Atorvastatin (Lipitor) Overview

Prototype Medications Overview

• Prototype medications are categorized by generic name, trade name, therapeutic classification, pregnancy category, and mechanism of action.
• Key aspects include examples, reasons for medication use, common side effects, potential adverse effects, and nursing considerations.

Atorvastatin (Lipitor)

• Generic name is atorvastatin calcium.
• Trade name is Lipitor.
• It's classified as an antilipemic medication.
• It belongs to the HMG-CoA reductase inhibitors class.
• Pregnancy category X.
• Functions by inhibiting HMG-CoA to reduce cholesterol production in the liver and increasing LDL receptors for LDL uptake.
• Used for CAD, MI, strokes, angina, and HF as an adjunct to diet and exercise to lower LDL, total cholesterol, and triglyceride levels while increasing HDL.
• Common side effects are insomnia, abdominal pain, diarrhea, dyspepsia, flatulence, nausea, muscle pain, and spasms.
• Potential adverse effect is rhabdomyolysis.
• A baseline lipid profile is needed before treatment, then again 4 and 12 weeks post-treatment or after a change in dosage.
• Assess for signs of myopathy.
• Clients should be educated with regards to cholesterol-lowering diets, weight control, exercise, and avoiding alcohol.
• Report any signs of myopathy.
• Take it at any time of the day, irrespective of meals.
• Discontinue usage immediately if pregnant or breastfeeding.
• Drug interactions may occur with antacids, diltiazem, nefazodone, verapamil, cyclosporine, ritonavir, digoxin, fluconazole, azithromycin, and erythromycin.
• Herbal interactions may occur with Jin bu huan and kava.

Cholestyramine (Questran, Prevalite)

• Generic name is cholestyramine.
• Trade names are Questran and Prevalite.
• Bile Acid Sequestrant, antilipemic
• Pregnancy Category C
• It functions by binding to bile in the intestine forming an insoluble complex that is excreted, reducing cholesterol levels by increasing LDL absorption in the liver.
• Administered as an adjunct to nutrition and exercise for hypercholesterolemia.
• Common side effects are constipation, diarrhea, hemorrhoids, increased libido, weight changes, and vitamin deficiencies.
• Affects drug absorption. Do not administer within 1 hour before or 4-6 hours after giving bile acid sequestrants.
• Monitor and report abnormal bleeding.
• Consumption of grapefruit juice should be discouraged.
• May increase drug levels when consumed in large quantities, and increase the risk of adverse effects

Ezetimibe (Zetia)

• Generic name is ezetimibe.
• Trade name is Zetia.
• Is an antilipemic medication.
• Functions by inhibiting cholesterol absorption in the small intestine
• Used to treat hypercholesterolemia with or without a reductase inhibitor
• Common side effects are fatigue, arthralgia, back pain, myalgia, angioedema, dizziness, headache, abdominal pain, diarrhea, pharyngitis, cough, and rash.
• May lead to thrombocytopenia, hepatitis, pancreatitis, and rhabdomyolysis.
• It is not a statin and can be used with a statin or alone.
• Immediately report unexplained muscle pain, tenderness, and weakness, as it could indicate kidney failure.
• Ensure lab work is monitored and females use birth control.
• Potential risks when taken with cyclosporine.

Nitroglycerin (Nitro-Par, Transderm-Nitro, Nitrostat)

• Generic name is nitroglycerin.
• Trade names are Nitro-Par, Transderm-Nitro, and Nitrostat.
• Pregnancy category C
• Dilates venous and arterial blood vessels to promote peripheral blood pooling and reduce peripheral resistance
• Used for angina pectoris, prophylaxis, treatment, management, and to control perioperative hypertension and CHF from acute MI administered via IV.
• Common side effects include headache, blurred vision, and postural hypotension.
• May cause circulatory collapse and anaphylactoid reaction.
• Non-chewable tablets should be taken 1 hour before or 2 hours after meals.
• Chewable tablets should be chewed well and held in the mouth for 2 minutes before swallowing.
• Sublingual tablets should dissolve under the tongue.
• Avoid changing positions rapidly.
• Use caution in potentially hazardous activates.
• Avoid alcohol, smoking, and strenuous exercise in hot environments.
• If pain is not relieved after the first tablet, take one additional tablet and if still not relieved go to the ED (call 911).
• Store it in the original container.
• Do not use OTC products unless directed.

Metoprolol (Toprol-XL, Lopressor)

• Generic name is metoprolol succinate (Toprol-XL sustained release form) and metoprolol tartrate (Lopressor immediate release).
• Functions by blocking the effects of epinephrine and slowing heart rate.
• Lowers blood pressure for clients with: HTN (IV, IM), prophylaxis for angina pectoris and acute Ml.
• Common side effects include fatigue, dizziness, depression, headache, insomnia, confusion, vertigo, hypotension, palpitations, bradycardia and erectile dysfunction.
• May lead to heart failure and stroke
• Nurses should assess the client for exercise tolerance, episodes of chest pain, and wheezing.
• Teach clients to take their radial pulse.
• May be taken with food (succinate) or without.

Diltiazem (Cardizem, Dilacor, Tiazac, Cardizem CD)

• Generic name is diltiazem.
• Trade names are Cardizem, Dilacor, Tiazac, and Cardizem CD.
• Vasospastic angina, stable angina and primary hypertension.
• Common side effects include headache, flushing or edema.
• May lead to arrhythmia and CHF.
• Withhold if systolic BP measures less than 90 mm Hg or diastolic measures less than 60 mm Hg.

Losartan Potassium

• Generic name is losartan potassium.
• Trade name is Cozaar.
• It blocks Angiotensin II receptors
• Pregnancy Category C
• Used to control hypertension
• Common side effects are dizziness, insomnia, headache, diarrhea, and dyspepsia

Nitroprusside (Nitropress)

• Generic name is nitroprusside.
• Trade name is Nitropress.
• Acts directly on the smooth vascular.
• Rapidly lowers BP in hypertensive crises or controlled hypotension during anesthesia
• Common side effects include diaphoresis, apprehension, restlessness, dizziness, and headache.
• Can lead to many drug-drug interactions
• Monitor consistency when titrating IV to response

Furosemide (Lasix)

• Generic name Furosemide.
• Trade Name Lasix.
• Loop Diuretic used to treat Acute HF, acute pulmonary edema, adult nocturia etc...
• Acts on the Loop of Henle.
• Common adverse effects include vertigo, paresthesia, and fever
• Loop Diuretics are one of six classifications of Diuretic.
• Assess fluid status and dietary education.

Hydrochlorothiazide (HCTZ)

• Generic name Hydrochlorothiazide.
• Trade Name Apo-Hydro, Microzide, Oretic.
• Thiazide Diuretic used to treat edema and hypertension.
• Acts on distal tubule and decreases CO.
• Common adverse effects include blurred vision, fatigue, and nausea.
• Adjunct in treatment of edema or HF
• Can cause hyperglycemia and hypokalemic.

Meds for Fluid Overload

• Common side effects include lethargy, blurred vision, dry mouth, anorexia, and arrhythmias.
• Drug interactions include digoxin, lithium, furosemide may show toxicity
• Diuretics are prescribed to lower extracellular volume and reduce edema.
• Potassium is often lost and must be supplemented or added to the diet.
• The diuretics used to treat fluid overload all work in different ways to affect Na, Cl, K and water levels. Also have different adverse effects.
• Teach the client the S&S of hypokalemia. Report muscle cramps and weakness.