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Drugs Used to Treat Dyslipidemias > Pharmacology
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Showing 16 questions, Sign in for moreA patient is being assessed before a newly ordered antilipemic medication is started. Which condition would be a potential contraindication?
A patient is currently taking a statin. The nurse considers that the patient may have a higher risk for developing rhabdomyolysis when also taking which product?
The medication order reads, “niacin, 500 mg PO, every evening.” The medication is available in 250-mg tablets. How many tablets will the patient receive per dose?
Explanation
Medication safety is paramount in nursing, and a foundational skill is accurate dosage calculation. The ability to correctly convert a prescribed dose into the number of tablets or volume to administer prevents medication errors and ensures therapeutic effectiveness. This specific calculation, where the ordered dose is divided by the available tablet strength, is a routine and critical task in medication administration.
Rationale for correct answer:
Step 1: Identify the Ordered Dose
First, identify the total amount of medication the patient is supposed to receive for a single dose.
- Ordered Dose: 500 mg
Step 2: Identify the Available Medication
Next, identify the strength of each tablet available from the pharmacy.
- Available: 250 mg per tablet
Step 3: Calculate the Number of Tablets
To find out how many tablets are needed for the ordered dose, divide the ordered dose by the strength of each tablet.
- Formula: Number of Tablets = AvailableTabletStrengthOrderedDose​
- Calculation: 250mg500mg​=2tablets
Therefore, the patient will receive 2 tablets for each dose.
Take-home points:
Always check the medication label to confirm the available strength (concentration) of the drug
Dose-to-tablet conversion: based on the available strength:
Formula: TabletstoGive= DoseAvailablePerTablet / DoseOrdered
The nurse is instructing a client on home use of niacin and will include important instructions on how to take the drug and about its possible adverse effects. Which of the following may be expected adverse effects of this drug? Select all that apply
The community health nurse is working with a client taking simvastatin (Zocor). Which client statement may indicate the need for further teaching about this drug?
A client has been on long-term therapy with colestipol (Colestid). To prevent adverse effects related to the length of therapy and lack of nutrients, which of the following supplements may be required? Select all that apply
Which laboratory test value does the nurse realize can contribute to the development of cardiovascular disease and stroke?
A patient is taking lovastatin (Mevacor). Which serum level is most important for the nurse to monitor?
For what severe skeletal muscle adverse reaction should the nurse observe in a patient taking rosuvastatin (Crestor)?
A patient is taking an HMG-CoA reductase inhibitor. Which of the following tests should be performed at the start of therapy and periodically thereafter?
The client is to begin taking atorvastatin (Lipitor) and the nurse is providing education about the drug. Which symptom related to this drug should be reported to the health care provider?
Patient Scenario:
A patient who is moderately overweight and has hypertension was recently informed of a new diagnosis of hyperlipidemia and needs to be started on a statin.
The nurse teaching a patient about lipoproteins created a table to explain the composition of each type. Indicate with an X the typical components of each of the above major types of lipoproteins.
Explanation
Chylomicrons and VLDLs are triglyceride-rich particles, primarily responsible for transporting dietary and endogenous triglycerides to tissues. IDLs and LDLs are more cholesterol-rich and carry cholesterol from the liver to peripheral tissues, with LDL being the main contributor to atherosclerosis. HDLs are protective, containing relatively low triglycerides but high cholesterol, functioning in reverse cholesterol transport to remove excess cholesterol from tissues back to the liver.
Rationale for correct answer:
Chylomicrons: High in triglycerides (>20%) and low in cholesterol, chylomicrons transport dietary fats from the intestines to peripheral tissues. They provide energy for muscles and store fat in adipose tissue, reflecting their role in postprandial lipid transport.
VLDLs: Produced by the liver, VLDLs are also rich in triglycerides and deliver endogenous triglycerides to tissues. As they circulate, they lose triglycerides and are converted into IDLs, linking triglyceride transport with cholesterol metabolism.
IDLs: Intermediate-density lipoproteins are transitional particles between VLDLs and LDLs. They contain more cholesterol than triglycerides and can be further metabolized into LDLs or removed by the liver, playing a role in lipid balance.
LDLs: Low in triglycerides but high in cholesterol, LDLs carry cholesterol to tissues and are considered atherogenic because excess LDL can deposit cholesterol in arterial walls, contributing to plaque formation and cardiovascular disease.
HDLs: Contain low triglycerides and high cholesterol, HDLs help remove excess cholesterol from tissues and transport it back to the liver. They protect against atherosclerosis and cardiovascular disease, reflecting their role as “good cholesterol.”
