Lip It Or

Brand Name: Lipitor Generic Name: Atorvastatin Indications:  Adjunct to diet to reduce low-density lipoprotein (LDL), total cholesterol, apo B, and triglyceride levels in patients with primary hypercholesterolemia and mixed dyslipidemia (Fredrickson types IIa and IIb); primary dysbetalipoproteinemia (Fredrickson type III) that doesn't respond adequately to diet; adjunctive therapy to diet for elevated serum triglyceride levels (Fredrickson type IV)  Alone or as an adjunct to lipid-lowering treatments such as LDL apheresis in patients with homozygous familial hypercholesterolemia.  Adjunct to diet to increase high-density lipoprotein cholesterol in patients with primary hypercholesterolemia (heterozygous familial and nonfamilial) and mixed dyslipidemia (Fredrickson types IIa and IIb) Drug Classification: Therapeutic: lipid-lowering agents. Pharmacologic: HMG-CoA reductase inhibitors. Mechanism of Action: Inhibits 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase, an early (and rate-limiting) step in cholesterol synthesis. Lowering total LDL cholesterol. Increasing HDL and decreasing VLDL cholesterol and triglycerides. Dosage: PO (Adults): 10-20 mg once daily initially (may start with 40 mg/day if LDL-C should be lowered by >45%); may may be increased q2w up to 80 mg/day.

Special Precaution: Use cautiously in history of liver disease or significant alcohol abuse, renal impairment, advanced age or hypothyroidism, visual disturbances, myopathy, women of child-bearing age, and children <8 years. Pregnancy Risk Category: X Adverse Reaction:  CNS: headache, asthenia, insomnia.  EENT: rhinitis, pharyngitis, sinusitis.  GI: abdominal pain, dyspepsia, flatulence, nausea, constipation, diarrhea.  GU: urinary tract infection.  Hepatic: increased liver function test results.  Musculoskeletal: arthritis, arthralgia, myalgia.  Respiratory: bronchitis.  Skin: rash.  Other: infection, flu like syndrome, allergic reaction, peripheral edema. Contraindications: Contraindicated in patients hypersensitive to drug and in those with active liver disease or conditions associated with unexplained persistent elevations of serum transaminase levels. Also contraindicated in pregnant and breast-feeding women and in women of childbearing age who are at risk for becoming pregnant. Form: Tablets: 10 mg, 20 mg, 40 mg, 80 mg

(continuation Lipitor) Nursing Responsibilities:  Drug should be withheld or discontinued in patients at risk for renal failure secondary to rhabdomyolysis due to trauma; in serious, acute conditions that suggest myopathy; and in major surgery; severe acute infection; hypotension; uncontrolled seizures; or severe metabolic, endocrine, and electrolyte disorders.  Use of atorvastatin in children has been limited to those over age 9 with homozygous familial hypercholesterolemia.  Initiate drug therapy only after diet and other nonpharmacologic treatments prove ineffective. Patient should follow a standard low-cholesterol diet before and during therapy.  Before initiating treatment, secondary causes for hypercholesterolemia should be excluded and a baseline lipid profile done. Obtain periodic liver function test results and lipid levels, as ordered, before starting treatment and at 6 and 12 weeks after initiation, or after an increase in dosage, and periodically thereafter.  Drug may be given as a single dose at any time of day, with or without food.  Watch for signs of myositis.  Teach patient about proper dietary management, weight control, and exercise. Explain the importance of these factors in controlling elevated serum lipid levels.  Warn patient to avoid alcohol.

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Tell patient to inform doctor of adverse reactions, such as muscle pain, malaise, and fever. Advise patient that drug can be taken at any time of day and without regard to meals. Alert: Inform woman that drug is contraindicated during pregnancy because of potential danger to the fetus. Advise her to notify doctor immediately if pregnancy occurs or is suspected.