Generic Name:
Atorvastatin calcium
 
Brand Name:
Lipitor
 
Classification:
HMG-CoA reductase inhibitor
 
Dosage or Frequency:
 
 10-80 mg once daily.
Individualized dose according to
baseline LDL-C levels, goal of
therapy & patient response.  hypercholesterolemia
 Primary hypercholesterolemia &
combined (mixed)
hyperlipidemia 10 mg once daily.  combined (mixed) hyperlipidemia
 Homozygous familial
hypercholesterolemia 80 mg.  elevated
 Combination w/ other medicinal
compd Max: 10 mg.  patients w/ dysbetalipoproteinemia
 Children ≥10 years old.
  Severe dyslipidemia 10 mg once
daily, may be increased to 80 mg
daily.
 
Route:
P.O
Mechanism of Action
Inhibits HMG-CoA reductase, an early
(and rate limiting) step in cholesterol
biosynthesis
 
Indication
 Adjunct to diet for the treatment of
patients w/ elevated total
cholesterol (total-C), low density
lipoprotein cholesterol (LDL-C),
apolipoprotein B (apo-B),
triglycerides (TG) & to increase
high density lipoprotein cholesterol
(HDL-C) in patients w/ primary
(heterozygous familial & non-
familial hypercholesterolemia),
(Fredrickson types IIa & IIb),
serum TG levels
(Fredrickson type IV) & for
(Fredrickson Type III) who do not
respond adequately to diet.
Reduction of total-C & LDL-C in
patients w/ homozygous familial
hypercholesterolemia. 
Side Effects
 Gastrointestinal symptoms such as
diarrhea
 Cold symptoms such as a runny or
stuffy nose
 Joint pain
 Insomnia
 Urinary tract infection
 Nausea
 Loss of appetite
 Indigestion symptoms such as
stomach discomfort or pain
 Increased transaminases
 Muscle spasms with or without
pain
 Musculoskeletal pain (pain that
affects the muscles, ligaments,
tendons bones, land joints
 
 
Adverse Effects
 Rhabdomyolysis
Nursing Responsibility
 Use only after diet and other
non-drug therapies prove
ineffective. Patient should follow
a standard low-cholesterol diet
before and during therapy.
  Before treatment, assess patient
for underlying causes for
hypercholesterolemia and obtain
a baseline lipid profile. Obtain
periodic liver function test results
at 6 to 12 weeks after initiation.
  Drug may be given as a single
dose at any time of the day, with
or without food,
  Watch for signs of myositis.
  Temporarily withheld or
discontinue in any patient with
an acute, serious condition
suggestive of myopathy or w/ a
risk factor predisposing to the
development of renal failure
secondary to rhabdomyolysis.
 Discontinue therapy if markedly
elevated CPK levels occur or if
myopathy is diagnosed or
suspected. 
Illustration:  Alone or as an adjunct to lipid-
lowering treatments, such as LDL
cholesterol in patients with
homozygous familial
hypercholesterolemia.

 Heterozygous familiar
hypercholesterolemia.
  
 To reduce the risk of MI, stroke,
angina, or revascularization in
patients with multiple risk factors
for CAD but who don’t yet have
the disease.
 
Contraindication
 Hypersensitivity to drug.
 Active liver disease or
unexplained persistent elevations
of serum transaminases
exceeding 3x the upper limit of
normal.
 Women of childbearing potential.
Pregnancy & lactation.
Generic Name:
Epoetin alfa (erythropoietin)
 
Brand Name:
Epogen, Eprex, Procrit
 
Classification:
Recombitant human erythropoietin
 
Dosage or Frequency:
Intravenous
Increase yield of autologous blood
Adult: As epoetin alfa or zeta: 600
U/kg over 2 minutes twice wkly for 3
wk before surgery; in conjunction with
iron, folate and B12 supplementation.
 
Parenteral
Anaemia of chronic renal failure
Adult: As epoetin alfa: Initially, 50
U/kg SC/IV 3 times wkly for
predialysis and haemodialysis patients
and 50 U/kg twice wkly for peritoneal
dialysis patients, may increase
according to response in steps of 25
U/kg 3 times wkly at 4 wkly intervals.
Mechanism of Action Side Effects Nursing Responsibility 
Erythropoietin regulates erythropoiesis
• Increased blood pressure;
by stimulating the differentiation and  Before starting therapy,
proliferation of erythroid precursors, • Joint pain, bone pain, muscle pain; evaluate patient’s status.
stimulating the release of reticulocytes Patient should receive
• Itching or rash;
into the circulation, and synthesis of
cellular haemoglobin. Recombinant • Fever, chills, cough; adequate iron
human erythropoietin is available as supplementation beginning no
• Mouth pain, trouble swallowing; later than when epoetin alfa
epoetin alfa and epoetin beta which
are used in the management of • Nausea, vomiting; treatment starts and
anaemias associated with CRF, cancer continuing throughout
• Headache, dizziness;
chemotherapy and anti-AIDS drug therapy. Patient may also
zidovudine. • Trouble sleeping;
need vitamin B12 and folic
 
