Antilipidemics.

3. Describe the nursing process including client teaching

for Antilipidemics.
STUDENT ACTIVITY 4. Describe the action of anticoagulants, antiplatelet and
SHEET thrombolytics.
5. Identify the side effects, adverse reaction of
anticoagulants, antiplatelet and thrombolytics.
6. Formulate nursing process including client teaching
LESSON TITLE: ANTILIPIDEMICS/ DRUGS AFFECTING associated with anticoagulants.

Pharmacology
BS NURSING / SECOND YEAR
Session 19 LESSON REVIEW/ PREVIEW OR HOOK ACTIVITY : (10

minutes) PRE TEST

Materials: Notebook, Pharmacology book, Drug handbook, pens &

BLOOD COAGULATION paper

LEARNING OUTCOMES: References

At the end of the lesson, the nursing student can:
1. Enumerate nonpharmacologic ways of cholesterol
reduction.
2. Identify side effects and adverse reaction of
Hayes, Evelyn R. Pharmacology: A Nursing Process
Approach: 6 th Edition. Singapore: Elsevier Saunders
Company.
Karch, Amy M. Focus on Nursing Pharmacology 5th edition.
Philedelphia: Lippincott William and Wilkins

TRUE OR FALSE. Write T if the statement is true and F if false. Write your answers on the space provided before
each number.

___1. Protamine sulfate is heparins antidote.

___2. Heparin is the most commonly used anticoagulant.
___3. Antilipidemic drugs inhibit platelet aggregation.
___4. It is specifically recommended to keep anticoagulant medication in original packaging until
administered. ___5. You may give this medication either subcutaneously or intramuscularly.
___6. A patient on warfarin should avoid foods high in Vitamin K as they may alter the effects of warfarin ___7.
Brands should never be interchanged with a patient who is on warfarin as the potencies may not be equivalent to
one another.
___8. Warfarin is an example of an anticoagulant
___9. Active bleeding indicates the use of anticoagulants and antiplatelets.
___10.Patient taking anticoagulants should be advised to avoid activities that could cause traumatic injury or bleeding
 This document and the information thereon is the property of
PHINMA Education (Department of Nursing) 1 of 12
MAIN LESSON (40 minutes)

ANTIHYPERLIPIDEMIC DRUGS

∙ lower serum levels of cholesterol and various lipids. They are also called as lipid-lowering agents; these drugs
provide effective treatment for hyperlipidemia (increased lipid level in the blood). The incidence of coronary
artery disease (CAD), the most common cause of death among adults, is higher in people with
hyperlipidemia. High level of lipids and triglyceride is associated with metabolic syndrome consist of
insulin resistance, abdominal obesity, hypertension, and proinflammatory and prothrombotic states.
∙ Due to various reasons, fatty streaks begin to develop in the endothelium of coronary arteries. Over time,
these fatty streaks develop into plaques (atheromas) and injure the lining of blood vessels. The
inflammatory reaction begins, and it attracts white blood cells and platelets to the area. These cells collect
on the injured vessels and cause the atheroma to grow bigger, further narrowing the diameter of blood
vessels, and therefore, limiting the blood flow.
∙ The injury decreases the flexibility of the vessels, rendering it less distensible and less reactive to
neurochemical stimuli. Coronary arteries are now unable to balance oxygen demand and blood supply.
∙ If not acted promptly, this can lead to total vessel blockage and vessel rupture. CAD is the leading cause of
death worldwide, and its incidence is high in people with hyperlipidemia.
∙ The cause of CAD remains unknown, but certain risk factors were identified, and these include increasing age,
male gender, sedentary lifestyle, smoking, obesity, high-fat diet, high-stress levels, menopause, and
medical conditions like hypertension, gout, and diabetes.

