Question 1

What should you teach a woman of childbearing age who is prescribed a statin drug?

Accepted Answer

Statin drugs have a high likelihood of increasing the risk for birth defects or fetal damage.They should not be taken by women who plan to become pregnant,are pregnant,or are breastfeeding.These drugs decrease the amount of fat in the body.Fat is essential to brain development in the fetus and infant.When there is not enough fat in the body during pregnancy and infancy,the results can be poor brain development and mental retardation.

Question 2

A patient is prescribed Cozaar (losartan)25 mg orally for hyperlipidemia.What is your best action?

Accepted Answer

An order for Zocor (simvastatin)may be confused with Cozaar (losartan).Zocor is a lipid-lowering statin,whereas Cozaar is a blood pressure-lowering angiotensin II receptor antagonist.

Question 3

A patient is prescribed niacin (Niaspan)500 mg orally.The pharmacy sends niacin (Niacor)500 mg.What is your best action?

Accepted Answer

Niaspan is an extended-release form of niacin that is taken once a day.Niacor is an immediate-release form of niacin.Immediate-release niacin should not be substituted for extended-release niacin.Additionally,extended-release niacin should be swallowed whole and never crushed or chewed because this causes immediate release of the entire drug dose and could lead to overdose.

Question 4

What action must you take for a diabetic patient who is prescribed niacin (Niacor)?

Accepted Answer

Niacin may increase blood glucose levels.You would check the patient's blood glucose level more often.Doses of drugs used to control blood glucose may need to be increased.

Question 5

For which patient is drug therapy with nicotinic acid contraindicated?

Accepted Answer

Nicotinic acid-based drugs dilate blood vessels and potentiate bleeding.Patients with any condition that includes active bleeding,such as a duodenal ulcer,should not be prescribed nicotinic acid.

Question 6

A patient who is prescribed cholestyramine (Questran)tablets reports experiencing bloating,nausea,and gas.What is your best action?

Accepted Answer

GI symptoms including constipation,bloating,nausea,vomiting,and gas are common side effects of bile acid sequestrants such as cholestyramine.The drug should not be held.You should teach the patient to take the tablet form of this drug with at least 12 to 16 ounces of water to prevent stomach and intestinal problems such as bowel obstruction.Administering the drug with meals can help to decrease GI symptoms and aid their action,which is to bind with cholesterol in the intestines.

Question 7

Which health problems should you teach a patient can be caused by chronic hyperlipidemia? (select all that apply)

Accepted Answer

Chronic hyperlipidemia contributes to development of narrowed arteries.It can cause health problems including atherosclerosis,coronary artery disease (angina,heart attack),hypertension,pancreatitis,peripheral vascular disease,stroke,and xanthomas (skin atheromas or abnormal fat deposits).

Question 8

A patient is prescribed cholestyramine (Questran)is also taking warfarin (Coumadin).For which specific action should you be prepared?

Accepted Answer

Bile acid sequestrants inhibit absorption of fat-soluble vitamins (A,D,E,and K),so patients may need to take a daily vitamin supplement.Bile acid sequestrants may change the action of the anticoagulant warfarin (Coumadin)in two ways.They can decrease the absorption of vitamin K which would intensify (increase)the effects of warfarin and increase the risk of bleeding.If administering a bile acid sequestrant to a patient who is also taking warfarin,be prepared to administer vitamin K,which is the antidote for warfarin.Bile acid sequestrants can also directly bind warfarin in the intestinal tract and cause its rapid elimination.

Question 9

A patient who is prescribed niacin (Niacor)reports experiencing flushing and hot flashes.What is your best action?

Accepted Answer

Flushing (redness)and hot flashes can be reduced by the use of aspirin or an NSAID 30 minutes before the niacin,or by giving the niacin during or after meals.While reassuring the patient that flushing and hot flashes are expected side effects is correct,it does not address the patient's discomfort.

Question 10

Why should the use of cholestyramine (Questran)and colestipol (Colestid)be avoided in children?

Accepted Answer

Cholestyramine (Questran)and colestipol (Colestid)should be avoided in children because they can cause intestinal obstructions.

Question 11

A patient prescribed ezetimibe (Zetia)has developed swelling around the eyes,nose,and lips.What is your priority action at this time?

Accepted Answer

Swelling under the skin,usually around the eyes,nose,and lips are symptoms of angioedema,a rare adverse effect of ezetimibe.It is caused by blood vessel dilation and may be life threatening when it affects the airways.

Question 12

Which statement made by a patient who has been prescribed simvastatin (Zocor)indicates the need for more teaching?

Accepted Answer

Statin drugs can help control LDL cholesterol levels but do not cure hyperlipidemia.For some people,lifestyle changes and reduced intake of cholesterol and saturated fats can lower cholesterol levels;however,no one is considered cured of hyperlipidemia based on a single test of blood cholesterol level.The fact that this patient's LDL cholesterol is in the normal range is likely a response to the drug.Continuing to have a normal LDL level is most likely to require continued therapy with simvastatin.

Question 13

Which laboratory blood value is most important for you to monitor when a patient is prescribed both colestipol (Colestid)and warfarin (Coumadin)?

Accepted Answer

Colestipol can change the action of the anticoagulant warfarin in two ways.It can decrease the absorption of vitamin K,which would intensify the effects of warfarin and increase the risk for bleeding (as evidenced by a high INR).Bile acid sequestrants can also directly bind warfarin in the intestinal tract and cause its rapid elimination.This action would inactivate warfarin activity and increase the risk for clot formation (as evidenced by an INR level that is lower than the therapeutic range).Although all of the above laboratory blood values can help diagnose a bleeding problem,the most sensitive test is the INR.

