Assignment: Atorvastatin in the Treatment of High Cholesterol Levels
Assignment: Atorvastatin in the Treatment of High Cholesterol Levels
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Assignment: Atorvastatin in the Treatment of High Cholesterol Levels
Drug therapy protocol for the administration of atorvastatin in the treatment of high cholesterol levels
| Clinical Indication for Use | Reducing amount of Low Density Lipoproteins (LDL), increasing the amount of High Density Lipoprotein (HDL), and lowering triglycerides level (Ramrakha, 2013.chapter 5, page 236) | |
| Inclusion Criteria | ||
| · Heart disease
· Heart complications in people with type 2 diabetes · Coronary heart disease
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· Adults and children above 10 years
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| Exclusion Criteria | ||
| · Allergy to atorvastatin
· Liver disease · Thyroid disorder · Kidney disease · Heavy alcoholic drinker |
· Not recommended for breastfeeding mothers
· Not recommended for pregnant women (Frandsen and Pennington, 2013. Chapter 8.p 136) |
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| Pharmacodynamics (Mechanism of Action) | ||
| Atorvastatin is a selective and active inhibitor of the hepatic enzyme hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase. HMG-CoA reductase converts HMG-CoA to mevalonate in the pathway of the biosynthesis of cholesterol. In the event where HMG-CoA reductase is inhibited by atorvastatin, there is a successive decrease in the levels of the hepatic cholesterol. Consequently, decrease in the levels of hepatic cholesterol stimulates the upregulation of hepatic Low-Density Lipoproteins Cholesterol (LDL-C) receptors thereby leading to an increase in hepatic uptake of LDL-C and reduces the concentrations of serum LDL-C (Moscou and Snipe, 2012. Chapter 24, p.393) | ||
| Pharmacokinetics (ADME) | ||
| Administration and absorption
Atorvastatin is rapidly absorbed after oral administration with or without food. The medication can be taken at any time every day but it is advisable to take it at around the same time every day. Atorvastatin is absolutely bioavailable at about 14% while the systemic availability of HMG-CoA inhibitory activity is at about 30%. Distribution Maximum concentration of plasma is accomplished in 1-2 hours after administration. The mean distribution volume is approximately 381litres and it is about 98% protein bound to the plasma membrane Metabolism Atorvastatin is metabolized to its ortho and para hydroxylated derivative and to its several products of beta oxidation. About 70% of HMG-CoA reductase inhibitory activity has been accredited to the active metabolites of atorvastatin Excretion Atorvastatin is eliminated in bile after extrahepatic or hepatic metabolism. Less than 2% of the orally administered dose of atorvastatin is recovered in urine (Frandsen and Pennington, 2013. Chapter 8.p 134). |
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| Drug Interactions | ||
| · Antibiotics such as erythromycin- the serum concentration of atorvastatin may be increased
· Antifungal medications such as fluconazole- the risk of severity of adverse effects is likely to be increased when fluconazole is combined with atorvastatin · Ciprofloxacin- the risk of severity of adverse effects is likely to be increased when ciprofloxacin is combined with atorvastatin Ciprofibrate-the severity of myopathy, myoglobulin, and rhabdomyolysis can be increased when ciprofibrate is combined with atorvastatin (Moscou and Snipe, 2012. Chapter 24, p.394). |
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| Dose, Route, Duration of Therapy Adult: | ||
| Dose and RouteInitial dose: 10mg or 20mg orally once a day. Initial dose of 40mg to be used in patients who need LDL-C reduction of more than 45% (Frandsen and Pennington, 2013. Chapter 8.p 134)
Maintenance dose: 10mg to 80mg orally once a day Duration of therapy 2-4 weeks and evaluation of lipids levels done |
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| Adverse Effects | ||
| Side effects
Diarrhoea, heartburn, gas, joint pain (Frandsen and Pennington, 2013. Chapter 8.p 136) Hypersensitivity Allergic reactions such as hives, difficulty in breathing, swelling of the throat, tongue, lips, face (Roberts, 2014) Adverse side effects Confusion and memory problems, unexplained muscle pain or tenderness, dark coloured urine, urinating less than normal or not urinating at all, dry mouth, fruity breath odour (Frandsen and Pennington, 2013.chapter 8.p. 136-137) |
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| Response to Adverse Event (this is directed at the practitioner to respond to an adverse event occurring) | ||
| · Stop the medication immediately
· Identify the cause of the adverse effect whether overdose, hypersensitivity, or drug interactions · Give an alternative solution based on the cause of the adverse effect · Document the adverse event |
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Critical discussion
Clinical decision making in nursing care is very key in ensuring safe and quality use of medications and principles of drug therapy (Standing, 2017. Chapter 1, p. 7). The purpose of this paper is to discuss the management of medication prescribed to a diabetic patient, Mavis, regarding the safety and proper use of the medication.
In light of this, the paper deliberates on the application of clinical decision-making process of assessment, implementation and evaluation with regards to the medication listed for Mavis. The paper also discusses patient education and cultural requirements as nursing responsibilities with respect to the patient and her medications.
Assessment
During assessment, the patient should be able to understand the treatment and the medications given. In understanding her medication and treatment, Mavis should be made aware that she is suffering from diabetes type two and that she has very high levels of cholesterol and triglycerides which may potentially lead to a heart disease. The medications prescribed for the Mavis in this case are metformin, glibenclamide, and atorvastatin. Mavis already had been taking metformin, and therefore assessment should be done on whether she understands any side effects of the medication and any hypersensitivity to the drugs being administered. If she needs any more clarification, then that should be communicated so that teaching can be done.
Due to the fact that Mavis had not used both atorvastatin and glibenclamide, understanding of these medications are essential for her. It is also necessary to note that both metformin and glibenclamide are indicated for the treatment of type two diabetes and the side effects tend to be similar. Mavis should be made aware that if she notices any adverse reaction of any of the medications, she should call the doctor right away. Mavis has already put on extra weight and so monitoring should be done since one of the side effects of glibenclamide is weight gain.
Below is the information about the medication listed for Mavis and the important points that Mavis should be made aware of.