Bile Acid Sequestrants : These drugs are used to normalize high serum level of
cholesterol. Therapeutic Action
∙ Bile acid sequestrants exert their effect in the intestines by binding into bile acids which contain a high level of
cholesterol.
∙ The resultant insoluble complex formed by this combination is then excreted through feces. ∙ As this happens,
more LDL segments from the circulation will be absorbed by the intrahepatic circulation to make more bile
acids.
Indications
∙ Bile Acid Sequestrants are used as the treatment for primary hypercholesterolemia (high cholesterol and high
LDL) as an adjunct to diet and exercise.
∙ Cholestyramine is also used to treat pruritus associated with partial biliary obstruction.

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PHINMA Education (Department of Nursing) 2 of 12
 ∙ Familial hypercholesterolemia treatment in children is limited to tight dietary restrictions of calorie and fats
because lipids in children are important for the development of the nervous system. In cases that are
unresponsive to dietary restrictions, other classes of antihyperlipidemic are used.
∙ Older adults are instructed on drugs that can’t be cut, crushed, and chewed.
Contraindications and Cautions
∙ Allergy to bile acid sequestrants. Prevent severe hypersensitivity reactions.
∙ Complete biliary obstruction. Prevent bile from being secreted into the intestines.
∙ Abnormal intestinal function. Aggravated by the presence of bile acid sequestrants.
∙ Pregnancy and lactation. Potential decrease in absorption of fat and fat-soluble vitamins can be detrimental to
fetus or neonate.
Adverse Effects
∙ CNS: headache, anxiety, fatigue, drowsiness
∙ GI: GI upset, constipation, fecal impaction, nausea, aggravated hemorrhoids
∙ Hema: increased bleeding time, decreased production of clotting factors
∙ Musculoskeletal: muscle aches, muscle pains
∙ Other: rash, fat-soluble vitamin deficiencies
Interactions
∙ Bile acid sequestrants delay the absorption of thiazide diuretics, corticosteroids, digoxin, warfarin, and thyroid
hormones. Therefore, if needed, these drugs are taken 1 hour before or 4-6 hours after a meal. Nursing
Responsibilities
∙ Administer powdered agents already mixed with fluids to ensure drug effectiveness.
∙ Instruct client not to chew, crush, and cut tablets because these drugs are meant to be broken down in the
intestines and premature crushing will render active ingredients ineffective.
∙ Administer drug before meals to ensure that drug is in the GI tract together with food.
∙ Administer other drugs 1 hour before or 4-6 hours after bile acid sequestrants to avoid drug
interactions. ∙ Arrange for a bowel program to effectively address constipation if it ever occurs.
∙ Instruct patient to increase oral fluid intake and dietary fiber intake to prevent constipation. ∙ Provide comfort
measures (e.g. small frequent meals for GI upset and instituting safety measures for drowsiness and
weaknesses) to help patient tolerate drug effects.
∙ Educate patient on drug therapy including drug name, its indication, and adverse effects to watch out for to
enhance patient understanding of drug therapy and thereby promote adherence to drug regimen.

HMG-CoA Reductase Inhibitors : This drug group increases the cell absorption of LDL by blocking the enzyme (HMG
CoA reductase) regulating the rate-limiting step in the synthesis of cholesterol. With this alteration in fat metabolism,
HDL increases slightly.
Therapeutic Action
∙ In a sense, HMG-CoA reductase inhibitors block the completion of cholesterol synthesis in the body. ∙ These
are primarily indicated as adjunct medicine with diet and exercise for treatment of high cholesterol and LDL
levels in the blood.
Indications
∙ Pravastatin, lovastatin, and simvastatin are indicated for patients with documented CAD to slow progression of
the disease.
∙ Together with these three agents, atorvastatin is used as prophylaxis for first myocardial infarction attack for
patients with multiple risk factors for CAD.
Children
∙ Treatment for familial hypercholesterolemia for this age group is strictly limited to tight dietary restrictions from
fats and calories because lipids in this age group are important for the development of nervous system. Adults
∙ HMG-CoA reductase inhibitor is the drug of choice for patients who have multiple risk factors or have already
developed CAD.
∙ The importance of lifestyle changes (e.g. dietary restrictions, regular exercise, and smoking cessation) should
be emphasized to this age group.
∙ This class is well-tolerated and is less expensive compared to other classes with the same therapeutic effect.
For cases who are slow to respond to this class alone, combination therapy with niacin, fibrate, and bile
acid sequestrants is instituted.
∙ For women who are pregnant, this drug class is contraindicated (pregnancy category
X). Contraindications and Cautions
∙ Allergy to HMG-CoA reductase inhibitors. Prevent severe hypersensitivity reactions.

