucose levels greater than 110 mg/dL, - waist measurement over 40 inches in men and - over 35 inches in women, - triglyceride levels greater than 150 mg/dL - or HDL levels less than 40 mg/dL in men or less than 50 mg/dL in women, blood pressure greater than 130/85 mm Hg, increased macrophages, levels of interleukin-6 and TNF, and increased plasminogen activator levels.
A client calls the clinic and talks to the nurse. The client tells the nurse the client has been taking colesevelam (Welchol) for six months and that the client is having small amounts of bright red rectal bleeding and is concerned. What would an appropriate response from the nurse be? "I should let your physician know immediately!" "Don't worry about it. This can happen some time." "Stop taking the medication now! This is a serious adverse effect." "The bleeding may be coming from hemorrhoids. We should check this out."
"The bleeding may be coming from hemorrhoids. We should check this out." Colesevelem is a bile acid sequestrant and these drugs can aggravate hemorrhoids and cause bright, red bleeding. This is not a serious adverse effect and can be treated.
An older adult client's most recent physical assessment and diagnostic workup reveal the presence of dyslipidemia. The client 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 daily" "Atorvastatin 50 mg PO TID with meals" "Atorvastatin 150 mg PO BID" "Atorvastatin 75 mg PO BID"
Atorvastatin 10 mg PO daily" Explanation: Atorvastatin is normally administered PO 10 to 80 mg daily in a single dose. The other options present twice or thrice daily administration and total dosages of 150 mg or 300 mg.
The clinic nurse has been assigned to a 43-year-old client who is obese and loves to eat. The client has been diagnosed with hyperlipidemia and has been prescribed lovastatin. Which dietary instruction would be a priority for the nurse to discuss with the client? Increase intake of milk and other dairy products Increase intake of fatty acids Decrease intake of plant stanols Avoid drinking grapefruit juice
Avoid drinking grapefruit juice It is generally recommended that clients avoid grapefruit juice when taking lovastatin because it inhibits the action of CYP3A4, the isoenzyme that metabolizes lovastatin. Education regarding the need for adequate intake of milk and other dairy products along with plant stanols is important but would not be as critical as the grapefruit juice inhibiting the metabolism of the lovastatin.
A client with atrial fibrillation who is receiving oral anticoagulant therapy is receiving atorvastatin. The nurse would monitor this client for: Bleeding Liver failure Abdominal pain Cataract development
Bleeding Increased serum levels and resultant toxicity can occur if a statin is combined with warfarin, an oral anticoagulant. This would increase the client's risk for bleeding. Abdominal pain and cataract development are related to the use of atorvastatin alone. Liver failure also is associated with atorvastatin use alone.
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
Blood in urine or stool Warfarin levels increase with ezetimibe, increasing the patient's risk for bleeding. Abdominal pain is a common adverse effect of ezetimibe and is unrelated to the combination therapy. Yellowing of the skin suggests liver dysfunction, which is not associated with the combination therapy. Blurred vision is not associated with the combination therapy. Reference:
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 Decrease in sitosterol and serum cholesterol Decrease in campesterol and LDL levels Decrease in serum cholesterol only
Decrease in serum cholesterol and LDL levels Atorvastatin is a beta-hydroxy-beta-methylglutaryl coenzyme A reductase inhibitor and should lower serum cholesterol and LDL levels as well as prevention of a first myocardial infarction and slow the progression of coronary artery disease. A decrease in serum cholesterol alone would result from the use of a bile acid sequestrant. A cholesterol absorption inhibitor would also decrease sitosterol and campesterol levels as well as decrease levels of serum cholesterol and LDL.
The nurse instructs a patient to take his prescribed simvastatin at bedtime to promote: Increase absorption of the drug Enhanced drug effectiveness Improved compliance with therapy A decreased risk for adverse effects
Enhanced drug effectiveness Simvastatin should be administered at bedtime because the highest rates of cholesterol synthesis occur between midnight and 5 AM and the drug should be taken when it will be most effective.
A patient with hyperlipidemia is prescribed ezetimibe. Which ongoing assessment should the nurse perform during treatment? Obtain reports of fasting blood sugar levels. Take a dietary history of the patient. Frequently monitor blood cholesterol. Inspect skin and eyelids for evidence of xanthomas.
Frequently monitor blood cholesterol. The nurse should frequently monitor blood cholesterol as part of the ongoing assessment for a patient receiving ezetimibe. Taking a dietary history of the patient and inspecting the skin and eyelids for evidence of xanthomas are the pre-administration assessments that a nurse should perform for a patient receiving ezetimibe. The nurse obtains the reports of fasting blood sugar for a diabetic patient.
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? Small intestine Liver Gallbladder Stomach
Gallbladder 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.
