Prophylaxis of Coronary Heart Disease: Drugs That Help Normalize Cholesterol and Triglyceride Levels Flashcards
A patient with a history of angina and hypertension is being started on nicotinic acid (Niacin). The nurse is providing patient education. What statement made by the patient demonstrates a need for further teaching?
a. “I will take Tylenol with my medication to reduce the inflammatory effects.”
b. “I will be cautious taking this medication, because I have mild liver damage.”
c. “I will take an aspirin 30 minutes before my niacin to reduce flushing.”
d. “This medication will lower my triglyceride levels.”
A
Intense flushing of the face, neck, and ears occurs in practically all patients taking nicotinic acid in pharmacologic doses. Tylenol will not reduce the flushing or inflammatory effects of the medication; further patient teaching is required. The flushing reaction diminishes in several weeks and can be attenuated by taking 325 mg of aspirin 30 minutes before each dose. Nicotinic acid is hepatotoxic; therefore, the patient should be taught to have the liver enzymes checked and to self-monitor for signs and symptoms. Nicotinic acid reduces low-density lipoprotein (LDL) cholesterol and triglyceride (TG) levels.
A prescriber has ordered rosuvastatin (Crestor) for a patient with non–alcoholic-related cirrhosis. Which intervention would be most appropriate for the nurse before administration of this drug?
a. Question the order, because rosuvastatin is contraindicated in patients with liver disease.
b. No intervention is necessary; just administer the drug as ordered.
c. Review the baseline liver function test results.
d. Assess the patient for liver disease.
C
Before administering rosuvastatin, the nurse should review the results of the baseline liver function tests (LFTs). Statins can be used by patients with liver disease but not by those with alcoholic or viral hepatitis. Administering the drug before obtaining baseline LFT results would not allow for an accurate baseline. The patient clearly already has liver disease.
A patient with malaise has been taking daptomycin (Cubicin) for an infection and is concurrently taking simvastatin (Zocor). The nurse should be concerned if the patient complains of:
a. nausea.
b. tiredness.
c. muscle pain.
d. headache.
C
Statins can injure muscle tissue, causing muscle aches and pain known as myopathy/rhabdomyolysis. Daptomycin also can cause myopathy and therefore should be used with caution in patients concurrently taking simvastatin. Nausea, tiredness, and headache would not cause the nurse as much concern as the likelihood of myopathy.
A patient who recently started therapy with an HMG-COA reductase inhibitor asks the nurse, “How long will it take until I see an effect on my LDL cholesterol?” The nurse gives which correct answer?
a. “At least 6 months is required to see a change.”
b. “A reduction usually is seen within 2 weeks.”
c. “Blood levels normalize immediately after the drug is started.”
d. “Cholesterol will not be affected, but triglycerides will fall within the first week.”
B
Reductions in LDL cholesterol are significant within 2 weeks and maximal within 4 to 6 weeks. It does not take 6 months too see a change. The blood level of LDL cholesterol is not reduced immediately upon starting the drug; a reduction is seen within 2 weeks. Blood cholesterol is affected, specifically LDL cholesterol, not triglycerides.
A patient taking gemfibrozil (Lopid) and rosuvastatin (Crestor) concurrently begins to complain of muscle aches, fatigue, and weakness. What should the nurse monitor?
a. For tendon tenderness
b. For a lupuslike syndrome
c. The patient’s LFT results
d. The patient’s creatinine kinase levels
D
Creatinine kinase levels are the best laboratory indicator of myopathy and/or rhabdomyolysis, which may lead to renal failure. As can the statins, gemfibrozil and other fibrates can cause myopathy. Fibrates must be used with caution in patients taking statins. Concurrent use of gemfibrozil and rosuvastatin does not cause tendon tenderness or a lupuslike syndrome. Liver function levels should be determined at the start of statin therapy and every 6 months thereafter in patients who do not have liver disease.
A patient presents to the clinic with complaints of muscle aches, muscle pain, and weakness. Upon review of the individual’s medications, the nurse notes that the patient is concurrently taking gemfibrozil (Lopid) and atorvastatin (Lipitor). The nurse should assess the patient for the development of:
a. migraines.
b. hypothyroidism.
c. myopathy.
d. heart failure.
C
When gemfibrozil and a statin are taken concurrently, the risk of myopathy is increased more than with either agent alone. Migraines, hypothyroidism, and heart failure are not drug-to-drug interactions.
A patient has begun taking an HMG-COA reductase inhibitor. Which statement about this class of drugs made by the nurse during patient education would be inappropriate?
a. “Statins reduce the risk of stroke.”
b. “You should come into the clinic for liver enzymes in 1 month.”
c. “Statins reduce the risk of coronary events in people with normal LDL levels.”
d. “You should maintain a healthy lifestyle and avoid high-fat foods.”
B
Baseline liver enzyme tests should be done before a patient starts taking an HMG-COA reductase inhibitor. They should be measured again in 6 to 12 months unless the patient has poor liver function, in which case the tests are indicated every 3 months. Statins do reduce the risk of stroke and coronary events in people with normal LDL levels. Maintaining a healthy lifestyle is important, as is avoiding high-fat foods.
A nurse is instructing a patient receiving a cholesterol-lowering agent. Which information should the nurse include in the patient education?
a. “This medication will replace other interventions you have been trying.”
b. “It is important for you to double your dose if you miss one to maintain therapeutic blood levels.”
c. “Stop taking the medication if you experience constipation.”
d. “You should continue your exercise program to increase your HDL serum levels.”