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PHINMA Education (Department of Nursing) 3 of 12
∙ Active liver disease. Exacerbated by drug’s therapeutic effect and has potential to lead to severe liver
failure. ∙ Pregnancy, lactation. Potential for drug adverse effects to fetus or neonate.
 ∙ Impaired endocrine function. Problems can arise due to alteration in the formation of steroid hormones. ∙
Renal impairment. Caution is given to patients taking other statins and close monitoring in instituted.
Atorvastatin is not affected by renal diseases.
Adverse Effects
∙ CNS: headache, dizziness, insomnia, fatigue, blurred vision, cataract development
∙ CV: increased risk for cardiovascular effects with simvastatin started at 80 mg for new
patients ∙ GI: flatulence, nausea, vomiting, cramps, abdominal pain, constipation
∙ Hepatobiliary: increase liver enzymes, acute liver failure with use of atorvastatin and
fluvastatin Interactions
∙ Cyclosporine, erythromycin, gemfibrozil, niacin, antifungal drugs: increased risk for
rhabdomyolysis ∙ Digoxin, warfarin: increased serum levels and resultant toxicity of HMG-CoA
reductase inhibitors ∙ Oral contraceptives: increased serum estrogen
∙ Grapefruit juice: increased serum levels and resultant toxicity
Nursing Responsibilities
∙ Administer drug at bedtime to maximize effectiveness of the drug because peak of cholesterol synthesis is
from midnight to 5 AM. However, atorvastatin can be given at any hour of the day.
∙ Monitor serum cholesterol and LDL levels to determine effectiveness of drug therapy.
∙ Monitor results of liver functions tests to determine possible liver damage.
∙ Ensure patient has initiated a 3-6 month diet and exercise program before initiating drug therapy to ensure
need for drug therapy.
∙ Emphasize the importance of lifestyle changes to the patient to decrease risk of CAD and promote drug
effectiveness.
∙ Provide comfort and safety measures to help patient tolerate drug side effects.
∙ Educate patient on drug therapy including drug name, its indication, and adverse effects to watch out for to
enhance patient understanding on drug therapy and thereby promote adherence to drug regimen.

Cholesterol Absorption Inhibitors : Cholesterol absorption inhibitors are one of the new class of drugs approved
(2003) to lower serum cholesterol levels.
Therapeutic Action
∙ Acting on the brush border of intestines, cholesterol absorption inhibitors block the absorption of dietary
cholesterol. Consequently, less cholesterol goes to the liver and it increases the cholesterol clearance to
make up for the drop.
Indications
∙ Adjunct to diet and exercise as a monotherapy or in combination with HMG-CoA inhibitors or bile acid
sequestrants.
∙ Used in combination with statins to treat homozygous familial hypercholesterolemia.
∙ Not indicated in children.
Contraindications and Cautions
∙ Allergy to cholesterol absorption inhibitors. Prevent severe hypersensitivity reactions.
∙ Liver disease, pregnancy, lactation: not used if combined with statins because of the effects of statins to these
health conditions. Effect of this class to fetuses and neonates is not known.
Adverse Effects
∙ CNS: headache, dizziness, fatigue
∙ Respiratory: upper respiratory tract infection (URI)
∙ GI: mild abdominal pain, diarrhea
∙ Musculoskeletal: muscle aches and pains, back pain
Interactions
∙ Cholestyramine, fenofibrate, antacid, gemfibrozil: elevated serum level of cholesterol absorption
inhibitors ∙ Cyclosporine: increased toxicity of cholesterol absorption inhibitors
∙ Fibrates: increased risk for development of cholelithiasis
∙ Warfarin: increased serum warfarin levels
Nursing Responsibilities
∙ Monitor serum cholesterol and LDL levels. To determine the effectiveness of drug
therapy. ∙ Monitor results of liver functions tests. To determine possible liver damage.
∙ Ensure patient has initiated a 3-6 month diet and exercise program before initiating drug therapy. To ensure
the need for drug therapy.

