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NURS 2042 Exam II Guide With Complete Solution
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NURS 2042 Exam II Guide WithComplete Solution
Artherosclerosis - ANSWER accumulation of fatty deposits on the inner walls
of the arteries and arterioles throughout the body that reduces the blood
supply to vital organs, resulting in strokes, angina pectoris, myocardial
infarction, and peripheral vascular disease.
Cholesterol - ANSWER naturally occurring substance that is essential for
synthesizing the body steroids that are used by the endocrine system, for
synthesizing the bile acids that are needed for food absorption, and for cell
membrane synthesis.
High intensity statin dosages - ANSWER Lowers LDL by over 50%. Includes
Atorvastatin 40-80mg and Rosuvastatin 20-40mg
Moderate intensity statin dosages - ANSWER Lowers LDL by 30-49%.
Includes Atorvastatin 10-20mg, Rosuvastatin 5-10mg, Simvastatin 20-40mg,
Pravastatin 40-80mg, Lovastatin 40mg, Fluvastatin 80mg and Pitavastatin
2-4mg.
Low intensity statin dosages - ANSWER Lowers LDL by under 30%. Includes
Simvastatin 10mg, Pravastatin 10-20mg, Lovastatin 20mg, Fluvastatin
20-40mg and Pitavastatin 1mg.
HMG-CoA Reductase Inhibitor (Statins) MOA - ANSWER The statins
competitively inhibit the enzyme that is responsible for converting HMG-CoA
to mevalonate in the biosynthetic pathway to cholesterol in the liver. The
reduction in liver cholesterol increases the removal of LDLs from the
,circulating blood. Levels of LDL-C may be reduced by as much as 50%. The
statins also cause reductions in VLDL and triglyceride levels (20% to 30%) and
mild increases (5% to 15%) in HDL levels. These agents are more effective if
administered at night because peak production of cholesterol occurs at this
time. Statins also have other beneficial effects unrelated to their
lipid-lowering capacity: they reduce inflammation, platelet aggregation,
thrombin formation, and plasma viscosity, thereby reducing the factors that
contribute to heart attacks and strokes.
HMG-CoA Reductase Inhibitors (Statins) Uses - ANSWER Statins are used in
conjunction with dietary therapy to decrease elevated cholesterol
concentrations in patients with hyperlipidemia and to reduce the risks of
atherosclerosis leading to ASCVD.
Statin Pre-Medication Assessment - ANSWER 1. Serum triglyceride,
lipoprotein, and cholesterol levels should be determined before initiating
therapy, then at 4 to 12 weeks, and then annually after that.
2. Liver function tests (AST, ALT) should be obtained before initiating therapy
and should be measured during therapy if symptoms suggestive of
hepatotoxicity develop, but do not need to be measured routinely. Obtain
data related to any GI alterations before initiating therapy (e.g., presence of
abdominal pain, nausea, or flatus).
3. Confirm that the patient is not pregnant before initiating a statin. Instruct
the female patient to notify her healthcare provider should she contemplate
conception or become pregnant while receiving statin therapy.
Common adverse effects of Statins - ANSWER headache, nausea, bloating
and gas
,Serious adverse effects of Statins - ANSWER Hepatotoxicity, myopathy, and
rhabdomyolysis. Early signs of Rhabdomyolysis is pinkish or red-tinged urine
secondary to myoglobin (muscle protein) passing through damaged
glomeruli into the urine (myoglobinuria).
Statin cultural consideration - ANSWER Chinese patients and those with a
Chinese ancestry should not be treated with doses of simvastatin greater
than 20 mg when also taking niacin. These patients are more susceptible to
developing myopathy. The cause of the increased frequency of myopathy is
unknown.
Bile Acid-Binding Resin MOA - ANSWER After oral administration, the resin
forms a nonabsorbable complex with bile acids, preventing the enterohepatic
recirculation of the bile acids. Removal of bile acids causes liver cells to
compensate by increasing the metabolism of cholesterol to produce more
bile acids, which results in a net reduction in the total cholesterol level. Bile
acid-binding resins can reduce LDL-C levels by 15% to 30% and increase HDL
levels by up to 5%. Some patients also have a 5% to 10% increase in their
triglyceride levels.
Bile Acid-Binding Resin Uses - ANSWER Cholestyramine, colestipol, and
colesevelam are used in conjunction with dietary therapy to decrease
elevated cholesterol concentrations in patients with hyperlipidemia and to
reduce the risks of atherosclerosis leading to ASCVD. These agents may also
be used with statins to lower the LDL-C level even further. They are generally
not used for patients who already have elevated triglyceride levels.
Other uses of the bile acid-binding resins include the treatment of pruritus
secondary to partial biliary stasis, diarrhea secondary to excess fecal bile
acids or pseudomembranous colitis, and digitalis glycoside toxicity.
, Colesevelam has also received US Food and Drug Administration approval for
reducing blood glucose and hemoglobin A1c in adult patients with type 2
diabetes. It may be used alone or in combination with metformin,
sulfonylureas, or insulin. Do not use this drug in patients with type 1
diabetes.
Bile Acid-Binding Resin drugs - ANSWER cholestyramine (Question) and
colesevelam (Welchol)
Bile Acid-Binding Resin Pre-Medication Assessment - ANSWER 1. Serum
triglyceride, lipoprotein, and cholesterol levels should be determined before
the initiation of therapy and periodically thereafter.
2. Obtain patient data related to any GI alterations before the initiation of
therapy (e.g., the presence of abdominal pain, nausea, flatus).
Bile Acid-Binding Resin Notes - ANSWER • The powder resin
(cholestyramine) must be mixed with 2 to 6 ounces of water, juice, soup,
applesauce, or crushed pineapple and should stand for a few minutes to
allow absorption and dispersion. Do not attempt to swallow the dry powder.
Follow administration with an additional glass of water.
• The recommended time of administration is with meals, but this may be
modified to avoid interference with the absorption of other medications.
• Tablets should be swallowed whole; do not crush, chew, or cut them.
Tablets should be taken with liquids.
• Taste may become a reason for noncompliance. Place the powder in a
favorite beverage or opt for tablets to minimize the medication's
objectionable taste.
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