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)
Lab value alterations caused by medicine
Evaluate serum cholesterol and triglyceride levels before
initiating, after 4-6 wk of therapy, and periodically thereafter.
Monitor liver function tests, including AST, before, at 6-12 wk
after initiation of therapy or after dose elevation, and then every
6 mo. If AST levels to 3 times normal, HMG-CoA reductase
inhibitor therapy should be discontinued. May also cause
alkaline phosphatase and bilirubin levels, may cause
thyroid function test abnormalities.
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
effectiveness and to monitor for side effects.

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.
Nursing Process- Assessment
Assessment
(Pre-administration assessment)
Why would you hold or not give this med?
Obtain a dietary history, especially with regard to If patient develops muscle tenderness during
fat consumption, ophthalmic exams are
therapy, monitor CPK levels. If CPK levels
recommended before and yearly during therapy.
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.