Take-home points:
• Chylomicrons and VLDLs are triglyceride-rich lipoproteins.
• LDLs are cholesterol-rich and contribute to atherosclerosis; HDLs are protective.
• Understanding lipoprotein composition helps guide treatment and lifestyle interventions for hyperlipidemia.
The nurse discusses with the patient in the scenario that they need to continue with lifestyle modifications in addition to starting on a statin. The nurse suggests which of these approaches to maintain lipid control? Select all that apply
The patient from the scenario who continues on the statin 3 months later has laboratory test results indicating that he still has high lipids and high triglycerides. Which medication would be appropriate to add to the patient’s drug regimen?
The nurse discussed the types of medications used for cholesterol control for the patient in the scenario
who was then concerned about starting on statins. The nurse created a table to help differentiate
between the antilipemic medications available.
Indicate with an X the type of antilipidemic medication that is used for control of cholesterol and the type of antilipidemic medication that is used for control of triglycerides.
Explanation
A patient with hyperlipidemia may require different classes of antilipidemic medications depending on whether LDL cholesterol or triglycerides are elevated. Each class works through distinct mechanisms to either reduce cholesterol production, inhibit absorption, or enhance lipid metabolism.
Rationale for correct answers:
Omega-3 fatty acids: Primarily used to lower triglyceride levels by reducing hepatic production of triglycerides.
Bile acid-binding resins: Bind bile acids in the intestines, leading to increased hepatic conversion of cholesterol to bile acids, effectively lowering LDL cholesterol.
HMG-CoA reductase inhibitors (statins): Inhibit the HMG-CoA reductase enzyme in the liver, reducing cholesterol synthesis and lowering LDL cholesterol.
Fibric acid derivatives: Activate peroxisome proliferator-activated receptors (PPARs) to decrease triglycerides and increase HDL cholesterol.
PCSK9 inhibitors: Monoclonal antibodies that inhibit PCSK9, increasing LDL receptor availability and lowering LDL cholesterol.
Bempedoic acid: Inhibits ATP citrate lyase, reducing cholesterol synthesis and lowering LDL cholesterol.
Ezetimibe: Inhibits intestinal absorption of dietary cholesterol, leading to decreased LDL cholesterol.
- Take-home points:
Different antilipidemic medications target either LDL cholesterol or triglycerides depending on lipid profile. - Statins, bile acid resins, PCSK9 inhibitors, bempedoic acid, and ezetimibe are mainly for LDL cholesterol reduction.
- Omega-3 fatty acids and fibric acid derivatives are primarily used to lower triglycerides.
Choose the most likely option for the information missing from the following sentences by selecting from the list of options provided.
The patient in the scenario was started on
Explanation
The patient in the scenario was started on atorvastatin and then had icosapent added. The mechanism of action of the first drug inhibits the HMG-CoA reductase and the second drug lowers cholesterol by unknown mechanism, respectively.
When managing dyslipidemia, statins such as atorvastatin are first-line therapy due to their ability to inhibit HMG-CoA reductase, the rate-limiting enzyme in cholesterol synthesis, effectively lowering LDL levels. If triglycerides or residual lipid abnormalities persist, icosapent, a prescription omega-3 fatty acid, can be added to further reduce triglyceride levels.
Rationale for correct answer:
Atorvastatin: Atorvastatin is an HMG-CoA reductase inhibitor, reducing cholesterol synthesis in the liver, which lowers LDL cholesterol levels and modestly increases HDL.
Icosapent: Icosapent is an omega-3 fatty acid that lowers triglycerides, though its precise mechanism is not fully defined. It serves as an adjunct for patients who have persistent hypertriglyceridemia despite statin therapy.
Rationales for incorrect answers:
Alirocumab: Alirocumab is a PCSK9 inhibitor, not relevant in this scenario. Its mechanism is to inhibit PCSK9 and increase LDL receptor recycling, lowering LDL cholesterol.
Gemfibrozil: Gemfibrozil is a fibrate that lowers triglycerides but should generally be avoided with statins due to increased risk of myopathy.
Pairing atorvastatin with PCSK9 inhibition or pairing icosapent with cholesterol absorption inhibition would not accurately describe the scenario.
Take-home points:
• Atorvastatin lowers cholesterol by inhibiting HMG-CoA reductase.
• Icosapent lowers triglycerides through mechanisms not fully understood, supplementing statin therapy.
• Combination therapy may be required if statins alone do not achieve lipid targets.
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