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PHINMA Education (Department of Nursing) 4 of 12
∙ Emphasize the importance of lifestyle changes. To the patient to decrease the risk of CAD and promote drug
effectiveness.
∙ Provide comfort and safety measures. To help patient tolerate drug side effects.
 ∙ Educate patient on drug therapy. Include in the teaching plan the drug name, its indication, and adverse
effects to watch out for to enhance patient understanding of drug therapy and thereby promote adherence
to the drug regimen.

These groups of drugs affect clot formation and resolution by hindering different steps in clotting formation which
include altering:
A. the formation of platelet plug (antiplatelet drugs),
B. interfering the clotting cascade and thrombin formation (anticoagulant drugs), and
C. stimulating the plasmin system to break down the formed clot (thrombolytic agents).

Disorders that directly affect coagulation process are divided into two main categories:
1. thromboembolic disorders, which involve overproduction of clots; and
2. hemorrhagic disorders, which is characterized by ineffective clotting process leading to excessive bleeding.

Thromboembolic disorders : include medical conditions (e.g. CAD) which involve overproduction of clots which result
into decreased blood flow and total vessel occlusion. Manifestations include hypoxia, anoxia, and even necrosis. These
disorders are treated by drugs that interfere with normal coagulation process to prevent formation of clots. On the other
hand, less common hemorrhagic disorders is characterized by excessive bleeding. These are treated by drugs that
promote the clotting process. Some of these conditions include:
∙ Hemophilia: characterized by genetic lack of clotting factors
∙ Liver disease: characterized by non-production of proteins and clotting factors necessary for clot
formation ∙ Bone marrow disorders: characterized by insufficient quantity of platelets rendering them
ineffective

ANTIPLATELET AGENTS

∙ This drug class exerts its action by decreasing the responsiveness of platelets to stimuli that cause it to clump or
aggregate. Through this, formation of platelet plug is decreased.
Therapeutic Action
∙ By blocking receptor sites on the platelet membrane, platelet adhesion and aggregation is inhibited. Also,
platelet-platelet interaction as well as interaction of platelets to clotting chemicals are prevented. Indications
∙ Primarily indicated for cardiovascular diseases that have potential for development of vessel occlusion. ∙ Other
indications include maintenance of arterial and venous grafts, preventing cerebrovascular occlusion, and
including them as adjunct to thrombolytic therapy for treatment of myocardial infarction.
∙ One drug, anagrelide, blocks the production of platelets in the bone marrow.
∙ Only heparin and warfarin are indicated for children but these drugs alone require careful dose calculation. ∙
Caution is particularly important to prevent injury (e.g. using electric razor and soft-bristled toothbrush). ∙ It is
also important that adults are educated on what to do should bleeding occurs (e.g. applying firm pressure) as
well as what signs of bleeding should be watched out for.
∙ Other drugs taken should be documented because there are a lot of drug interactions with these drug class. It
should also be emphasized that periodic blood tests is expected to monitor the effect of therapy. ∙ For pregnant
women, it is not advisable unless the benefit to the mother would clearly outweigh the risk for the fetus. On the
other hand, for lactating women, it is generally inadvisable.
∙ Are more susceptible to drug toxicity and drug-to-drug interactions.
∙ Careful monitoring of liver and kidney function is important for this age group.
∙ Therapy is always started at the lowest level possible and adjusted accordingly.
Contraindications and Cautions
∙ Allergy to antiplatelet agents. Prevent severe hypersensitivity reactions.
∙ Known bleeding disorder. Increased risk of excessive blood loss
∙ Recent surgery. Increased risk of bleeding in unhealed blood vessels
∙ Closed head injuries. Increased risk of bleeding in injured blood vessels of the brain
∙ History of thrombocytopenia. Anagrelide decreased bone marrow production of platelets. ∙
Pregnancy, lactation. Generally inadvisable because of potential adverse effects to fetus or neonate

