Dyslipidemia Meds

Question 1

Dyslipidemia

Answer 1

Abnormally elevated cholesterol or fat in the blood

Question 2

How do Statins work?

Answer 2

They inhibit HMG-CoA reductase so mevalonate isnt formed, therefore Cholesterol CANNOT be made (DOC for Decreasing LDL)

Question 3

Statins cause ________ in LDL, ________ HDL, ________ in vLDL

Answer 3

decreases, increases, decreases

Question 4

Niacin (Nicotinic acid or vitamin b) causes a _____ in HDL, ________ in LDL, _______ in trigylcerides

Answer 4

Increase HDL, Decrease LDL, Decrease triglycerides

Question 5

How doe Bile-acid Sequestrants work?

Answer 5

Bile is made from cholesterol. This drug keeps bile in the GI tract to prevent absorption and promote excretion.

Question 6

Bile-acid Sequestrants will ______ LDL cholesterol levels and _______ triglycerides

Answer 6

Reduce LDL cholesterol levels, INCREASE triglycerides (bad)

Question 7

How does Ezemtimibe work?

Answer 7

Ezemtimibe acts on cells of the small intestine to inhibit dietary cholesterol absorption.

Question 8

Ezemtimibe _______LDL

Answer 8

decreases LDL

Question 9

How do Fibrates work?

Answer 9

Activates PPAR alpha receptors which increase breakdown of fatty acids

Question 10

Fibrates _______ triglycerides

Answer 10

Decrease triglycerides

Question 11

Your patient has a history of non-alcoholic fatty liver disease. They also have high cholesterol. The doctor prescribed Pravastatin. Should the nurse administer the drug?

Answer 11

Yes, but take caution

Question 12

A pregnant woman is prescribed Atorvastatin (LIPITOR) what should the nurse do?

Answer 12

Hold the med and call the doctor. Pregnancy risk X

Question 13

Your patient has a history of viral and alcoholic hepatitis and is prescribed Rosuvastatin. What should the nurse do and why?

Answer 13

Hold the med and call the doctor. Contraindicated

Question 14

Any side effects for Rosuvastatin?

Answer 14

Doesn’t work well with people from asia, causes Rhabdo (breakdown of muscle tissue that releases a damaging protein into the blood.)

Question 15

What are the Pleiotropic effects of Statins?

Answer 15

• Stabilizes arterial pressure
• anti-inflammatory properties
• Anti-oxidant properties
• Anti-platelet/thrombotic properties

Question 16

Adverse effects of Statins?

Answer 16

Muscle pain (myopathy)
Hepatotoxicity ( AST ALT tests)
CYP interactions
Pregnancy risk X

Question 17

What should the nurse teach the client about taking Statins?

Answer 17

• The drug will take ~2 weeks to work
• We will take this in the evening when your body produces cholesterol
• report unexplained muscle pain
• will not replace diet and exercise.

Question 18

What percentage of clients develop myopathy?

Answer 18

5-10%

Can progress to rhabdomyolysis so really Monitor CK levels. Hold statins if CK > 10x the upper limit of normal

Question 19

What percentage of clients develop Hepatoxicity?

Answer 19

0.5-2%
Obtain baseline LFTs and if they have liver disease call the doctor but don’t call if its
nonalcoholic fatty liver disease

Question 20

Niacin (Nicotinic Acid or Vitamin B3) signs and symptoms of adverse effects?

Answer 20

*flushing- Take aspirin 30 min before to help
*GI upset- Take with meals
*Increased Uric Acid
Hepatotoxicity (rare)

*Must control lipid levels through diet- may need dietary counseling

Question 21

Patient has gout and is taking 5 hour energy. What should the nurse do and why?

Answer 21

Tell them to stop. It can increase Uric acid because it contains Niacin.

Question 22

Bile-Acid Squestrants signs and symptoms of adverse effects?

Answer 22

• Mild GI side effects (nausea, bloating)

- Can bind with other drugs (b/c sticky substance—may interfere with absorption of other drugs)

Question 23

Cholesevelam

Answer 23

Bile-Acid Squestrant
↓LDL
• Can increase triglycerides (bad)
• No absorption into blood
• Only mild GI side effects (nausea)
• Can bind with other drugs

Question 24

Ezetimibe signs and symptoms of adverse effects?

Answer 24

• DOES NOT CAUSE GI issues

- Wouldn’t want to combine with a Statin b/c of increase risk of hepatotoxicity or Rhabdomyolysis

Question 25

Fibrates signs and symptoms of adverse effects?

Answer 25

-RASH (very common)
-GI disturbances (nausea, vomiting, diarrhea (NVD))
Increased gallstone formation with GEMFIBROZIL
iv) Myopathy (muscle damage)

Question 26

Fenofibrate

Answer 26

Fibrate
↓Triglycerides
Increase breakdown of fatty acids

Question 27

Gemfibrozil

Answer 27

Fibrate

*Watch for Increased gallstone formation

Question 28

You have two patients. One is taking Fenofibrate and the other is taking Gemfibrozil. The doctor prescribes Warfarin to both for blood clots. What should the nurse do and why?

Answer 28

Both of these drugs are protein bound so they can knock off warfarin from protein and cause bleeding

Question 29

Fish Oil help with heart disease?

Answer 29

no advantage in prevention of heart disease in high-risk populations.

Question 30

What will fish oil do?

Answer 30

↓ Triglycerides; ↑ LDL

Reduces platelet aggregation (watch out for blood thinners)

Question 31

Why would one chose a Statin over Fish oil?

Answer 31

Unlike fish oil Statins decrease number of MIs and strokes (what we are actually trying to prevent)

Question 32

Client teaching for Bile-Acid Squestrants?

Answer 32

• will appear cloudy and not clear if powder form is mixed.
• Constipation? - increase fiber and fluids
• take 1 hour before other meds or 4 hours after

Question 33

client teaching for Ezemtimibe?

Answer 33

• Can be taken with or without food
• Combining with statin? okay, but may increase risk if hepatotoxicity or rhabdo)
• Combining with bile-acid sequestrant? - take 2 hours before sequestrant or 4 hours after

Question 34

Patient has liver disease, severe renal dysfunction, and gallbladder disease and the doctor prescribes Gemfibrozil. What should the nurse do?

Answer 34

Call the doctor - contraindicated