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Exam (elaborations) NURS 271 (NURS271) NURS 271 - Exam 1 Study Guide.
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Exam (elaborations) NURS 271 (NURS271) NURS 271 - Exam 1 Study Guide.
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NURS 271 Exam 1 Study GuideModule Chapter Areas of Focus
Module 1 10 ● Dyslipidemia: abnormal lipid levels in the blood; associated
with atherosclerosis and its many pathophysiological effects
17 questions (e.g.myocardial ischemia and infarction, stroke, peripheral
arterial occlusive disease)
○ Overview including testing for dyslipidemia and Metabolic
syndrome
■ Metabolic syndrome: a group of cardiovascular risk
factors linked with obesity
● Central adiposity (increased waist
circumference)
● Elevated triglycerides
● Reduced HDL cholesterol
● Elevated BP
● Elevated fasting glucose
■ Screening
● Universal lipid screening should begin between
9-11
● In the absence of of risk factors, middle aged
adults should be screened for dyslipidemia at
least every 1-2 years
■ Desirable Levels
● Total serum cholesterol: <200
● LDL: <130
● HDL: 40 or above
● Triglycerides: <150
■ Borderline Levels
● Total serum cholesterol: 200-239
● LDL: 130-159
● Triglycerides: 150-199
■ Undesirable Levels
● Total serum cholesterol: 240 or above
● LDL: 160 or above
● HDL <40
● Triglycerides: 200 or above
○ Drug classifications to treat (Statins, Bile Acid Sequestrants,
Fibrates, Niacin)
○ HMG-CoA Reductase Inhibitors (Statins): Atorvastatin
(Liptior)
■ MAO: inhibit HMG-CoA enzyme required for
hepatic synthesis of cholesterol
■ Uses: treatment of hypercholesterolemia and
reducing cardiovascular events in people with
multiple risk factors
● Most powerful drug class for reduction of LDL
cholesterol
● Result in an 18-55% decrease in LDL levels as
1
, well as 5-15% increase in HDL levels and a 7-
30% decrease in triglycerides
■ Adverse effects and contraindications: usually well
tolerated; most common effects include nausea,
constipation, diarrhea, abdominal cramps or pain,
headache, skin rash; myopathies
■ Administration specifics: take in the evening or at
bedtime because the bulk of cholesterol synthesis
appears to occur at night; no grapefruit juice
■ QSEN Alerts and BBWs: Risk of teratogenicity
appears to be relatively small, but use of birth control
measures when taking statins is essential in sexually
active women; Potential benefits of using the drug
must outweigh the risks in pregnant women;
Adequate patient education is critical to minimize
complications associated with pregnancy
○ Bile Acid Sequestrants: Cholestyramine (Prevalite,
Questran)
■ MAO: binds bile acids in the intestinal lumen,
causing the bile acids to be excreted in feces,
preventing recirculation to the liver
■ Uses: reduced LDL cholesterol levels (15-30%) and
also produced minimal elevation in HDL cholesterol
(3-5%)
■ Adverse Effects: abdominal fullness, flatulence,
diarrhea, constipation
■ Administration specifics: it is necessary to mix
cholestyramine powder with water or other fluids; do
not take in dry form; LDL cholesterol levels will
return to original levels within a month
○ Fibrates: Fenofibrate (TriCor)
■ MAO: increase the oxidation of fatty acids in liver
and muscle tissue; decrease hepatic production of
triglycerides, decrease LDL cholesterol and increase
HDL cholesterol
■ Uses: most effective drug for reducing serum
triglyceride values, and their main indication for use
is high serum triglycerides (greater than 500 mg/dL);
they may also result in a 20-50% decreased in
triglyceride levels; also helpful for patient with low
HDL cholesterol (10-20% increase)
■ Adverse Effects: GI discomfort, diarrhea, increased
cholesterol concentration in the biliary tract and
formation of gallstones
■ Administration specifics: give with food to increase
drug absorption
○ Niacin (nicotinic acid)
■ MAO: inhibits mobilization of free fatty acids from
peripheral tissues, thereby reducing hepatic synthesis
of triglycerides and secretion of VLDL, which leads
2
, to decreased production of LDL cholesterol (5-35%
decrease); raises HDL levels by reducing lipid
transfer of cholesterol from HDL or VLDL and
delaying clearance of HDL (30-35% increase)
■ Uses: most effective drug for increasing
concentration of HDL cholesterol, is most helpful in
preventing heart disease when used in combination
with another dyslipidemic drug such as a bile acid
sequestrant or fibrate
■ Adverse Effects: poor tolerability; skin flushing,
pruritus, gastric irritation, tachycardia, hypotension,
dizziness, hyperglycemia, hyperuricemia, elevated
liver aminotransferases and hepatitis
■ Administration specifics: give immediate release
niacin with meals to prevent gastric irritation
26 ● Overview of nonpharmacologic management of hypertension
○ Initial intervention, often referred to as “first-line
treatment”, include lifestyle modifications like weight loss
and reduction of sodium intake, regular physical activity,
moderate alcohol intake, and cessation of smoking to
maintain normal BP
■ DASH: Dietary Approaches to Stop Hypertension
states that diets that consist of fresh fruits and
veggies and low-fat dairy products can reduce
hypertension
■ Sodium intake should be moderately restricted
● Sodium restriction alone reduces BP
● Sodium restriction potentiates the
antihypertensive actions of diuretics and other
antihypertensive meds. Conversely, excessive
sodium intake decreases the antihypertensive
actions of all antihypertensive drugs.
○ Patients with unrestricted salt intake
who are taking thiazides may lose
excessive potassium and become
hypokalemic
● Sodium restriction may decrease dosage
requirements of antihypertensive drugs,
thereby decreasing the incidence and severity
of adverse effects
○ If lifestyle modifications alone do not produce the target BP
or substantial progress toward that target BP, it is then that
antihypertensive drugs are introduced while also continuing
lifestyle modifications
● Medications used to treat hypertension (ACE inhibitors,
Angiotensin II Receptor Blockers, Calcium Channel Blockers)
○ Captopril (Capoten) - ACE inhibitor
■ MAO (expected actions and therapeutic effects)
3
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