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PHINMA Education (Department of Nursing) 5 of 12
Adverse Effects
∙ CNS: headache, dizziness, weakness
∙ GI: GI distress, nausea
 ∙ Skin: skin rash
∙ Hema: bleeding (oftenly occurs while brushing the teeth)
Interactions
∙ Increased risk of bleeding if combined with another drug that affects blood clotting.
Nursing Responsibilities
∙ Administer drug with meals to relieve GI upset.
∙ Provide comfort measures for headache because pain due to headache may decrease patient compliance to
treatment regimen.
∙ Educate patient on ways to promote safety like using electric razor, soft-bristled toothbrush, and cautious
movement because any injury at this point can precipitate bleeding.
∙ Educate patient on drug therapy including drug name, its indication, and adverse effects to watch out for to
enhance patient understanding on drug therapy and thereby promote adherence to drug regimen. ∙ Monitor
patient compliance to drug therapy.

ANTICOAGULANTS
∙ By interfering with clotting cascade and thrombin formation, anticoagulants are able to interfere with the
normal clotting process.
Therapeutic Action
∙ Warfarin, an oral agent in this class, reduces Vitamin K-dependent clotting factors. As a result, clotting
process is prolonged.
∙ Two new oral agents, dabigatran and rivaroxaban, directly inhibits thrombin (last step in clotting process) and
factor Xa, respectively.
∙ Heparin and antithrombin block formation of thrombin from prothrombin.
Indications
∙ Among the many indications for this drug class include: stroke and systemic emboli risk reduction, nonvalvular
atrial fibrillation, and deep vein thrombosis.
∙ Heparin is used for prevention of blood clots in blood samples, dialysis, and venous tubing. It also does not
enter breastmilk so it is the anticoagulant of choice for lactating women.
∙ Antithrombin is a naturally-occurring anticoagulant and is a natural safety feature in the clotting system. ∙ Only
heparin and warfarin are indicated for children but these drugs alone require careful dose calculation. ∙ Caution
is particularly important to prevent injury (e.g. using electric razor and soft-bristled toothbrush). ∙ It is also
important that adults are educated on what to do should bleeding occurs (e.g. applying firm pressure) as well
as what signs of bleeding should be watched out for.
∙ Other drugs taken should be documented because there are a lot of drug interactions with these drug class. It
should also be emphasized that periodic blood tests is expected to monitor the effect of therapy. ∙ For pregnant
women, it is not advisable unless the benefit to the mother would clearly outweigh the risk for the fetus. On the
other hand, for lactating women, it is generally inadvisable.
∙ Are more susceptible to drug toxicity and drug-to-drug interactions.
∙ Careful monitoring of liver and kidney function is important for this age group.
∙ Therapy is always started at the lowest level possible and adjusted accordingly.
Contraindications and Cautions
∙ Allergy to anticoagulants. Prevent severe hypersensitivity reactions.
∙ Known bleeding disorder, recent trauma/surgery, presence of indwelling catheters, threatened abortion, GI
ulcers. These conditions can be compromised by increased bleeding tendencies.
∙ Pregnancy, lactation. Warfarin is a contraindication.
Adverse Effects
∙ Warfarin is associated with alopecia, dermatitis, bone marrow depression, and less frequently with prolonged
and painful erections.
∙ Direct drug toxicity is characterized by nausea, GI upset, diarrhea, and hepatic
dysfunction. Interactions
∙ Anticoagulants, salicylates, penicillin, cephalosporin: increased bleeding if combined with
heparin ∙ Nitroglycerin: decreased anticoagulation if combined with heparin
∙ Cimetidine, clofibrate, glucagon, erythromycin: increased bleeding if combined with warfarin ∙
Vitamin K, phenytoin, rifampin, barbiturates: decreased anticoagulation if combined with warfarin ∙
Antifungals, erythromycin, phenytoin, rifampin: alteration in metabolism of dabigatran and rivaroxaban

