NURS 323 Final Exam Review Study Guide
,.. ,.. ,.. ,.. ,.. ,..
| Comprehensive Nursing Practice Questi
,.. ,.. ,.. ,.. ,..
ons and Course Preparation Resource
,.. ,.. ,.. ,..
10,..%,..Old,..stuff.,..Majority,..on,..stuff,..from,..Quiz,..2.
Lipid,..Drugs
General, . . info/teaching
2,..question
s
Take ,..statins,..at,..night,,..monitor,..liver,..enzymes,,..avoid,..grapefruit
Statins
1,..question
s ● Statins
○ MOA
■ lower,..cholesterol,..levels,..in,..the,..blood,..by,..blocking,..cholesterol,..production,..in,..the
,..liver
■ slows,..down,..the,..production,..of,..LDL,..in,..the,..liver,.. ,..INHIBIT,..HM
GCOA,..REDUCTASE
○ Atorvastatin,..(lipitor)
■ Highly,..effective,..and,..most,..prescribed,..class,..of,..antilipid,..agents
■ Increases,..HDL,..(good,..one)
■ Decreases,..LDL,..(bad,..one)
■ Take,..at,..night,..→,..this,..is,..when,..your,..body,..makes,..the,..
most,..cholesterol
○ Other,..statins:,..lovastatin,,..rosuvastatin,..(reduce,..dosage,..if,..Asian,..herita
ge),,..simvastatin,,..fluvastatin,,..pravastatin
○ ADRs
■ Elevated,..liver,..enzymes
■ Myopathy/rhabdomyolysis ,..→,..injury,..to,..muscle,..tissue,..may,..occur,..(d
ark,..urine)
○ PK
■ Metabolized,..via,..hepatic,..enzyme,..CYP34A
● Avoid,..grapefruit
■ PREGNANCY,..CATEGORY,..X
○ Nursing
■ Monitor,..LFTs
■ Monitor,..CK
■ Get,..baselines,..before,..starting,..therapy
Nicotinic,..Acid/Niacin
● Statins
○ No,..longer,..used,..because,..greater,..harm,..than,..benefit
○ ADR, . . , . . SWEATY, . . HOT, . . FLUSHING
○ Need,..to,..ask,..what,..other,..supplements,..or,..herbals,..pt,..is,..taking
,Bile,..Acid,..Sequestrants
● Bile,..acid,..sequestrants
○ 2nd,..or,..3rd,..line,..of,..therapy,..→,..can,..be,..added,..on,..top,..of,..statin,..if,..needed
, ○ MOA
■ Binds,..with,..bile,..acids,..in,..intestine,..to,..make,..them,..non,..reabsorbable,,..t
hen,..is,..excreted
● Lowered,..levels,..prompts,..cholesterol,..to,..be,..used,..to,..make,..more,..bile,..a
cid
■ Work,..by,..increasing,..excretion,..of,..bile,..through,..stool,,..your,..liver,..then,..us
es,..the,..cholesterol,..from,..your,..blood,..to,..make,..more,..bile,..acid
■ Bile,..acid,..is,..synthesized,..from,..cholesterol,..in,..the,..liver
○ Examples:,..cholestyramine,,..colesevelam,,..colestipol
○ ADR
■ GI,..upset
■ Risk,..of,..hyperchloremic,..acidosis
○ Drug-Drug,..Interactions
■ Reduced,..absorption,..of,..many,..meds,,..fat,..soluble,..vitamins
● Cholestyramine, . . (Questran)
● Colestipol,.. (Colestid)
Ezetimibe
● Ezetimibe,..[Zetia]
○ MOA
■ Blocks,..absorption,..of,..cholesterol,..@,..small,..intestine,..brush,..border,..cells
● Decereased,..TC,,..LDL,,..TGs
● Increased,..HDL
○ Can,..be,..used,..alone,..or,..with,..statins
○ PK
■ Oral,,..not,..affected,..by,..food
■ Converted,..to,..active,..metabolites,..in,..intestine,..and,..liver
■ Eliminated,..in,..bile
■ Bioavailability,..increased,..in,..presence,..of,..liver,..dysfxn
○ C/I,..in,..patients,..with,..liver,..problems
○ ADRs
■ Myopathy/rhabdomyolysis
■ Hepatitis,,..pancreatitis
○ Drug-Drug,..Interactions
■ Zetia,..+,..Statin,.. ,..liver,,..myopathy
■ Fibrates,..+,..Zetia,.. ,..NOT,..RECOMMENDED
■ Bile-
Acid,..Sequestrants,..+,..Zetia,.. ,..affects,..absorption;,..administer,..2,..hours,..before,..
