Pharm Ch.27 T2

1. When teaching a patient who is beginning antilipemic therapy about possible drug-food interactions, the nurse will discuss which food?

Oatmeal

Grapefruit juice

Licorice

Dairy products

Taking HMG-CoA reductase inhibitors with grapefruit juice may cause complications. Components in grapefruit juice inactivate CYP3A4 in both the liver and intestines. This enzyme plays a key role in statin metabolism. The presence of grapefruit juice in the body may therefore result in sustained levels of unmetabolized statin drug, which increases the risk for major drug toxicity, possibly leading to rhabdomyolysis. The other foods do not interact with these drugs.

Explanation

Taking HMG-CoA reductase inhibitors with grapefruit juice may cause complications. Components in grapefruit juice inactivate CYP3A4 in both the liver and intestines. This enzyme plays a key role in statin metabolism. The presence of grapefruit juice in the body may therefore result in sustained levels of unmetabolized statin drug, which increases the risk for major drug toxicity, possibly leading to rhabdomyolysis. The other foods do not interact with these drugs.

2. While a patient is receiving antilipemic therapy, the nurse knows to monitor the patient closely for the development of which problem?

Neutropenia

Pulmonary problems

Vitamin C deficiency

Liver dysfunction

Antilipemic drugs may adversely affect liver function; therefore, liver function studies need to be closely monitored. The other options do not reflect problems that may occur with antilipemic drugs.

Explanation

Antilipemic drugs may adversely affect liver function; therefore, liver function studies need to be closely monitored. The other options do not reflect problems that may occur with antilipemic drugs.

3. A patient with coronary artery disease asks the nurse about the "good cholesterol" laboratory values. The nurse knows that "good cholesterol" refers to which lipids?

Triglycerides

Low-density lipoproteins (LDLs)

Very-low-density lipoproteins (VLDLs)

High-density lipoproteins (HDLs)

HDLs are responsible for the “recycling” of cholesterol. HDLs are sometimes referred to as the “good” lipid (or good cholesterol) because they are believed to be cardioprotective. LDLs are known as the “bad” cholesterol.

Explanation

HDLs are responsible for the “recycling” of cholesterol. HDLs are sometimes referred to as the “good” lipid (or good cholesterol) because they are believed to be cardioprotective. LDLs are known as the “bad” cholesterol.

4. A patient with elevated lipid levels has a new prescription for nicotinic acid (niacin). The nurse informs the patient that which adverse effects may occur with this medication?

Pruritus, cutaneous flushing

Tinnitus, urine with a burnt odor

Myalgia, fatigue

Blurred vision, headaches

Possible adverse effects of nicotinic acid include pruritus, cutaneous flushing, and gastrointestinal distress. Tinnitus, urine with a burnt odor, and headaches are possible adverse effects of bile acid sequestrants. Headaches are also possible adverse effects of HMG-CoA reductase inhibitors, as are myalgia and fatigue.

Explanation

Possible adverse effects of nicotinic acid include pruritus, cutaneous flushing, and gastrointestinal distress. Tinnitus, urine with a burnt odor, and headaches are possible adverse effects of bile acid sequestrants. Headaches are also possible adverse effects of HMG-CoA reductase inhibitors, as are myalgia and fatigue.

5. The nurse will monitor for myopathy (muscle pain) when a patient is taking which class of antilipemic drugs?

Niacin

HMG-CoA reductase inhibitors

Fibric acid derivatives

Bile acid sequestrants

Myopathy (muscle pain) is a clinically important adverse effect that may occur with HMG-CoA reductase inhibitors. It may progress to a serious condition known as rhabdomyolysis. Patients receiving statin therapy need to be advised to report any unexplained muscular pain or discomfort to their health care providers immediately. The other drugs and drug classes do not cause muscle pain or myopathy.

Explanation

Myopathy (muscle pain) is a clinically important adverse effect that may occur with HMG-CoA reductase inhibitors. It may progress to a serious condition known as rhabdomyolysis. Patients receiving statin therapy need to be advised to report any unexplained muscular pain or discomfort to their health care providers immediately. The other drugs and drug classes do not cause muscle pain or myopathy.

