Lipid Lowering Agents

Question 1

modifiable risk factors for coronary artery disease

Answer 1

gout, cigarette smoking, sedentary lifestyle, high stress levels, hypertension, obesity, diabetes, untreated bacterial infections, treatment with tetracycline and fluororoentgenography

Question 2

unmodifiable risk factors for coronary artery disease

Answer 2

genetic predisposition, age, gender

Question 3

causes of hyperlipidemia

Answer 3

excessive dietary intake of fats; genetic alterations in fat metabolism leading to a variety of elevated fats in blood

Question 4

action of lipid-lowering agents

Answer 4

lower serum levels of cholesterol and lipids; prevention of CAD

Question 5

bile acid sequestrants

Answer 5

cholestyramine; decrease plasma cholesterol levels

Question 6

actions of cholestyramine

Answer 6

used to bind with bile and prevent cholesterol from being absorbed into intestines and into blood stream

Question 7

indications of cholestyramine

Answer 7

reduces elevated serum cholesterol in patients with primary hypercholesterolemia, pruritus associated with partial biliary obstruction

Question 8

pharmacokinetics of cholestyramine

Answer 8

excreted through GI tract

Question 9

contraindications of cholestyramine

Answer 9

allergy, complete biliary obstruction, abnormal intestinal function, pregnancy and lactation

Question 10

adverse effects of cholestyramine

Answer 10

headache, fatigue, drowsiness, nausea, constipation, increased bleeding times, vitamin A and E deficiences

Question 11

drug-drug interactions of cholestyramine

Answer 11

malabsorption of fat-soluble vitamins; thiazide diuretics, digoxin, warfarin, thyroid hormones, and corticosteroids

Question 12

nursing considerations for cholestyramine

Answer 12

elimination patterns

Question 13

what is the main side affect of cholestyramine

Answer 13

bloating, constipation

Question 14

HMG-CoA reductase inhibtors

Answer 14

atorvastatin; the early rate-limiting step cellular cholesterol synthesis involves the enzyme HMG-CoA reductase. if this enzyme is blocked, serum cholesterol and LDL decrease

Question 15

actions of atorvastatin

Answer 15

inhibits HMG-CoA, decreased serum cholesterol levels, LDLs, and triglycerides, increased HDL levels

Question 16

indications of atorvastatin

Answer 16

adjunct to diet in the treatment of elevated cholesterol, triglycerides, and LDL; increase HDL-C in patients with primary hypercholesterolemia and two+ risk factors for CAD

Question 17

pharmacokinetics of atorvastatin

Answer 17

absorbed from the GI tract, undergo first-pass metabolism by the liver; excreted in urine and feces

Question 18

contraindications of atorvastatin

Answer 18

allergy; acute liver disease or history of alcoholic liver disease; pregnancy or lactation

Question 19

caution of atorvastatin

Answer 19

impaired endocrine function

Question 20

adverse effects of atorvastatin

Answer 20

flatulence, abdominal pain, cramps, nausea, vomiting, and constipation; headache, dizziness, blurred vision, insomnia, fatigue; liver failure; rhabdomylosis

Question 21

drug-drug interactions of atorvastatin

Answer 21

erythromycin, cyclosporine, gemfibrozil, niacina; digioxin or warfarin; estrogen; grapefruit juice

Question 22

nursing considerations for atorvastatin

Answer 22

active liver disease or history of alcoholic liver disease; pregnancy and lactation

Question 23

when should you take a -statin drug

Answer 23

after dinner or bedtime because that is when cholesterol is made by the liver

Question 24

rhabdomylosis

Answer 24

side effect of -statin use; breakdown of muscle tissue

Question 25

when should you stop a -statin drug

Answer 25

when pt. complains of muscle pain, or urine becoming darker yellow or tea colored

Question 26

what causes the discoloration of urine from the -statin drug

Answer 26

caused by myoglobin that is excreted from muscles and excreted by the kidneys; can damage the kidneys

Question 27

what does niacin cause?

Answer 27

pruritus’ and facial flushing

Question 28

how should you relieve niacin side effects

Answer 28

take ASA or tylenol a half hour before taking niacin

Question 29

cholesterol absorption inhibitor

Answer 29

ezetimibe

Question 30

action of ezetimibe

Answer 30

works in the brush border of the small intestine to inhibit the absorption of cholesterol

Question 31

indication of ezetimibe

Answer 31

lower serum cholesterol levels; treat homozygous familial hypercholesterolemia; treat homozygous sitosterolemia to lower sitosterol and campesterol levels

Question 32

pharmacokinetics of ezetimibe

Answer 32

absorbed in the GI tract; metabolized in the liver, excreted in urine and feces

Question 33

contraindications of ezetimibe

Answer 33

allergy; pregnancy or lactation if combined with a -statin drug

Question 34

cautions with ezetimibe

Answer 34

elderly people; liver disease

Question 35

adverse effects of ezetimibe

Answer 35

abdominal pain and diarrhea; headache, dizziness, fatigue, URI, back pain; muscle aches and pain

Question 36

drug-drug interactions of ezetimibe

Answer 36

cholestyramine, fenofibrate, gemfibrozil, or antacids; cyclosporine; fibrates; warfarin

Question 37

nursing considerations fo ezetimibe

Answer 37

liver dysfunction, orientation, and reflexes; respirations; bowel elimination patterns

Question 38

what are some other agents used to lower lipid levels

Answer 38

niacin; fenofibrates; omega-3 fatty acids

Question 39

niacin

Answer 39

vitamin B3; inhibits release of free fatty acids from adipose tissue

Question 40

fenofibrates

Answer 40

inhibits triglyceride synthesis in the liver- decreased LDL; increased uric acid secretion- may stimulate triglyceride breakdown

Question 41

omega-3 fatty acids

Answer 41

omega-3 acid: fish oil mixture of free fatty acids approved as an adjunct to diet to reduce triglyceride levels in adults with severe hypertriglyceridemia