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Chapter 21: Lipid-Lowering Drugs
10 problems · 0 figures21-1 §21.RQ source ↗
A nurse is explaining a client’s lipid panel results. Which statement by the client indicates a need for further teaching?
- a.“LDL-cholesterol is ‘bad cholesterol.’”
- b.“Medications can be used to increase my triglyceride levels.”
- c.“HDL-cholesterol is ‘good cholesterol.’”
- d.“Medications can decrease my cholesterol levels.”
Answer
B. “Medications can be used to increase my triglyceride levels.”
Medications can be used to decrease cholesterol levels but are not intended to increase triglyceride levels.
21-2 §21.RQ source ↗
A nurse is explaining administration instructions for a client who is starting alirocumab, a PCSK9 inhibitor. Which statement will the nurse include in the instructions?
- a.It can be taken orally at bedtime.
- b.It is self-administered as a subcutaneous injection by the client.
- c.It is administered as a subcutaneous injection by a health care professional.
- d.It comes in a powder form that must be mixed with liquid before taking.
Answer
B. It is self-administered as a subcutaneous injection by the client.
Alirocumab is a monoclonal antibody that is self-administered by the client.
21-3 §21.RQ source ↗
A client began treatment for severe hypertriglyceridemia and goes to the clinic for follow-up. Which medication does the nurse expect to find on the client’s home medication list?
- a.Ezetimibe
- b.Cholestyramine
- c.Colesevelam
- d.Fenofibrate
Answer
D. Fenofibrate
Fenofibrate is indicated to treat hypertriglyceridemia. Fibrates stimulate lipoprotein lipase to break down triglycerides.
21-4 §21.RQ source ↗
A client calls the nurse because they experienced intolerable flushing after taking over-the-counter niacin. Which intervention might the nurse recommend?
- a.Take flush-free niacin.
- b.Switch to immediate-release niacin.
- c.Take aspirin 30 minutes before taking niacin.
- d.Take niacin with an alcoholic beverage.
Answer
C. Take aspirin 30 minutes before taking niacin.
Flushing can be mitigated by taking an NSAID 30 minutes before taking niacin or by switching to an extended-release product.
21-5 §21.RQ source ↗
A nurse is evaluating a follow-up lipid panel in a client who recently began taking ezetimibe. Which of the following changes would the nurse expect to see?
- a.Decreased HDL-cholesterol level
- b.Decreased LDL-cholesterol level
- c.Increased triglyceride level
- d.Increased VLDL level
Answer
B. Decreased LDL-cholesterol level
The therapeutic effect of ezetimibe is that of lowering LDL-cholesterol via decreased cholesterol absorption.
21-6 §21.RQ source ↗
A nurse educator is training new nurses on the cardiac step-down unit about medications administered on the unit. Which statement indicates understanding of the drug cholestyramine?
- a.It can cause diarrhea as the major adverse effect.
- b.It should be taken in the morning when cholesterol synthesis is highest.
- c.It is available as an oral powder that must be mixed with fluid before taking.
- d.It works primarily to lower triglyceride levels in clients with hypertriglyceridemia.
Answer
C. It is available as an oral powder that must be mixed with fluid before taking.
Cholestyramine is a bile acid sequestrant available as a powder. It must be mixed with fluid prior to administration.
21-7 §21.RQ source ↗
A client is admitted to the cardiac unit after undergoing stent placement after an acute myocardial infarction. The provider states that the client will need high-intensity statin therapy. Which medication does the nurse expect to be ordered for the client?
- a.Simvastatin
- b.Pravastatin
- c.Rosuvastatin
- d.Fluvastatin
Answer
C. Rosuvastatin
Rosuvastatin at a dose of 20–40 mg daily is considered a high-intensity statin medication.
21-8 §21.RQ source ↗
Which of the following statements is true about pravastatin?
- a.It is considered a hydrophilic statin, which means it may confer a lower risk of myalgia compared with other statins.
- b.The FDA has issued a statement that doses of 80 mg are no longer appropriate due to myalgia risk.
- c.It is metabolized by CYP3A4 and is subject to many drug interactions.
- d.It is considered a high-intensity statin.
Answer
A. It is considered a hydrophilic statin, which means it may confer a lower risk of myalgia compared with other statins.
Pravastatin is considered a hydrophilic statin. It can less easily enter the muscle, which may confer a lower risk of myalgia.
21-9 §21.RQ source ↗
A client with a past medical history of CAD has been taking rosuvastatin 40 mg orally daily for 1 month and has a follow-up LDL-cholesterol level of 135 mg/dL, which exceeds their goal LDL-cholesterol level of 70 mg/dL. Which would be an appropriate next step for the client?
- a.Add gemfibrozil for combination therapy.
- b.Change administration to bedtime rather than morning.
- c.Change to pravastatin 80 mg orally daily.
- d.Add ezetimibe for combination therapy.
Answer
D. Add ezetimibe for combination therapy.
Ezetimibe is an appropriate combination therapy with statin medications. Gemfibrozil is contraindicated for use with rosuvastatin. Rosuvastatin does not need to be taken at bedtime because it has a long half-life.
21-10 §21.RQ source ↗
A client is taking atorvastatin. Which severe adverse drug reaction should the client be monitored for?
- a.Rhabdomyolysis
- b.Stroke
- c.Severe constipation
- d.Myocardial infarction
Answer
A. Rhabdomyolysis
This drug may cause severe myopathy, which can lead to rhabdomyolysis.
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Problems and answers are adapted from Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris and Dorie Weaver, OpenStax, and are used under the CC BY-NC-SA 4.0 licence. Access for free at https://openstax.org/books/pharmacology/pages/1-introduction. Illustrations: Copyright Rice University, OpenStax, under CC BY-NC-SA 4.0 license. This adaptation is released under the same licence, is non-commercial, and is neither affiliated with nor endorsed by OpenStax or Rice University.