311 Flashcards
if the creatine kinase level becomes elevated during statin therapy, what should happen?
the drug should be immediately discontinued.
What is the drug that’s mechanism of action interferes with HMG-CoA reductase, the critical enzyme in the biosynthesis of cholesterol.
Statins
What is the drug that’s mechanism of action decreases both VLDL and LDL levels
Niacin.
What is the drugs that’s mechanism of action blocks the absorption of cholesterol from the small intestine
Ezetimibe
What is the drug that’s mechanism of action binds bile acids, thus increasing the excretion of cholesterol in the stool
Bile acid sequestrants
Rare but serious adverse effects of statins
Severe myopathy and rhabdomyolisis
Patients taking statins could benefit from enhancing their diet with foods rich in CoQ10- like pork- why?
Statins reduce coQ10 synthesis
Lipid lowering drugs can deplete or diminish the absorption of what?
Fat soluble vitamins and folic acid
Gemfibrozil is contraindicated in patients with what
Chronic kidney disease
What drug is the only drug in a class called cholesterol absorption inhibitors and can block absorption of cholesterol which can cause the body to respond by creating more cholesterol?
Ezetimibe (Zetia)
Gemfibrozil (fibric acid derivative) is indicated for the treatment of what conditions
Hyper triglycerides and hypercholesterolemia
(It lowers VLDL with an increase in HDL)
NOT effective for lowering LDL
A patient has a triglyceride level of 450 mg/dL. Which drug should the nurse anticipate being prescribed for this patient
Fibric acid
Cholestyramine (Questran) can bind to other drugs. When should it be taken with a patient who also takes digoxin
2hours before or 4 hours after
If statins are having minimal impact and aren’t tolerated well by the patient, what drug would be the next choice
Gemfibrozil (lopid)
A patient is prescribed Gemfibrozil (Lopid). For which reason should the nurse expect the medication to be discontinued for this patient
Elevated low density lipoproteins (LDL)
Cholestyramine is contraindicated for what
Biliary obstruction
Triglycerides should be less than what number to be in normal range
Less than 150
What is the drug Atorvastatin (Lipitor)
Statin.
Side effects- myalgia, arthralagia, rhabdomyolisis (leads to renal failure!) elevated hepatic enzymes.
What do B-complex Vitam B do for lipid disorders and name the drug given
Decreases the VLDL into LDL, reduced triglycerides.
Niacin is what’s given
Side effects- flushing, nausea, diarrhea, hepatotoxicity, gout
What do Fibric Acid Drugs do for lipid disorders
Activate the enzyme lipoprotein lipase, lower LDL, triglycerides and most effective lipid drug to increase HDL
Fenofibrate (Lofibra)
-administered with meals to decrease GI upset
What do the kidney excrete that helps regulate bp
Renin enzyme
What do kidneys excrete that stimulates red blood cell production
Erythropoietin hormone
If a drug is bound to plasma proteins will it pass through the glomerulus and enter the filtrate or continue circulating in the blood.
Continue circulating. It’s too big
Diuretic drugs and therapy for kidney failure
Diuretics: Loop/ thiazide/ potassium sparing.
Used for: HTN, AKI & CKD, heart failure, pulmonary edema.
Nurse teaching: monitor weight, HR, BP
Bumetanide (bumex) is what kind of drug
Loop diuretic. Most potent of them.
It blocks the reabsorption of Na+ an Cl- in the nephron loop.
Side effect: hypokalemia, hypotension
Ototoxic
Ethacrynic acid (edecrin) is what kind of drug
Loop diuretic.
Side effect: ototoxicity.
Chlorothiazide (Diuril) and hydrochlorothiazide (microzide) are what kind of drugs
Thiazide diuretics.
Block Na+ reabsorption and increase k+ and water excretion.
Side effect: hypokalemia (palpitations), hypotension, dehydration
Spironolactone (Aldactone) is what kind of drug?
Potassium sparing diuretic. Na+ & water excretion is increased & body retains more K.
Side effect: hyperkalemia, no K supplements and limit K in diet.
Reduces mortality in pt with CHF.
Furosemide and torsemide are what kind of drugs
Loop diuretic
Furosemide (Lasix)- is the most popular and lasts 6 hrs.
Loop diuretics are mainly used for ….
Edema …..
Loop diuretic side effects.
Ototoxic. Decreased potassium and magnesium. Metabolic alkalosis (blood pH turning basic). Dehydration. (Fluid loss)
Potassium sparing diuretics can treat what and have what side effects
Tx: HTN, heart failure, edema.
Side effects: elevated potassium levels; high levels can lead to gynecomastia
Thiazide and thiazide like diuretics work on what part of kidneys. Used for what?
Distal convoluted tubule. To prevent sodium from being reabsorbed.
Used for HTN, Edema.
Thiazide diuretics side effects
Gout.
Decreased sodium (hyponatremia)
Decreased potassium (hypokalemia)
Increased Uric acid (hyperuremia)
Increased blood glucose (hyperglycemia)
OTC medications like NSAIDs, antacids, acetaminophen, and cough and flu, should be avoided with diuretics why?
All contain high levels of sodium.
If a patient is dehydrated and has a low BP. What do you give
Normal saline.
If a patient is dehydrated with a normal BP. What do you give.
0.45% NaCl
The drug Questran can take how long for effectiveness?
30 days or more.
Gemfibrozil is contraindicated in clients with what conditions
hepatic impairment, severe chronic kidney disease (CKD), pre-existing gallbladder disease, or those with prior hypersensitivity to the drug
Loop diuretics, compared with potassium-sparing diuretics, will result in what?
greatly increase urinary output, decrease edema, and promote the excretion of potassium.
A client is prescribed spironolactone (Aldactone). For which electrolyte imbalance should the nurse monitor this client?
Because spironolactone is a potassium-sparing diuretic, the client is at risk for cardiac dysrhythmias and hyperkalemia. The client is also at risk for hyponatremia and hypomagnesemia.
A client taking a diuretic develops gynecomastia. Which medication should the nurse suspect as causing this finding?
Spironolactone
client is taking hydrochlorothiazide (Microzide). Which effect should the nurse expect from concurrent use with a corticosteroid?
decreased serum potassium levels
Hydrochlorothiazide and corticosteroids can both cause hypokalemia, and this likelihood is increased when the two medications are taken together
A client is prescribed a carbonic anhydrase inhibitor. Which response should the nurse expect after administering this medication?
minimal diuresis.
The carbonic anhydrase inhibitors are rarely used as diuretics because they produce only a weak diuresis and can contribute to metabolic acidosis.
Normal levels for….
Na, K, Mg, Ca, creatinine
Na: 135-145
Ca: 8-10
K: 3.5-5.0
Mg: 1.5-2.5
Creatinine: 0.7-1.2
