Exam 2: Statins

Question 1

What do statins lower?

Answer 1

Statins lower cholesterol

Question 2

In the Statin mechanism of action, what do Statins hinder?

a.) HCO3- production
b.) HMG-CoA Reductase
c.) Aldosterone Reductase
d.) HCT levels in the liver

Answer 2

b.) Statins are HMG-CoA reductase inhibitors

Question 3

HMG-CoA reductase is an enzyme made by the liver that conducts “Cholesterol Synthesis.” If Statins inhibit HMG-CoA reductase, what does this do to cholesterol levels?

Answer 3

Statins decrease the cholesterol levels.

Question 4

Which cholesterol level do you want to lower, and which one do you want to raise?

-LDL
-HDL

What should their levels be?

Answer 4

Lower LDL, and raise HDL

LDL should be below <100

HDL should be greater than >60

Question 5

What disease can high LDL cause in a patients blood vessels?

Answer 5

High blood pressure due to Atherosclerosis

Question 6

Why is it good to have high levels of HDL?

Answer 6

HDL help to remove LDL’s

Question 7

State the purpose of Statins in a nutshell

Answer 7

Lower cholesterol synthesis in the Liver

Question 8

When cholesterol synthesis of the liver is inhibited, the liver “blank” the amount of LDL receptors it has.

This effect then “blank” LDL levels in the blood, due to HDL doing what?

Answer 8

The liver increases LDL receptors which lower LDL in the blood, because HDL will take the floating LDLs and put them on the livers receptor sites.

Question 9

What conditions do Statins treat and what can statins be used to prevent?

Answer 9

Statins treat high cholesterol levels, and can be used to prevent CAD (Coronary Artery Disease)

Question 10

A patient taking a Statin may experience sore muscles. What labs would the nurse monitor for in that patient with sore muscles?

Answer 10

CK-Creatine Kinase levels.

If the CK is 10x the upper limits, stop the use of the Statin immediately, because that means that there is damage in the skeletal muscles and they are leaking CK

Question 11

What can a patient taking a Statin ingest that can cause liver toxicity due to the Statin usage?

Answer 11

Grapefruit

Question 12

If you wanted to monitor a patients liver function while they were using a Statin, what lab values would you assess for?

Answer 12

ALT and AST measurements. These are enzymes that show proper Liver function

Question 13

If a patient taking a Statin was at risk for Diabetes type II, would you increase or decrease their glucose intake?

Answer 13

decrease

Question 14

Statins can cause the disease known as Rhabdomyolysis. Rhabdomyolysis is myoglobin leaking into the blood from damaged skeletal muscles, which can lead to Kidney failure.

Why would Rhabdomyolysis cause Kidney failure?

Answer 14

Because Kidneys filter blood, and if myoglobin were leaking into the blood, the kidneys would be filtering out myoglobin.

Question 15

What lab levels would assess for Rhabdomyolysis?

Answer 15

Ck-Creatine Kinase

Question 16

Rhabdomyolysis can be caused by certain drugs as well, known as Fibrates. Which of these drugs are Fibrates?

-Simvastatin
-Ramipril
-Nifedipine
-Metoprolol
-Gemfibrozil

Answer 16

-Gemfibrozil

Look for “Fib” or “Fibr”

Question 17

A patient is prescribed Pravastatin. This medication is known as a ______________________?

A. Fibric Acid Derivative
B. Bile-acid Sequestrant
C. HMG-CoA Reductase Inhibitor
D. Cholesterol Absorption Inhibitor

Answer 17

The answer is C: HMG-CoA Reductase Inhibitor. Pravastatin is a STATIN medication which is part of the HMG-CoA Reductase Inhibitor family.

Question 18

Your patient is prescribed a statin medication for the treatment of hyperlipidemia. What medication below may increase the patient’s risk of developing rhabdomyolysis if taken with a statin?