or,..4,..hours,..after,..a,..sequestrant
■ Cyclosporine,..+,..Zetia,.. ,..increase,..Zetia,..levels---monitor
Fibrinic,..Acid,.. Derivatives/Fibrates
● Fibrates
○ MOA
■ Increases,..the,..enzymes,..that,..breakdown,..LDL,..while,..promoting,..production,..of,..H
DL
■ [lowers,..TG,,..raises,..HDL]
○ ADRs
■ Liver,..injury
■ Myopathy
, ■ Gallstones
○ Gemfibrozil,..[Lopid],..and,..Fenofibrate,..[Tricor]
Monoclonal,.. Antibodies
● MABs
○ Alirocumab,..(Praluent),..&,..evolocumab,..(Repatha)
○ MOA
■ Proprotein,.. Convertase,.. Subtilisin/Kexin,.. Type,.. 9,.. (PCSK9),.. Inhibitors
○ Uses
■ Heterozygous,..familial,..hypercholesterolemia,..adjunct,..therapy
○ PK
■ SQ,.. injection
■ Degrade,..to,..small,..peptides,..and,..amino,..acids
■ Long,..half-life
○ Adverse, . . Effects
■ Hypersensitivity,..reactions
Anticoagulants
General, . . principles
1,..questio
n ● Pathophysiology,..of,..coagulation
○ Thrombus:,..blood,..clot,..in,..an,..artery,..or,..vein
■ Damage,..to,..the,..endothelial,..vessel,..lining
■ Stasis,..→,..platelet,..aggregation
○ Embolism:,..blood,..clot,..that,..becomes,..mobile
■ Venous,.. vs.,.. arterial
● Venous, . . →, . . PE
● Arterial,.. →,.. TIA,,.. MI,,.. CVA
● Key,..lab,..studies
○ Complete,..blood,..count,..(CBC),..→,..platelet,..count,..150,000-450,000
■ Thrombocytopenic:,..under,..100,000,..→,..think,..lack,..of,..clotting,..factor
■ Risk,..of,..bleeding,..out,..when,..under,..50,000
○ Prothrombin,..time,..(PT),..and,..International,..normalized,..ratio,..(INR),..→,..assesse
s,..the,..time,..it,..takes,..for,..your,..blood,..to,..clot
Heparin
1,..questio
n ● Heparin
○ MOA
■ Prevents,..conversion,..of,..prothrombin,..to,..thrombin,,..firbinogen,..to,..fibrin,.. inhibit,..
clot,..formation
● Check,..aPTT,..values,.. w/,..this,.. →,..want,..this,.. to,..be,..between,..60-
80
■ Prevents,..blood,..clots,..from,..forming,..or,..extending
● Do,..NOT,..break,..down,..existing,..clots
○ Principle, . . indication, . . →, . . prevention, . . of, . . thrombosis, . . in,.. veins
○ PK
,.. ,.. ,.. ,.. ,.. ,..
| Comprehensive Nursing Practice Questi
,.. ,.. ,.. ,.. ,..
ons and Course Preparation Resource
,.. ,.. ,.. ,..
10,..%,..Old,..stuff.,..Majority,..on,..stuff,..from,..Quiz,..2.
Lipid,..Drugs
General, . . info/teaching
2,..question
s
Take ,..statins,..at,..night,,..monitor,..liver,..enzymes,,..avoid,..grapefruit
Statins
1,..question
s ● Statins
○ MOA
■ lower,..cholesterol,..levels,..in,..the,..blood,..by,..blocking,..cholesterol,..production,..in,..the
,..liver
■ slows,..down,..the,..production,..of,..LDL,..in,..the,..liver,.. ,..INHIBIT,..HM
GCOA,..REDUCTASE
○ Atorvastatin,..(lipitor)
■ Highly,..effective,..and,..most,..prescribed,..class,..of,..antilipid,..agents
■ Increases,..HDL,..(good,..one)
■ Decreases,..LDL,..(bad,..one)
■ Take,..at,..night,..→,..this,..is,..when,..your,..body,..makes,..the,..
