Drug Name Dosages Therapeutic Actions Indications Adverse effects Contraindications Nursing considerations

atorvastatin ADULTS Inhibits HMG-CoA  Adjunct to diet in  CNS:  Contraindicated CLINICAL ALERT!
calcium reductase, the treatment of elevated Headache, with allergy to
(ah tor' va  Initially, 10 mg enzyme that total cholesterol, asthenia atorvastatin,  Name confusion has been
stah tin) PO once daily catalyzes the first serum triglycerides,  GI: fungal reported between written
Lipitor without regard step in the and LDL cholesterol in Flatulence, byproducts, active orders for Lipitor
to meals; for cholesterol synthesis patients with primary abdominal liver disease or (atorvastatin) and Zyrtec
Pregnancy maintenance, pathway, resulting in hypercholesterolemi a pain, cramps, unexplained and (certirizine). Use extreme
Category X 10–80 mg PO a decrease in serum (types IIa and IIb) and constipation, persistent caution.
daily. May be cholesterol, serum mixed dyslipidemia, nausea, elevations of
Drug combined with LDLs (associated primary dyspepsia, transaminase Assessment
classes bile acid– with increased risk dysbetalipoproteine heartburn, levels, pregnancy,
binding resin. of CAD), and mia, and homozygous liver failure lactation.
increases serum familial  Use cautiously  History: Allergy to
 Antihyper  Respiratory:
HDLs (associated hypercholesterolemi a with impaired atorvastatin, fungal
lipidemic PEDIATRIC Sinusitis,
with decreased risk whose response to endocrine byproducts; active hepatic
 HMG- PATIENTS 10–17 pharyngitis
of CAD); increases dietary restriction of function. disease; acute serious illness;
CoA YR  Other:
hepatic LDL saturated fat and pregnancy, lactation
reductase Rhabdomyoly
recapture sites, cholesterol and other  Physical: Orientation, affect,
inhibitor sis with acute
 Initially, 10 mg enhances reuptake nonpharmacologic muscle strength; liver
renal failure,
PO daily. and catabolism of measures has not been evaluation, abdominal
arthralgia,
Maximum, 20 LDL; lowers adequate examination; lipid studies,
myalgia
mg/day; do not triglyceride levels.  To increase HDL-C LFTs, renal function tests
change dose of in patients with
intervals < 4 primary Interventions
wk. hypercholesterolemi a
and mixed  Obtain LFTs as a baseline
dyslipidemia and periodically during
 Adjunct to diet to treat therapy; discontinue drug if
elevated serum AST or ALT levels increase
triglyceride levels to 3 times normal levels.
 Adjunct to diet in  WARNING: Withhold
treatment of boys and atorvastatin in any acute,
postmenarchal girls serious condition (severe
ages 10–17 with infection, hypotension, major
heterozygous familial surgery, trauma, severe
cholesterolemia if diet metabolic or endocrine
alone is not adequate disorder, seizures) that may
to control lipid levels suggest myopathy or serve as
and LDL- C levels are risk factor for development
> 190 of renal failure.
 Ensure that patient has tried
 mg/dL or if LDL-C cholesterol-lowering diet
level is > 160 mg/dL regimen for 3–6 mo before
and there is a family beginning therapy.
history of premature  Administer drug without
CV disease or the regard to food, but at same
child has two or more time each day.
risk factors for the  Atorvastatin may be
development of combined with a bile acid–
coronary disease binding agent. Do not
 Prevention of CV combine with other HMG-
disease in adults CoA reductase inhibitors or
without clinically fibrates.
evident coronary  Consult dietitian about low-
disease but with cholesterol diets.
multiple risk factors  WARNING: Ensure that
for CAD such as age patient is not pregnant and has
> 55 yr, smoking, appropriate contraceptives
hypertension, low available during therapy;
HDL-C, family serious fetal damage has been
history of early CAD; associated with this drug.
to reduce the risk of
MI and risk for Teaching points
revascularization
procedures and angina
 Take this drug once a day, at
about the same time each day,
preferably in the evening; may
be taken with food. Do not
drink grapefruit juice while
taking this drug.
 Institute appropriate dietary
changes.
 Arrange to have periodic
blood tests while you are
taking this drug.
 Alert any health care provider
that you are on this drug; it
will need to be discontinued if
acute injury or illness occurs.
 Do not become pregnant while
you are on this drug; use
barrier contraceptives. If
 you wish to become
pregnant or think you are
pregnant, consult your
health care provider.
 You may experience these
side effects: Nausea (eat
frequent small meals);
headache, muscle and joint
aches and pains (may lessen
over time).
 Report muscle pain,
weakness, tenderness;
malaise; fever; changes in
color of urine or stool;
swelling.