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PHINMA Education (Department of Nursing) 6 of 12
Nursing Responsibilities
∙ Assess for signs signifying blood loss (e.g. petechiae, bruises, dark-colored stools, etc.) to determine therapy
effectiveness and promote prompt intervention for bleeding episodes.
∙ Establish safety precautions (e.g. raising side rails, ensuring adequate room lighting, padding sides of bed,
 etc.) to protect patient from injury.
∙ Maintain antidotes on bedside (e.g. protamine sulfate for heparin, Vitamin K for warfarin) to promptly treat
drug overdose.
∙ Evaluate effectiveness by monitoring the following blood tests: prothrombin time (PT) and international
normalized ratio (INR) for warfarin; and whole blood clotting time (WBCT) and activated partial
thromboplastin time (APTT) for heparin.
∙ Educate patient on drug therapy including drug name, its indication, and adverse effects to watch out for to
enhance patient understanding on drug therapy and thereby promote adherence to drug regimen.

THROMBOLYTIC AGENTS

∙ Thrombolytic agents promote clot resolution, the process of activating the plasmin system to break down the
thrombus or clot that has been formed.
Therapeutic Action
∙ The conversion of plasminogen to plasmin is the body’s natural anticlotting system. Thrombolytic agents’
action to activate this promotes breakdown of fibrin threads and dissolution of formed clots.
∙ It is necessary to prevent vessel occlusion and therefore, to deliver adequate blood flow to body
systems. Indications
∙ For treatment of acute MI, pulmonary embolism, and acute ischemic stroke.
∙ Also for clearing of occluded intravenous catheters and central venous access devices.
∙ Caution is particularly important to prevent injury (e.g. using electric razor and soft-bristled toothbrush). ∙ It is
also important that adults are educated on what to do should bleeding occurs (e.g. applying firm pressure) as
well as what signs of bleeding should be watched out for.
∙ Other drugs taken should be documented because there are a lot of drug interactions with these drug class. ∙
It should also be emphasized that periodic blood tests is expected to monitor the effect of therapy. ∙ For
pregnant women, it is not advisable unless the benefit to the mother would clearly outweigh the risk for the
fetus.
∙ On the other hand, for lactating women, it is generally inadvisable.
∙ Are more susceptible to drug toxicity and drug-to-drug interactions.
∙ Careful monitoring of liver and kidney function is important for this age group.
∙ Therapy is always started at the lowest level possible and adjusted accordingly.
Contraindications and Cautions
∙ Allergy to thrombolytics. Prevent severe hypersensitivity reactions.
∙ Known bleeding disorder, recent trauma/surgery, acute liver disease, cerebrovascular accident within 2
months, GI ulcers. These conditions can affect normal clotting factors and normal plasminogen production. ∙
Pregnancy, lactation. Potential adverse effects to fetus or neonate.
Adverse Effects
∙ CV: cardiac arrhythmias, hypotension
∙ Hema: bleeding (most common)
∙ Hypersensitivity reaction (uncommon) is characterized by rash, flushing, and
bronchospasm. Interactions
∙ Anticoagulant, antiplatelet: increased risk of bleeding
Nursing Considerations
Here are important nursing considerations when administering thrombolytics:
Nursing Assessment
These are the important things the nurse should include in conducting assessment, history taking, and examination: ∙
Assess for the mentioned contraindications to this drug (e.g. hypersensitivity, acute liver disease, CVA within 2
months, etc.) to prevent potential adverse effects.
∙ Conduct thorough physical assessment before beginning drug therapy to establish baseline status, determine
effectivity of therapy, and evaluate potential adverse effects.
∙ Obtain baseline status for complete blood count, fecal occult blood test (FOBT), and clotting studies to
determine any potential adverse effects.
Nursing Responsibilities

