Review Practice Excercise 5

Drugs Used to Treat Dyslipidemias > Pharmacology

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Practice Excercise 5

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Total Questions : 3

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Question 1:

A nurse is caring for a client who is starting niacin (Niaspan) to reduce cholesterol. The nurse should monitor the client for which of the following adverse effects? Select all that apply

A. Muscle aches B. Hyperglycemia C. Hearing loss D. Flushing of the skin E. Jaundice

Answer and Explanation

Choice A:

Muscle aches:Muscle pain and myopathy are associated with statins, especially when combined with fibrates, but they are not a typical adverse effect of niacin therapy.

Choice B:

Hyperglycemia:Niacin can impair glucose tolerance and raise blood sugar levels. Clients with diabetes require close monitoring of blood glucose while taking this drug, as adjustments to therapy may be necessary.

Choice C:

Hearing loss:Niacin is not linked to ototoxicity. Hearing loss is a potential effect of drugs like aminoglycoside antibiotics, not lipid-lowering agents like niacin.

Choice D:

Flushing of the skin:Skin flushing, warmth, or itching is a common and well-documented side effect caused by prostaglandin-mediated vasodilation. This can be minimized by taking aspirin 30 minutes before niacin or using extended-release formulations.

Choice E:

Jaundice:Niacin carries a risk of hepatotoxicity. Jaundice, dark urine, and right upper quadrant pain may be signs of liver injury. Clients require baseline and periodic liver function tests.Rationales for incorrect answers:

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Question 2:

A nurse administering niacin would implement which action to help to reduce adverse effects?

A. Give the medication with grapefruit juice. B. Administer a small dose of aspirin or an NSAID 30 minutes before the niacin dose. C. Administer the medication on an empty stomach. D. Have the patient increase dietary fiber intake.

Answer and Explanation

Choice A:

Give the medication with grapefruit juice.This is incorrect because grapefruit juice interacts with many lipid-lowering drugs (especially statins) and may increase drug toxicity. It is not used to reduce flushing associated with niacin.

Choice B:

Administer a small dose of aspirin or an NSAID 30 minutes before the niacin dose.Pretreating with a low-dose aspirin (e.g., 325 mg) or an NSAID helps reduce niacin-induced prostaglandin-mediated flushing and discomfort. This is a well-established nursing action that allows patients to better tolerate niacin therapy and continue with treatment.Rationales for incorrect answers:

Choice C:

Administer the medication on an empty stomach.Taking niacin on an empty stomach worsens gastrointestinal irritation, which is a common adverse effect. Niacin should be taken with food to minimize nausea, vomiting, and abdominal discomfort.

Choice D:

Have the patient increase dietary fiber intake.While fiber is generally recommended for cholesterol management, it does not prevent niacin’s flushing reaction. This action would not address the adverse effect in question.

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Question 3:

In administering niacin, the nurse must monitor for which adverse effects? Select all that apply

A. Flushing of the skin B. Muscle pain C. Pruritus D. Headache E. Priapism F. GI upset

Answer and Explanation

Choice A:

Flushing of the skinThis is the hallmark side effect of niacin. It occurs due to prostaglandin-mediated vasodilation and presents as redness, warmth, and tingling.

Choice B:

Muscle painWhile more characteristic of statins, muscle aches and myopathy can occur when niacin is combined with statins, so monitoring is important. Severe muscle pain may indicate rhabdomyolysis, a rare but serious complication.

Choice C:

PruritusItching often accompanies flushing due to vasodilation and histamine release. This is a frequent and bothersome side effect.

Choice D:

HeadacheVasodilation triggered by niacin can also result in headaches. While not dangerous, it is uncomfortable and may affect adherence.

Choice E:

PriapismPriapism is not associated with niacin therapy. It is unrelated to niacin’s mechanism or side effect profile.

Choice F:

GI upsetNausea, vomiting, dyspepsia, and abdominal pain are common. Taking niacin with food can help minimize these gastrointestinal adverse effects.Rationale for incorrect answer:

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Practice Excercise 5

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