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 total serum cholesterol levels Increase in HDL levels Reduction in triglycerides Reduction in LDL cholesterol levels
Reduction in LDL cholesterol levels Reduction in LDL cholesterol levels Explanation: 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 category of blood lipids is involved in the formation of atherosclerotic plaques? nitroglycerin triglycerides cholesterol phospholipids
cholesterol Explanation: Blood lipids are a category of fatty acids, which are substances used within the body to perform essential functions. Cholesterol is the portion of blood lipids involved in the formation of atherosclerotic plaques. Triglycerides and phospholipids are not involved in the formation of plaque. Nitroglycerin is not a blood lipid.
The nurse is providing education to an older adult client who has been prescribed atorvastatin. How should the nurse describe the common adverse effects of the drug? "The most common side effects of atorvastatin include some mild gastrointestinal upset." "The more serious side effects of atorvastatin involve a risk of bleeding." "Most people who experience side effects from atorvastatin report stiffness in their joints." "Some clients experience mild chest pain initially."
"The most common side effects of atorvastatin include some mild gastrointestinal upset." 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. Chest pain, joint stiffness, and bleeding are not common adverse effects.
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? "Atorvastatin is approved to be taken during pregnancy, but you would have to stop taking it if you chose to breastfeed." "There's no evidence that atorvastatin is either safe or unsafe during pregnancy, so it's best to err on the side of caution." "Atorvastatin can be taken safely throughout your pregnancy since it does not cross through the placenta." "It's important that you stop taking atorvastatin before you stop using contraception."
"It's important that you stop taking atorvastatin before you stop using contraception." 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.
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? "You need to stop taking the medication immediately. I will notify the health care provider." "This is an expected adverse effect of the drug. It should subside in time." "Don't worry about it. I'm sure it's not really noticeable." "You need to decide if you want to take this medication. The flushing will be present as long as you take the medication."
"This is an expected adverse effect of the drug. It should subside in time." 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. Reference:
In addition to being synthesized in the liver and intestine, from where are blood lipids derived? medications kidneys exercise diet
diet 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 client who is receiving colestipol is also taking a thiazide diuretic. Which instruction would be most appropriate for the nurse to give? "Take the colestipol at the same time as the thiazide diuretic." "Take the thiazide diuretic about 4 hours before the colestipol." "Take the colestipol first and then take the diuretic a half hour later." "Take the thiazide diuretic about 1 hour before the colestipol."
"I will take the digoxin about an hour before the cholestyramine." Explanation: The absorption of digoxin can be decreased or delayed with cholestyramine, a bile acid sequestrant. Therefore, the digoxin should be taken 1 hour before for 4 to 6 hours after the cholestyramine.
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." "Sometimes this causes a full body rash when you first take it, but that doesn't necessarily mean you're allergic to it." "It's important to avoid eating shellfish and to tell your care provider before having any diagnostic imaging tests." "You're likely to have some nausea when you begin taking the drug, but this will dissipate with time." ● Vitamin B3 (known as Niacin (Niacor, Niaspan)) ○ inhibits release of free fatty acids from adipose tissue ○ Increases rate of triglyceride removal from plasma ○ reduces LDL and triglyceride levels and increases HDL levels ○ Niacin is associated with intense cutaneous flushing, nausea, and abdominal pain, making its use somewhat limited. A full body rash should always be reported and self-limiting nausea is not expected.
"Some people get very flushed skin when they take this medication." Niacin is associated with intense cutaneous flushing, nausea, and abdominal pain, making its use somewhat limited. A full body rash should always be reported and self-limiting nausea is not expected. There is no need to avoid shellfish or contrast solution when taking niacin.
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? "I'll give you the names of some salt substitutes that you can start using to season your food." "A low-fat diet is a good idea, and the animal sources of fat are always preferable to plant sources." "Try to get most of your food energy from protein sources rather than carbohydrates." "It's a good idea to keep your intake of saturated fat to a bare minimum."
"It's a good idea to keep your intake of saturated fat to a bare minimum." Explanation: Statins should be accompanied by a low-cholesterol diet that is also low in saturated fats. Reduction of sodium intake is a useful health-promotion measure but is not particular to treatment with statins. Plant sources of fat are typically lower in saturated fat than animal sources and it is unnecessary to prioritize protein intake over carbohydrates.
A client asks how ezetimibe will help to treat high lipid levels. The nurse explains that:
It decreases the absorption of cholesterol in the small intestine. Explanation: Ezetimibe inhibits the absorption of cholesterol by the small intestine. Fibric acid derivatives work by stimulating catabolism of triglyceride-rich proteins. Gemfibrozil reduces the production of triglycerides by the liver.
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? Continued therapeutic lifestyle changes during drug therapy will guarantee success. Nonpharmacologic interventions are cheaper than using medications. Therapeutic lifestyle changes are easier to comply with than medication therapies. Therapeutic lifestyle changes are the preferred method for lowering blood lipids.
Therapeutic lifestyle changes are the preferred method for lowering blood lipids. Nonpharmacologic interventions are always preferred to pharmacologic ones if there is potential for success. Appropriate lifestyle changes should be maintained, but there will not assure guaranteed success. Medications are to be used only when nonpharmacologic efforts have proven unsuccessful. While nonpharmacologic interventions may be less expensive, that is not the basis for the recommendation.