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PHINMA Education (Department of Nursing) 7 of 12
∙ Assess for signs signifying blood loss (e.g. petechiae, bruises, dark-colored stools, etc.) to determine therapy
effectiveness and promote prompt intervention for bleeding episodes.
∙ Establish safety precautions (e.g. raising side rails, ensuring adequate room lighting, padding sides of bed,
etc.) to protect patient from injury.
∙ Evaluate effectiveness by monitoring coagulation studies to adjust drug dose appropriately. Educate patient
on drug therapy including drug name, its indication, and adverse effects to watch out for to enhance patient
understanding on drug therapy and thereby promote adherence to drug regimen.

CHECK FOR UNDERSTANDING (30 minutes)

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct rationalization. Superimpositions or erasures in you answer/ratio is not
allowed. You are given 25 minutes for this activity:

Multiple Choice

1. Lipid levels of individuals with coronary artery disease (CAD) is usually high. All of the following are factors of CAD,
except:
A. Men
B. Gout
C. Untreated Chlamydia infections
A. None of the above
ANSWER: ________
RATIO:________________________________________________________________________________________
___
______________________________________________________________________________________________
___
______________________________________________________________________________________________

2. Which assessment finding in a patient taking an HMG-CoA reductase inhibitor will the nurse act on
immediately? A. Decreased haemoglobin
B. Elevated liver function tests
C. Elevated HDL
D. Elevated LDL
ANSWER: ________
RATIO:________________________________________________________________________________________
___
______________________________________________________________________________________________
___
______________________________________________________________________________________________

3. A patient is taking pravastatin sodium. Which assessment finding requires immediate action by the
nurse? A. Headache
B. Slight nausea
C. Muscle pain
D. Fatigue
ANSWER: ________
RATIO:________________________________________________________________________________________
___
______________________________________________________________________________________________
___
______________________________________________________________________________________________

4. Antihyperlipidemic agent that is used to decrease plasma cholesterol levels.

A. HMG-CoA reductase inhibitors
B. Phosphodiesterase inhibitors
C. Bile acid sequestrants
D. Cholesterol absorption inhibitor
ANSWER: ________
RATIO:________________________________________________________________________________________
___
______________________________________________________________________________________________
___
______________________________________________________________________________________________

5. A pregnant woman needs a lipid-lowering agent. What would be the best class of lipid-lowering agent for pregnant
women?
A. HMG-CoA reductase inhibitors
 This document and the information thereon is the property of
PHINMA Education (Department of Nursing) 8 of 12
B. Bile acid sequestrants
C. Cholesterol absorption inhibitors
D. Phosphodiesterase inhibitors
ANSWER: ________
RATIO:________________________________________________________________________________________
___
______________________________________________________________________________________________
___
______________________________________________________________________________________________

6. A patient begins taking cholestyramine (Questran) to treat hyperlipidemia. The patient reports abdominal discomfort
and constipation. The nurse will provide which instruction to the patient?
A. Increase fluid and slowly increase fiber intake.
B. Stop the medication.
C. Decrease oral fluids
D. Give stool softeners
ANSWER: ________
RATIO:________________________________________________________________________________________
___
______________________________________________________________________________________________
___
______________________________________________________________________________________________

7. The only statin with outcome data to show effectiveness in decreasing CAD and incidence of myocardial
infarction. A. atorvastatin (Lipitor)
B. simvastatin (Zocor)
C. pravastatin (Pravachol)
D. fluvastatin (Lescol)
ANSWER: ________
RATIO:________________________________________________________________________________________
___
______________________________________________________________________________________________
___
______________________________________________________________________________________________

8. Which organ(s) produce(s) clotting factors?

B. Bone marrow
C. Spleen and other lymphoid tissues
D. Liver
E. Both B and C
ANSWER: ________
RATIO:________________________________________________________________________________________
___
_____________________________________________________________________________________________
___
_____________________________________________________________________________________________
___