6. The nurse is conducting a class about antilipemic drugs. The antilipemic drug ezetimibe (Zetia) works by which mechanism?

Inhibiting HMG-CoA reductase

Preventing resorption of bile acids from the small intestines

Activating lipase, which breaks down cholesterol

Inhibiting cholesterol absorption in the small intestine

Ezetimibe selectively inhibits absorption in the small intestine of cholesterol and related sterols. The other options are incorrect.

Explanation

Ezetimibe selectively inhibits absorption in the small intestine of cholesterol and related sterols. The other options are incorrect.

7. A patient who has recently started therapy on a statin drug asks the nurse how long it will take until he sees an effect on his serum cholesterol. Which statement would be the nurse's best response?

“Blood levels return to normal within a week of beginning therapy.”

“It takes 6 to 8 weeks to see a change in cholesterol levels.”

“It takes at least 6 months to see a change in cholesterol levels.”

“You will need to take this medication for almost a year to see significant results.”

The maximum extent to which lipid levels are lowered may not occur until 6 to 8 weeks after the start of therapy. The other responses are incorrect.

Explanation

The maximum extent to which lipid levels are lowered may not occur until 6 to 8 weeks after the start of therapy. The other responses are incorrect.

8. A patient reports having adverse effects with nicotinic acid (niacin). The nurse can suggest performing which action to minimize these undesirable effects?

Take the drug on an empty stomach.

Take the medication every other day until the effects subside.

Take an aspirin tablet 30 minutes before taking the drug.

Take the drug with large amounts of fiber.

The undesirable effects of nicotinic acid can be minimized by starting with a low initial dose, taking the drug with meals, and taking small doses of aspirin with the drug to minimize cutaneous flushing. Fiber intake has no effect on niacin’s adverse effects, and it is not within the nurse’s scope of practice to suggest a change of medication dosage.

Explanation

The undesirable effects of nicotinic acid can be minimized by starting with a low initial dose, taking the drug with meals, and taking small doses of aspirin with the drug to minimize cutaneous flushing. Fiber intake has no effect on niacin’s adverse effects, and it is not within the nurse’s scope of practice to suggest a change of medication dosage.

9. A patient tells the nurse that he likes to eat large amounts of garlic "to help lower his cholesterol levels naturally." The nurse reviews his medication history and notes that which drug has a potential interaction with the garlic?

Acetaminophen (Tylenol)

Warfarin (Coumadin)

Digoxin (Lanoxin)

Phenytoin (Dilantin)

When using garlic, it is recommended to avoid any other drugs that may interfere with platelet and clotting function. These drugs include antiplatelet drugs, anticoagulants, nonsteroidal anti-inflammatory drugs, and aspirin. The other drugs listed do not have known interactions with garlic.

Explanation

When using garlic, it is recommended to avoid any other drugs that may interfere with platelet and clotting function. These drugs include antiplatelet drugs, anticoagulants, nonsteroidal anti-inflammatory drugs, and aspirin. The other drugs listed do not have known interactions with garlic.

10. A patient calls the clinic office saying that the cholestyramine (Questran) powder he started yesterday clumps and sticks to the glass when he tries to mix it. The nurse will suggest what method for mixing this medication for administration?

Mix the powder in a carbonated soda drink to dissolve it faster.

Add the powder to any liquid, and stir vigorously to dissolve it quickly.

Mix the powder with food or fruit, or at least 4 to 6 ounces of fluid.

Sprinkle the powder into a spoon and take it dry, followed by a glass of water.

Mix the powder with food or at least 4 to 6 ounces of fluid. The powder may not mix completely at first, but patients should be sure to mix the dose as much as possible and then dilute any undissolved portion with additional fluid. The powder should be dissolved for at least 1 full minute. Powder and granule dosages are never to be taken in dry form.

