Zocor (simvastatin)

Clinical Medications Worksheets Generic Name simvastatin

Trade Name Zocor

Peak unknown

Onset unknown

Classification Dose Route Time/frequency HMG-CoA reductase inhibitors 40 mg PO Qd lipid-lowering agents Duration Normal dosage range unknown 5mg/day initially. Increase at 4-week intervals up to 40mg/day

Why is your patient getting this medication Hyperlipidemia Mechanism of action and indications (Why med ordered) Inhibit an enzyme, 3-hydroxy-3-methylglutaryl- coenzyme A (HMG-CoA) reductase, which is responsible for catalyzing an early step in the synthesis of cholesterol.

For IV meds, compatibility with IV drips and/or solutions N/A Nursing Implications (what to focus on) Contraindications/warnings/interactions Hypersensitivity, cross-sensitivity among agents may occur, sepsis, acute hypotension, history of liver disease or significant alcohol use/abuse, visual disturbances. Common side effects Abdominal cramps, constipation, diarrhea, flatus, heartburn, rashes, rhabdmyolysis (rapid breakdown of skeletal muscle tissue)

Interactions with other patient drugs, OTC or herbal medicines (ask patient specifically) Protonix: A case report suggests that coadministration with esomeprazole may increase the plasma concentrations of atorvastatin and the associated risk of myopathy. The proposed mechanism is competitive inhibition of intestinal Pglycoprotein, resulting in decreased drug secretion into the intestinal lumen and increased drug bioavailability. Another, perhaps minor mechanism is competitive inhibition of CYP450 3A4 metabolism. Synthroid: Rarely, lovastatin and simvastatin have been reported to reduce the pharmacologic effects of thyroid hormone. The exact mechanism of interaction is unknown. In isolated case reports, patients stabilized on levothyroxine developed symptoms of hypothyroidism and/or elevated thyroid-stimulating hormone (TSH) levels following the addition of lovastatin or simvastatin. Discontinuation of the statin led to resolution of symptoms and normalization of TSH levels. In one case, the patient was subsequently prescribed pravastatin without any adverse effects on his thyroid status. No particular intervention should be necessary when lovastatin or simvastatin is prescribed to patients receiving thyroid hormone therapy, since the interaction appears to be extremely rare. However, thyroid hormone dosage may need to be adjusted if an interaction is suspected. Alternatively, a switch to a statin with a different metabolic profile such as fluvastatin, pravastatin, or rosuvastatin may help.

Lab value alterations caused by medicine Evaluate serum cholesterol and triglyceride levels before initiating, after 4-6 wk of therapy, and periodically thereafter. u s e t h y r o i d f u n c t i o n t e s t a b n o r m a l i t i e s .

Be sure to teach the patient the following about this medication Instruct patient to take medication as directed and not to skip doses or double up on missed doses. Advise patient to avoid drinking more that 1 qt/day of grapefruit juice during therapy. Medication helps control but does not cure elevated serum cholesterol levels. Advise patient that this medication should be used in conjunction with diet restrictions (fat, cholesterol, carbohydrates, alcohol), exercise, and cessation of smoking. Instruct patient to notify health care professional if unexplained muscle pain, tenderness, or weakness occurs, especially if accompanied by fever or malaise. Advise patient to wear sunscreen and protective clothing to prevent photosensitivity reactions (rare). Emphasize the importance of follow-up exams to determine

Nursing Process- Assessment (Pre-administration assessment) Obtain a dietary history, especially with regard to fat consumption, ophthalmic exams are recommended before and yearly during therapy.

Assessment Why would you hold or not give this med? If patient develops muscle tenderness during therapy, monitor CPK levels. If CPK levels are markedly ↑ or myopathy occurs, therapy should be discontinued.

Evaluation Check after giving Decrease in serum LDL, VLDL, and total cholesterol levels. Increase in HDL cholesterol levels. Decrease in triglyceride levels.