D
Regular exercise can reduce LDL cholesterol and elevate high-density lipoprotein (HDL) cholesterol, thereby reducing the risk of coronary heart disease (CHD). The patient should consider the cholesterol-lowering drug an adjunct to a proper diet and exercise. Drug therapy cannot replace other important interventions, such as diet and exercise. The patient should never be instructed to double the dose. Constipation is a side effect of most cholesterol-lowering agents. The patient should be encouraged to eat a high-fiber diet and increase fluids if not contraindicated.
An Asian patient comes to the clinic. Upon assessment, the nurse notes a slight yellow tint to the skin and sclera, edema, and hepatomegaly. The drug history reveals that the patient has been taking rosuvastatin (Crestor) for 6 months. The nurse is concerned, because rosuvastatin (Crestor) has been shown to do what?
a. Cause renal and pancreatic toxicity specifically in Asian patients
b. Cause renal failure
c. Create myoglobin in the urine
d. Reach levels twice as high in Asians as in Caucasians, resulting in a greater chance of hepatotoxicity
D
Rosuvastatin reaches abnormally high levels in people of Asian heritage. Consequently, hepatotoxicity may occur more often in Asian patients because of the high level of the drug in the blood. Rosuvastatin does not cause renal or pancreatic toxicity. Rosuvastatin does not cause renal failure. Rosuvastatin does not create myoglobin in the urine.
Lovastatin (Mevacor) is prescribed for a patient for the first time. The nurse should provide the patient with which instruction?
a. “Take lovastatin with your evening meal.”
b. “Take this medicine before breakfast.”
c. “You may take lovastatin without regard to meals.”
d. “Take this medicine on an empty stomach.”
A
Patients should be instructed to take lovastatin with the evening meal. Statins should be taken with the evening meal, not before breakfast. Statins should not be administered without regard to meals and should not be taken on an empty stomach.
A nurse is providing discharge teaching instructions for a patient taking cholestyramine (Questran). Which statement made by the patient demonstrates a need for further teaching?
a. “I will take warfarin (Coumadin) 1 hour before my medicine.”
b. “I will increase the fluids and fiber in my diet.”
c. “I can take cholestyramine with my hydrochlorothiazide.”
d. “I will take digoxin 4 hours after taking the cholestyramine.”
C
Drugs known to form complexes with the sequestrants include thiazide diuretics, such as hydrochlorothiazide, digoxin, warfarin, and some antibiotics. To reduce the formation of sequestrant-drug complexes, oral medication should be administered either 1 hour before the sequestrant or 4 hours after. Further teaching is needed. Warfarin should be taken 1 hour before or 4 hours after cholestyramine. Adverse effects of Questran are limited to the gastrointestinal (GI) tract. Constipation, the principal complaint, can be minimized by increasing dietary fiber and fluids. Digoxin should be taken 1 hour before or 4 hours after cholestyramine.
A nurse is providing patient education about colesevelam (Welchol), a bile acid sequestrant. Which statement made by the patient demonstrates a need for further teaching?
a. “Colesevelam will reduce my levels of low-density lipoprotein.”
b. “Colesevelam will augment my statin drug therapy.”
c. “I will not have to worry about having as many drug interactions as I did when I took cholestyramine.”
d. “I cannot take digoxin while on this medication.”
D
Digoxin can be taken 1 hour before or 4 hours after taking a bile acid sequestrant. Colesevelam reduces the LDL cholesterol level, which is one of its therapeutic uses. Colesevelam augments statin therapy. Colesevelam does not significantly interact with or reduce the absorption of statins, digoxin, warfarin, or most other drugs.
A nurse is reviewing the medications of a patient with diabetes before discharge. The nurse realizes that the patient will be going home on colesevelam, a bile acid sequestrant, and insulin. What patient education should the nurse provide in the discharge teaching for this patient?
a. The patient needs to monitor the blood sugar carefully, because colesevelam can cause hypoglycemia.
b. The patient needs to monitor the blood sugar carefully, because colesevelam can cause hyperglycemia.
c. The patient needs to take the insulin at least 3 hours before the colesevelam.
d. The patient needs to use an oral antidiabetic agent or agents, not insulin, with colesevelam.
A
Colesevelam can help control hyperglycemia in patients with diabetes; therefore, hypoglycemia is a possible risk. Hyperglycemia is not a risk for patients with diabetes who take colesevelam. Insulin and colesevelam do not interact; therefore, the insulin can be taken at the patient’s preferred time or times. Either insulin or oral antidiabetic agents can be taken with colesevelam.
A nurse is reviewing a patient’s medications and realizes that gemfibrozil (Lopid) and warfarin (Coumadin) are to be administered concomitantly. This finding concerns the nurse, who is aware that the _____ will be _____.
a. level of gemfibrozil; increased
b. level of gemfibrozil; reduced
c. anticoagulant effects; increased
d. anticoagulant effects; reduced
C
Gemfibrozil displaces warfarin from the plasma albumin, thereby increasing anticoagulant effects. The level of gemfibrozil will not be increased or decreased. The anticoagulation effects will not be reduced, because free-floating drug is present in the system; the dosage of warfarin may need to be reduced.
During discharge instruction, a nurse wants to assess a patient’s understanding of treatment with cholestyramine (Questran). Which statement made by the patient best demonstrates a need for additional teaching?
a. “I will take cholestyramine (Questran) 1 hour before my other medications.”
b. “I will increase fluids and fiber in my diet.”
c. “I will weigh myself weekly.”
d. “I will have my blood pressure checked weekly.”
C
Patients need not weigh themselves weekly when taking cholestyramine. Cholestyramine should be taken at least 1 hour before other medications. When taken with other medications, cholestyramine can inhibit the absorption of the other drugs. Constipation is the principal complaint with cholestyramine. It can be minimized by increasing dietary fiber and fluids. Regular blood pressure checks are a good idea. The patient is taking cholestyramine because of high cholesterol, which contributes to hypertension.