Question 14

A hospitalized patient who is prescribed lovastatin (Mevacor)80 mg orally looks at the four tablets you provides and says,"At home,I only take two pills for 80 mg.I think this is too many pills." What is your best action?

Accepted Answer

There are many different dosage strengths for this drug,including both 20 and 40 mg tablets.The patient is right to question a dose that seems different from what is taken at home.You know that the drug available on the hospital unit is available as lovastatin 20 mg tablets and should reassure the patient by explaining the differences in tablet content.If further evidence is needed to completely reassure the patient,you can provide the drug container.

Question 15

A patient is prescribed colesevelam (WelChol)1875 mg twice a day.Available tablets are 625 mg each.How many tablets should you administer to the patient for each dose?

Accepted Answer

Need 1875 mg/X tablets,Have 625 mg/1 tablets.1875/625 = 3 tablets.

Question 16

Why should you ask a patient prescribed a "statin" drug for hyperlipidemia about his or her daily alcohol consumption?

Accepted Answer

Ask patients about their alcohol consumption.Statin drugs can damage the liver.Statins should not be given to patients who consume more than two alcoholic drinks per day because drinking alcohol puts even more stress on the liver.

Question 17

A patient who has been taking niacin (Niacor)daily for 1 week reports intense itching.What is your best response?

Accepted Answer

Niacin causes a mild systemic inflammatory response with vasodilation that can result in the sensation of itching.This is not an allergy but can be very distressing to the patient.Often,taking aspirin reduces the inflammatory response and eliminates the itchiness.If the patient has no other health problems that would be worsened by aspirin,this should be tried first.

Question 18

Which food,drink,or herbal supplement should you warn a patient prescribed gemfibrozil (Lopid)to avoid?

Accepted Answer

The metabolism of gemfibrozil is affected by grapefruit and grapefruit juice to the extent that the drug's activity is reduced.If possible,patients should avoid grapefruit juice completely,or at least,patients should not take gemfibrozil with grapefruit juice.

Question 19

Why do the most common side effects of any bile acid sequestrant include bloating,abdominal discomfort,and constipation?

Accepted Answer

Bile acid sequestrants are taken by mouth and work directly on dietary fats in the intestinal tract.They bind with cholesterol in the intestine,preventing fats from being absorbed into the blood.This action then eliminates the cholesterol from the body through the stool and is also likely to change the general activity of the intestinal tract,leading to intestinal side effects.

Question 20

A patient prescribed niacin extended action (Niaspan)reports all of the following new onset problems.For which problem should you notify the prescriber?

Accepted Answer

One adverse reaction to niacin is an increase in uric acid crystals and calcium that can precipitate in joints and cause gout.The great toe is one of the most common sites of gout.The condition is painful and reduces mobility.Usually,the patient can continue the niacin therapy along with another drug that reduces uric acid production.Teach the patient that drinking plenty of water can help reduce the precipitation of uric acid.

Quiz 19: Drug Therapy for High Blood Lipids

What should you teach a woman of childbearing age who is prescribed a statin drug?

A patient is prescribed Cozaar (losartan) 25 mg orally for hyperlipidemia.What is your best action?

A patient is prescribed niacin (Niaspan) 500 mg orally.The pharmacy sends niacin (Niacor) 500 mg.What is your best action?

What action must you take for a diabetic patient who is prescribed niacin (Niacor) ?

For which patient is drug therapy with nicotinic acid contraindicated?

A patient who is prescribed cholestyramine (Questran) tablets reports experiencing bloating,nausea,and gas.What is your best action?

Which health problems should you teach a patient can be caused by chronic hyperlipidemia? (select all that apply)

A patient is prescribed cholestyramine (Questran) is also taking warfarin (Coumadin) .For which specific action should you be prepared?

A patient who is prescribed niacin (Niacor) reports experiencing flushing and hot flashes.What is your best action?

Why should the use of cholestyramine (Questran) and colestipol (Colestid) be avoided in children?

A patient prescribed ezetimibe (Zetia) has developed swelling around the eyes,nose,and lips.What is your priority action at this time?

Which statement made by a patient who has been prescribed simvastatin (Zocor) indicates the need for more teaching?

Which laboratory blood value is most important for you to monitor when a patient is prescribed both colestipol (Colestid) and warfarin (Coumadin) ?

A hospitalized patient who is prescribed lovastatin (Mevacor) 80 mg orally looks at the four tablets you provides and says,"At home,I only take two pills for 80 mg.I think this is too many pills." What is your best action?

A patient is prescribed colesevelam (WelChol) 1875 mg twice a day.Available tablets are 625 mg each.How many tablets should you administer to the patient for each dose?

Why should you ask a patient prescribed a "statin" drug for hyperlipidemia about his or her daily alcohol consumption?

A patient who has been taking niacin (Niacor) daily for 1 week reports intense itching.What is your best response?

Which food,drink,or herbal supplement should you warn a patient prescribed gemfibrozil (Lopid) to avoid?

Why do the most common side effects of any bile acid sequestrant include bloating,abdominal discomfort,and constipation?

A patient prescribed niacin extended action (Niaspan) reports all of the following new onset problems.For which problem should you notify the prescriber?