Drug therapy protocol for the administration of atorvastatin in the treatment of high cholesterol levels Clinical Indication for Use
Added on 2021-06-18
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Running head: DRUG PROTOCOL AND CRITICAL DISCUSSION1Pharmacology for Nursing PracticeStudent’s nameInstitution
DRUG PROTOCOL AND CRITICAL DISCUSSION2Drug therapy protocol for the administration of atorvastatin in the treatment of high cholesterollevels Clinical Indication forUseReducing 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 diseaseHeart complications in people with type 2 diabetesCoronary heart diseaseAdults and children above 10 yearsExclusion CriteriaAllergy to atorvastatinLiver diseaseThyroid disorderKidney diseaseHeavy alcoholic drinkerNot recommended for breastfeeding mothersNot recommended for pregnant women (Frandsen and Pennington, 2013. Chapter 8.p 136)Pharmacodynamics (Mechanism of Action)Atorvastatin is a selective and active inhibitor of the hepatic enzyme hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase. HMG-CoA reductase convertsHMG-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
DRUG PROTOCOL AND CRITICAL DISCUSSION3(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 absorptionAtorvastatin 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%.DistributionMaximum 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 MetabolismAtorvastatin 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 beenaccredited to the active metabolites of atorvastatin ExcretionAtorvastatin is eliminated in bile after extrahepatic or hepatic metabolism. Less than 2% ofthe orally administered dose of atorvastatin is recovered in urine (Frandsen and Pennington, 2013. Chapter 8.p 134).Drug InteractionsAntibiotics such as erythromycin- the serum concentration of atorvastatin may be increasedAntifungal medications such as fluconazole- the risk of severity of adverse effects is likely to be increased when fluconazole is combined with atorvastatin
DRUG PROTOCOL AND CRITICAL DISCUSSION4Ciprofloxacin- 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).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 therapy2-4 weeks and evaluation of lipids levels done Adverse Effects Side effectsDiarrhoea, heartburn, gas, joint pain (Frandsen and Pennington, 2013. Chapter 8.p 136)HypersensitivityAllergic reactions such as hives, difficulty in breathing, swelling of the throat, tongue, lips, face (Roberts, 2014)Adverse side effectsConfusion 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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