DRUG GENERIC NAME: Simvastatin BRAND NAME: Zocor CLASSIFICATI ON: Antihyperlipidemi cs

DOSAGE 20 mg / tab 1 tab once a day at bedtime

ACTION Inhibits 3hydroxy-3methylgluta ryl coenzyme A reductase. This enzyme is an early (and ratelimiting) step in the synthetic pathway of cholesterol.

INDICATIO NS Reduction of low-density lipoprotein and total cholesterol levels in patients with primary hypercholes terolemia.

CONTRAINDICAT IONS Contraindicated in patients with hypersensitivity to drug. DRUG INTERACTIONS: Digoxin: simvastatin may elevate digoxin levels slightly. Closely monitor plasma digoxin levels at initiation of simvastatin therapy.

SIDE EFFECTS AND ADVERSE REACTION Side Effects: Muscle pain, tenderness, weakness, change in the amount of urine, yellowing of the skin, dark urine, abdominal pain, persistent nausea / vomiting. Adverse Effects: CNS: headache GI: constipation, diarrhea, dyspepsia, flatulence RESP: upper respiratory tract infection HEPATIC: elevated liver enzymes. REMARKS:

NURSING RESPONSIBILITIES *Use cautiously in patients who consume substantial quantities of alcohol or have a history of liver disease. *Know that simvastatin is initiated only after diet and other nonpharmacologic therapies prove ineffective. The patient should be on a standard lowcholesterol diet during therapy. *Know that liver function tests should be performed at the start of therapy and periodically thereafter. A liver biopsy may be performed if enzyme elevations persist. *Instruct patient to take simvastatin with the evening meal; absorption is enhanced and cholesterol biosynthesis is greater. *Teach the patient about proper dietary management of serum lipids. When appropriate, recommend weight-