9. What is the first reaction to a blood vessel injury?

A. Vasodilation and swelling
B. Vasoconstriction
C. Bleeding
D. Blood coagulation
ANSWER: ________
RATIO:________________________________________________________________________________________
___
______________________________________________________________________________________________
___
______________________________________________________________________________________________
___

10. Heparin is an anticoagulant. What family of anticoagulant medications does this drug belong
to? A. Direct thrombin inhibitors
B. Indirect thrombin inhibitors
C. Vitamin K antagonists
D. Factor Xa inhibitors
ANSWER: ________
RATIO:________________________________________________________________________________________
___
______________________________________________________________________________________________
___
______________________________________________________________________________________________
___ .

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PHINMA Education (Department of Nursing) 9 of 12
11. Which statement below BEST describes how Heparin works as an anticoagulant?
A. “It inhibits clotting factors from synthesizing Vitamin K.”
B. “It inactivates the extrinsic pathways of coagulation.”
C. “It prevents Factor Xa from activating prothrombin to fibrinogen.”
D. “It enhances the activation of antihrombin III, which prevents the activation of thrombin and the conversion of
fibrinogen to fibrin.”
ANSWER: ________
RATIO:________________________________________________________________________________________
___
______________________________________________________________________________________________
___
______________________________________________________________________________________________
___

12. Which patients below would be at a HIGH risk for developing adverse effects of Heparin drug therapy? Select all
that apply:
A. A 55-year-old male patient who is post-op day 1 from brain surgery.
B. A 45-year-old female patient with a pulmonary embolism.
C. A 36-year-old male patient with active peptic ulcer disease.
D. A 43-year-old female with uncontrolled atrial fibrillation.
A. All of the above.
ANSWER: ________
RATIO:________________________________________________________________________________________
___
______________________________________________________________________________________________
___
______________________________________________________________________________________________
___ .
13. A patient is ordered to start an IV continuous Heparin drip. Prior to starting the medication, the nurse would ensure
what information is gathered correctly before initiating the drip?
A. Vital signs
B. Weight
C. PT/INR level
D. EKG
ANSWER: ________
RATIO:________________________________________________________________________________________
___
______________________________________________________________________________________________
___
______________________________________________________________________________________________
___ .
14. What is the approximate NORMAL level range for an activated partial thromboplastin time
(aPTT)? A. 20-25 seconds
B. 2-3 seconds
C. 30-40 seconds
D. 60-80 seconds
ANSWER: ________
RATIO:________________________________________________________________________________________
___
______________________________________________________________________________________________
___
______________________________________________________________________________________________
___ .
15. A patient, who is receiving continuous IV Heparin, has an aPTT of 105 seconds. What is your next nursing action
per protocol?
A. Continue with the infusion because no change is needed based on this aPTT.
B. Increase the drip rate per protocol because the aPTT is too low.
C. Re-draw the aPTT STAT.
D. Hold the infusion for 1 hour and decrease the rate per protocol because the aPTT is too
high. ANSWER: ________
RATIO:________________________________________________________________________________________
___
______________________________________________________________________________________________
___
______________________________________________________________________________________________
___ .

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PHINMA Education (Department of Nursing) 10 of 12
RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION) The instructor
will now rationalize the answers to the students. You can now ask questions and debate among yourselves. Write the
correct answer and correct/additional ratio in the space provided.

1. ANSWER: ________
RATIO:____________________________________________________________________________________
___
__________________________________________________________________________________________
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PHINMA Education (Department of Nursing) 11 of 12
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LESSON WRAP-UP (5 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help
you track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.
KEY IDEAS
Students list the key ideas from the lesson and why they were important and give at least three non
pharmacologic methods to lower cholesterol

For next session, review Drugs Used To Treat Anemias, Drugs Acting On The Renal System : Diuretics

This document and the information thereon is the property of

PHINMA Education (Department of Nursing) 12 of 12