Cholesterol Absorption Inhibitors

Every question here, with the answer

1. A client takes ezetimibe together with a statin. The client calls to report new muscle pain and weakness in both legs. What should the nurse do?

   1. Notify the health care provider about the muscle symptoms.
   2. Tell the client this is expected and will pass.
   3. Tell the client to take the statin every other day.
   4. Advise the client to take an extra dose of ezetimibe.

   Answer: Notify the health care provider about the muscle symptoms.

   Myopathy and rhabdomyolysis are the most significant adverse events of ezetimibe, especially with statins, and clients are taught to report muscle pain or weakness. Dismissing the symptom, doubling the dose, or changing the statin on one's own are unsafe.

2. A client's medication list shows Vytorin, and a new order is written for simvastatin. What should the nurse recognize?

   1. Vytorin already contains simvastatin together with ezetimibe.
   2. Vytorin is a bile acid sequestrant and must be separated from simvastatin.
   3. Vytorin contains ezetimibe only.
   4. Vytorin and simvastatin have no connection.

   Answer: Vytorin already contains simvastatin together with ezetimibe.

   Vytorin is a combination product containing both ezetimibe and simvastatin, so the new order may duplicate a drug the client already takes. Zetia is the single-drug tablet; the other options misidentify the product.

3. Which clients should NOT receive ezetimibe? Select all that apply.

   1. A client with active liver disease
   2. A client who also takes a statin with normal liver enzymes
   3. A client who is breastfeeding
   4. A client with primary hypercholesterolemia
   5. A client who is pregnant

   Answer: A client with active liver disease, A client who is breastfeeding, A client who is pregnant

   Ezetimibe should not be used in active liver disease, pregnancy, or breastfeeding. Primary hypercholesterolemia is an indication, and use with a statin calls for monitoring rather than being a contraindication.

4. Which laboratory values should the nurse monitor for a client taking ezetimibe?

   1. International normalized ratio
   2. Serum sodium
   3. Serum potassium
   4. ALT and AST

   Answer: ALT and AST

   Liver enzyme abnormalities are among the most significant adverse events, so the nurse monitors hepatic transaminases ALT and AST. The other values are not named for ezetimibe in the section.

5. A nurse is teaching a client who is starting ezetimibe. Which statements by the client show understanding? Select all that apply.

   1. "If I miss a day, I will take two doses the next day."
   2. "I will tell my provider if I get muscle pain or weakness."
   3. "I should not take this if I become pregnant."
   4. "Diarrhea cannot be caused by this drug."
   5. "I will take no more than one dose a day."

   Answer: "I will tell my provider if I get muscle pain or weakness.", "I should not take this if I become pregnant.", "I will take no more than one dose a day."

   Clients take ezetimibe daily with no more than one dose per day, avoid it in pregnancy, and report muscle pain or weakness. Doubling doses breaks the one-dose rule, and diarrhea is a listed adverse effect.

6. A client asks how ezetimibe lowers cholesterol. Which explanation by the nurse is accurate?

   1. It blocks a transporter that absorbs cholesterol in the small intestine.
   2. It activates receptors that break down triglycerides.
   3. It increases prostaglandins in the capillaries.
   4. It binds bile acids in the intestine.

   Answer: It blocks a transporter that absorbs cholesterol in the small intestine.

   Ezetimibe inhibits the Niemann-Pick C1-Like 1 transporter, which absorbs cholesterol in the small intestine. Binding bile acids describes sequestrants, and the other two describe niacin and fibrates.