A. Ezetimibe
B. Gemfibrozil
C. Cholestyramine
D. Colesevelam

Answer 18

The answer is B. The usage of fibric acid derivatives (fibrates….such as Gemfibrozil or Fenofibrate) and statins together can increase the risk of rhabdomyolysis (break down of skeletal muscle which leads to renal failure).

Question 19

Which statement below accurately describes how statin medications work to lower cholesterol levels?

A. Statins increase the activity of LDL receptors in the liver by increasing the bioavailability of fibric-acid.
B. Statins inhibit bile acid in the GI tract from being absorbed and as a result the liver turns cholesterol into bile acid.
C. Statins increases hydroxymethylglutaryl–coenzyme A enzyme and this increases renal excretion of cholesterol.
D. Statins inhibit HMG-CoA reductase which in turn hinders cholesterol synthesis in the liver.

Answer 19

The answer is D: Statins inhibit HMG-CoA reductase which in turn hinders cholesterol synthesis in the liver.

Question 20

Your patient is taking Simvastatin. Which of the following findings below demonstrate this medication is providing therapeutic effects to this patient? Select-all-that-apply:

A. HDL 80 mg/dL
B. LDL 72 mg/dL
C. HDL 30 mg/dL
D. LDL 190 mg/dL

Answer 20

The answers are A and B. Statins should lower LDL (the bad cholesterol….approximate normal range <100 mg/dL) and increase HDL (the good cholesterol…. approximate normal range >60 mg/dL)).

Question 21

You’re providing education to a group of participants in the community about cholesterol and cardiac disease. Which statements below verbalized by some of the participants are inaccurate and require you to provide clarification?

A. “HDL levels should be less than 60 mg/dL to maintain good cardiac health.”
B. “LDL is a fatty substance that sticks to vessels walls and can lead to atherosclerosis.”
C. “HDL is a fatty substance that helps remove low-density lipoprotein from the blood so it doesn’t have the chance to stick to vessel walls.”
D. “LDL levels should be greater than 100 mg/dL to maintain good cardiac health.”

Answer 21

The answers are A and D. These statements are false. LDL levels should be LESS (not greater) than 100 mg/dL, and HDL levels should be HIGHER (not lower) than 60 mg/dL. The other statements are true.

Question 22

A patient has been taking Simvastatin and reports to you that they are experiencing soreness and weakness of the muscles. The physician orders lab work. What lab result below will you immediately report to the physician?

A. Increased High-density Lipoprotein level
B. Decreased Creatine Kinase level
C. Decreased Low-density Lipoprotein level
D. Increased Creatine Kinase level

Answer 22

The answer is D: Increased Creatine Kinase level. Statins have a slight risk of causing “statin-induced rhabdomyolysis”. This is the breaking down of skeletal muscle. If a patient reports muscle soreness or weakness while taking a statin the CK levels (Creatine Kinase) should be measured. Creatine Kinase is a protein found in skeletal muscle (it’s also found in the heart). If skeletal muscle is breaking down CK will be found in the blood in high amounts and this tells us there is muscle damage. The CK level will be 10 x’s the upper limit of normal…if this occurs the statin should be discontinued.

Question 23

Your patient is prescribed Lovastatin due to their risk factors for developing cardiac disease. You’re providing education about the importance of continuing exercise and a healthy diet while taking this medication. You are helping the patient create a weekly food plan. Which food item below should the patient avoid including in the food plan while taking this medication?

A. Bananas
B. Spinach
C. Grapefruit
D. Aged-cheese

Answer 23

The answer is C. Grapefruit or grapefruit juice can increase the toxicity of statins.

Question 24

Your patient who is taking a statin develops yellowing of the skin, abdominal pain in the right upper quadrant, and nausea. What lab result below correlates with this finding?

A. Elevated ALT and AST level
B. Elevated BUN and creatinine
C. Decreased WBC
D. Decreased Hbg

Answer 24

The answer is A. Liver injury is a risk with statins. Therefore, a liver functions test (LFTs) should be ordered to assess the liver’s function. The patient is presenting with signs and symptoms of liver injury. An elevated ALT and AST level would correlate with these presenting signs and symptoms.