c23 - mod 7

Question 1

Atorvastatin (Lipitor) classes

Answer 1

Therapeutic Class: Antihyperlipidemic

Pharmacologic Class: HMG-CoA reductase inhibitor, statin

Question 2

Atorvastatin (Lipitor actions/uses

Answer 2

The primary indication for atorvastatin is hypercholesterolemia. The statins act by inhibiting HMG-CoA reductase. As the liver makes less cholesterol, it responds by making more LDL receptors on the surface of liver cells. The greater number of LDL receptors in liver cells results in increased removal of LDL from the blood. Blood levels of both LDL and cholesterol are reduced, although at least 2 weeks of therapy is required before these effects are realized. To enhance the drug’s therapeutic effects, patients receiving atorvastatin should be placed on a cholesterol-lowering diet. The primary goal in atorvastatin therapy is to reduce the risk of myocardial infarction (MI) and stroke.

Question 3

administration alerts of Atorvastatin (Lipitor)

Answer 3

Administer with food to decrease GI discomfort.

May be taken at any time of the day.

onset: 2 wk for lipid-lowering effect

Question 4

adverse effects of Atorvastatin (Lipitor)

Answer 4

Headache and GI complaints such as intestinal cramping, diarrhea, and constipation are common during therapy

hepatic function is monitored during the first few months of therapy. The most serious adverse effect is rhabdomyolysis.

Contraindications include serious liver disease

Question 5

interactions of Atorvastatin (Lipitor)

Answer 5

interacts with many other drugs; Erythromycin may increase atorvastatin levels 40%. Risk of rhabdomyolysis increases with concurrent administration of atorvastatin with macrolide antibiotics, cyclosporine, and niacin.

Lab Tests: May increase serum transaminase and creatine kinase levels.

Herbal/Food: Grapefruit juice inhibits the metabolism of statins, allowing them to reach toxic levels.

Question 6

Cholestyramine (Questran) classes

Answer 6

Therapeutic Class: Antihyperlipidemic

Pharmacologic Class: Bile acid sequestrant

Question 7

Actions and Uses of Cholestyramine (Questran)

Answer 7

powder that is mixed with fluid before being taken once or twice daily.

it does not produce any systemic effects.

may take 30 days or longer to produce its maximum effect. Questran binds with bile acids (containing cholesterol) in an insoluble complex that is excreted in the feces. Cholesterol levels decline due to fecal loss.

Question 8

administration alerts of Cholestyramine (Questran)

Answer 8

Mix thoroughly with 60 to 180 mL

Have the patient drink it immediately

Give other drugs more than 2 hours before or 4 hours after the patient takes cholestyramine.

Question 9

Adverse Effects of Cholestyramine (Questran)

Answer 9

patients may experience constipation, bloating, gas, and nausea that sometimes limit its use.

contraindicated in patients with total biliary obstruction and in those with prior hypersensitivity to the drug.

Question 10

interactions of Cholestyramine (Questran)

Answer 10

can bind to other drugs, such as digoxin, penicillins, thyroid hormone, and thiazide diuretics, and interfere with their absorption, it should not be taken at the same time as these other medications. Cholestyramine may increase the effects of anticoagulants by decreasing the levels of vitamin K in the body.

Taking cholestyramine with food may interfere with the absorption of the following essential nutrients: beta-carotene, calcium, folic acid, iron, magnesium, vitamin B12, vitamin D, vitamin E, vitamin K, and zinc. Manifestations of nutrient depletion may include weakened immune system, cardiovascular problems, and osteoporosis.

Question 11

Gemfibrozil (Lopid) classes

Answer 11

Therapeutic Class: Antihyperlipidemic

Pharmacologic Class: Fibric acid drug (fibrate)

Question 12

Gemfibrozil (Lopid) actions + uses

Answer 12

treatment of hypertriglyceridemia and hypercholesterolemia. Effects of gemfibrozil include up to a 50% reduction in VLDL with an increase in HDL.

It is less effective than the statins at lowering LDL

Question 13

Gemfibrozil (Lopid) administration alerts

Answer 13

Administer with meals to decrease GI distress.

Question 14

Gemfibrozil (Lopid) adverse effects

Answer 14

produces few serious adverse effects, but it may increase the likelihood of gallstones and may occasionally affect liver function.

most common adverse effects are GI related: dyspepsia, diarrhea, nausea, and cramping.

Question 15

contraindication of Gemfibrozil (Lopid

Answer 15

patients with hepatic impairment, severe renal dysfunction, or pre-existing gallbladder disease, or those with prior hypersensitivity to the drug.

Question 16

interactions of Gemfibrozil (Lopid

Answer 16

Concurrent use of gemfibrozil with oral anticoagulants may potentiate anticoagulant effects.

Concurrent use with statins should be avoided because this increases the risk of myopathy and rhabdomyolysis.

Gemfibrozil may increase the effects of certain antidiabetic agents, statins, sulfonylureas, and vitamin K antagonists.