Explanation

Mix the powder with food or at least 4 to 6 ounces of fluid. The powder may not mix completely at first, but patients should be sure to mix the dose as much as possible and then dilute any undissolved portion with additional fluid. The powder should be dissolved for at least 1 full minute. Powder and granule dosages are never to be taken in dry form.

11. A patient is concerned about the adverse effects of the fibric acid derivative she is taking to lower her cholesterol level. Which is an adverse effect of this class of medication?

Constipation

Diarrhea

Joint pain

Dry mouth

Fibric acid derivatives may cause nausea, vomiting, diarrhea, drowsiness, and dizziness. Other effects are listed in Table 27-8. The other options are not adverse effects of fibric acid derivatives.

Explanation

Fibric acid derivatives may cause nausea, vomiting, diarrhea, drowsiness, and dizziness. Other effects are listed in Table 27-8. The other options are not adverse effects of fibric acid derivatives.

12. Antilipemic drug therapy is prescribed for a patient, and the nurse is providing instructions to the patient about the medication. Which instructions will the nurse include? (Select all that apply.)

Limit fluid intake to prevent fluid overload.

Eat extra servings of raw vegetables and fruit.

Report abnormal or unusual bleeding or yellow discoloration of the skin.

Report the occurrence of muscle pain immediately.

Drug interactions are rare with antilipemics.

Take the drug 1 hour before or 2 hours after meals to maximize absorption.

Instructions need to include preventing constipation by encouraging a diet that is plentiful in raw vegetables, fruit, and bran. Forcing fluids (up to 3000 mL/day unless contraindicated) may also help to prevent constipation. Notify the prescriber if there are any new or troublesome symptoms, abnormal or unusual bleeding, yellow discoloration of the skin, or muscle pain. These drugs are highly protein bound; therefore, they interact with many drugs. Taking these drugs with food may help to reduce gastrointestinal distress.

Explanation

Instructions need to include preventing constipation by encouraging a diet that is plentiful in raw vegetables, fruit, and bran. Forcing fluids (up to 3000 mL/day unless contraindicated) may also help to prevent constipation. Notify the prescriber if there are any new or troublesome symptoms, abnormal or unusual bleeding, yellow discoloration of the skin, or muscle pain. These drugs are highly protein bound; therefore, they interact with many drugs. Taking these drugs with food may help to reduce gastrointestinal distress.

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Pharm Ch.27 T2

1. When teaching a patient who is beginning antilipemic therapy about possible drug-food interactions, the nurse will discuss which food?

2.

What first name or nickname would you like us to use?

2. While a patient is receiving antilipemic therapy, the nurse knows to monitor the patient closely for the development of which problem?

3. A patient with coronary artery disease asks the nurse about the "good cholesterol" laboratory values. The nurse knows that "good cholesterol" refers to which lipids?

4. A patient with elevated lipid levels has a new prescription for nicotinic acid (niacin). The nurse informs the patient that which adverse effects may occur with this medication?

5. The nurse will monitor for myopathy (muscle pain) when a patient is taking which class of antilipemic drugs?

6. The nurse is conducting a class about antilipemic drugs. The antilipemic drug ezetimibe (Zetia) works by which mechanism?

7. A patient who has recently started therapy on a statin drug asks the nurse how long it will take until he sees an effect on his serum cholesterol. Which statement would be the nurse's best response?

8. A patient reports having adverse effects with nicotinic acid (niacin). The nurse can suggest performing which action to minimize these undesirable effects?

9. A patient tells the nurse that he likes to eat large amounts of garlic "to help lower his cholesterol levels naturally." The nurse reviews his medication history and notes that which drug has a potential interaction with the garlic?

10. A patient calls the clinic office saying that the cholestyramine (Questran) powder he started yesterday clumps and sticks to the glass when he tries to mix it. The nurse will suggest what method for mixing this medication for administration?

11. A patient is concerned about the adverse effects of the fibric acid derivative she is taking to lower her cholesterol level. Which is an adverse effect of this class of medication?

12. Antilipemic drug therapy is prescribed for a patient, and the nurse is providing instructions to the patient about the medication. Which instructions will the nurse include? (Select all that apply.)