most,..cholesterol
○ Other,..statins:,..lovastatin,,..rosuvastatin,..(reduce,..dosage,..if,..Asian,..herita
ge),,..simvastatin,,..fluvastatin,,..pravastatin
○ ADRs
■ Elevated,..liver,..enzymes
■ Myopathy/rhabdomyolysis ,..→,..injury,..to,..muscle,..tissue,..may,..occur,..(d
ark,..urine)
○ PK
■ Metabolized,..via,..hepatic,..enzyme,..CYP34A
● Avoid,..grapefruit
■ PREGNANCY,..CATEGORY,..X
○ Nursing
■ Monitor,..LFTs
■ Monitor,..CK
■ Get,..baselines,..before,..starting,..therapy
Nicotinic,..Acid/Niacin
● Statins
○ No,..longer,..used,..because,..greater,..harm,..than,..benefit
○ ADR, . . , . . SWEATY, . . HOT, . . FLUSHING
○ Need,..to,..ask,..what,..other,..supplements,..or,..herbals,..pt,..is,..taking
,Bile,..Acid,..Sequestrants
● Bile,..acid,..sequestrants
○ 2nd,..or,..3rd,..line,..of,..therapy,..→,..can,..be,..added,..on,..top,..of,..statin,..if,..needed
, ○ MOA
■ Binds,..with,..bile,..acids,..in,..intestine,..to,..make,..them,..non,..reabsorbable,,..t
hen,..is,..excreted
● Lowered,..levels,..prompts,..cholesterol,..to,..be,..used,..to,..make,..more,..bile,..a
cid
■ Work,..by,..increasing,..excretion,..of,..bile,..through,..stool,,..your,..liver,..then,..us
es,..the,..cholesterol,..from,..your,..blood,..to,..make,..more,..bile,..acid
■ Bile,..acid,..is,..synthesized,..from,..cholesterol,..in,..the,..liver
○ Examples:,..cholestyramine,,..colesevelam,,..colestipol
○ ADR
■ GI,..upset
■ Risk,..of,..hyperchloremic,..acidosis
○ Drug-Drug,..Interactions
■ Reduced,..absorption,..of,..many,..meds,,..fat,..soluble,..vitamins
● Cholestyramine, . . (Questran)
● Colestipol,.. (Colestid)
Ezetimibe
● Ezetimibe,..[Zetia]
○ MOA
■ Blocks,..absorption,..of,..cholesterol,..@,..small,..intestine,..brush,..border,..cells
● Decereased,..TC,,..LDL,,..TGs
● Increased,..HDL
○ Can,..be,..used,..alone,..or,..with,..statins
○ PK
■ Oral,,..not,..affected,..by,..food
■ Converted,..to,..active,..metabolites,..in,..intestine,..and,..liver
■ Eliminated,..in,..bile
■ Bioavailability,..increased,..in,..presence,..of,..liver,..dysfxn
○ C/I,..in,..patients,..with,..liver,..problems
○ ADRs
■ Myopathy/rhabdomyolysis
■ Hepatitis,,..pancreatitis
○ Drug-Drug,..Interactions
■ Zetia,..+,..Statin,.. ,..liver,,..myopathy
■ Fibrates,..+,..Zetia,.. ,..NOT,..RECOMMENDED
■ Bile-
Acid,..Sequestrants,..+,..Zetia,.. ,..affects,..absorption;,..administer,..2,..hours,..before,..
or,..4,..hours,..after,..a,..sequestrant
■ Cyclosporine,..+,..Zetia,.. ,..increase,..Zetia,..levels---monitor
Fibrinic,..Acid,.. Derivatives/Fibrates
● Fibrates
○ MOA
■ Increases,..the,..enzymes,..that,..breakdown,..LDL,..while,..promoting,..production,..of,..H
DL
■ [lowers,..TG,,..raises,..HDL]
○ ADRs
■ Liver,..injury
■ Myopathy
, ■ Gallstones
○ Gemfibrozil,..[Lopid],..and,..Fenofibrate,..[Tricor]
Monoclonal,.. Antibodies
● MABs
○ Alirocumab,..(Praluent),..&,..evolocumab,..(Repatha)
○ MOA
■ Proprotein,.. Convertase,.. Subtilisin/Kexin,.. Type,.. 9,.. (PCSK9),.. Inhibitors
○ Uses
■ Heterozygous,..familial,..hypercholesterolemia,..adjunct,..therapy
○ PK
■ SQ,.. injection
■ Degrade,..to,..small,..peptides,..and,..amino,..acids
■ Long,..half-life
○ Adverse, . . Effects
■ Hypersensitivity,..reactions
Anticoagulants
General, . . principles
1,..questio
n ● Pathophysiology,..of,..coagulation
○ Thrombus:,..blood,..clot,..in,..an,..artery,..or,..vein
■ Damage,..to,..the,..endothelial,..vessel,..lining
■ Stasis,..→,..platelet,..aggregation
○ Embolism:,..blood,..clot,..that,..becomes,..mobile
■ Venous,.. vs.,.. arterial
● Venous, . . →, . . PE
● Arterial,.. →,.. TIA,,.. MI,,.. CVA
● Key,..lab,..studies
○ Complete,..blood,..count,..(CBC),..→,..platelet,..count,..150,000-450,000
■ Thrombocytopenic:,..under,..100,000,..→,..think,..lack,..of,..clotting,..factor
■ Risk,..of,..bleeding,..out,..when,..under,..50,000
○ Prothrombin,..time,..(PT),..and,..International,..normalized,..ratio,..(INR),..→,..assesse
s,..the,..time,..it,..takes,..for,..your,..blood,..to,..clot
Heparin
1,..questio
n ● Heparin
○ MOA
■ Prevents,..conversion,..of,..prothrombin,..to,..thrombin,,..firbinogen,..to,..fibrin,.. inhibit,..
clot,..formation
● Check,..aPTT,..values,.. w/,..this,.. →,..want,..this,.. to,..be,..between,..60-
80
■ Prevents,..blood,..clots,..from,..forming,..or,..extending
● Do,..NOT,..break,..down,..existing,..clots
○ Principle, . . indication, . . →, . . prevention, . . of, . . thrombosis, . . in,.. veins
○ PK