• Sleep problems (insomnia), acid.
Indication
• Increase yield of autologous blood  
• Anaemia of chronic renal failure  Monitor blood pressure
Adverse Effects
• Anaemia in zidovudine-treated before therapy. Patients with
HIV-infected patients • Hypertensive crisis with chronic renal failure have
• Anaemia related to non-myeloid
encephalopathy-like symptoms e.g. hypertension. Blood pressure
malignant disease chemotherapy
• Reduce need for allogenic blood Headache, confusion, generalized may increase, especially
transfusion in anemic patient when hematocrit increases in
seizures, thrombosis.
scheduled to have elective, non- the early part of the therapy.
cardiac, nonvascular surgery..  • Hyperkalemia  
   Institute diet restrictions or
• Seizures
drug therapy to control blood
pressure.
.
Child: As epoetin alfa: Initially, 50 Contraindication  Monitor hemoglobin level
U/kg 3 times wkly. May increase dose Uncontrolled hypertension, twice weekly until it stabilizes
at 4 wkly intervals in increments of 25 hypersensitivity to mammalian cell in the target range (10 to 12
U/kg 3 times wkly until a target products and human albumin
haemoglobin concentration of 9.5-11   g/dl for most patients) and
g/100 mL is reached. Usual maintenance dose is
maintenance dose: <10 kg: 225-450 established, then continue to
U/kg/wk; 10-30 kg: 180-450 U/kg/wk monitor at regular intervals.
and >30 kg: 90-300 U/kg/wk.  
   Monitor blood counts,
Parenteral
elevated hematocrit may
Anaemia in zidovudine-treated HIV-
infected patients cause excessive clotting.
Adult: As epoetin alfa: Initially, 100
U/kg SC/IV thrice wkly for 8 wk;  Evaluate patient who
increase every 4-8 wk by 50-100 U/kg experiences a lack or loss of
according to response. Max: 300 U/kg effect for pure red cell aplasia
thrice wkly.

Subcutaneous
Anaemia related to non-myeloid
malignant disease chemotherapy
Adult: As epoetin alfa or zeta: Initially,
150 U/kg 3 times wkly. Dose may be
increased at 4-8 wk intervals to 300
U/kg 3 times wkly. Stop treatment if
response is still inadequate after 4 wk
of treatment using this higher dose.
 
:
Route:
Intravenous
Subcutaneous
 
Illustration:
Generic Name: Mechanism of Action Side Effects Nursing Responsibility
Furosemide
  A potent drug that inhibits sodium and  Diarrhea, constipation;  To prevent nocturia, give PO
Brand Name: chloride reabsorption at the proximal and IM preparations in the
and distal tubules and the ascending  Numbness or tingling; morning. Give second dose in
Apo-furosemide, furosemide special
IV, furoside, Lasix, Novo-semide, loop of henle. the afternoon.
 Headache, dizziness; or
uritol  
Indication  If oliguria and azotemia
   Blurred vision.
develops or increases, drug
Classification:  Hepatic impairment Fluid
 Ringing in your ears, hearing may need to be stopped.
Loop diuretic retention associated w/ liver
loss;
  disease   Monitor fluid intake and
Dosage or Frequency:  Renal impairment Fluid  Easy bruising, unusual output, electrolyte, BUN and
Adult Recommended max daily retention associated w/ chronic bleeding; carbon dioxide levels
dose: 1,500 mg. Use lowest dose renal failure  frequently.
sufficient to achieve desired effect.  Hepatic impairment Fluid  Sudden weakness or ill feeling,
Give IV only when PO is not feasible retention associated w/ liver fever, chills;  Watch for signs of
or ineffective (eg, impaired intestinal disease hypokalemia, such as muscle
 Renal impairment Fluid  Painful or difficult urination; weakness and cramps.
absorption) or if a rapid effect is
retention associated w/ chronic
required. Transfer to PO therapy as  Numbness, tingling, or burning  Drug may not be well
renal failure
soon as possible if IV is used. pain; absorbed orally in patients
 Renal impairment Maintenance
  with severe heart failure.
of fluid excretion in acute renal  A light-headed feeling, like you
Hepatic impairment Fluid retention failure Drug may need to be given
might pass out;
associated w/ liver disease Initially, IV even if patient is taking
20-80 mg daily as a single dose or   other oral drugs.
divided doses. 
 
Renal impairment Fluid retention Contraindication Adverse Effects  Monitor elderly patients, who
associated w/ chronic renal are especially susceptible to
failure Initially, 40-80 mg daily as a  Hypersensitivity to furosemide,  Pancreatitis excessive diuresis, because
single dose or 2 divided doses. sulfonamides or to any of the  Agranulocytosis circulatory collapse and
Maintenance: 250-1,500 mg daily in excipients.  Aplastic anemia thromboembolic
dialysis patients.     Leukopenia complications are possible
   Hypovolemia or dehydration;  Thrombocytopenia
Renal impairment Fluid retention anuric renal failure not
responding to furosemide;
associated w/ nephrotic
severe hypokalemia &
syndrome Initially, 40-80 mg daily
hyponatremia; pre-comatose &
as a single dose or several divided
comatose states associated w/
doses.
hepatic encephalopathy.
Children 2 mg/kg. Max: 40 mg
daily. IV   Lactation
 
Adult Hepatic impairment Fluid
retention associated w/ liver
disease Initially, 20-40 mg as a
single dose. 
 
Renal impairment Fluid retention
associated w/ chronic renal
failure Initially, 0.1 mg/min
continuous IV infusion, gradually
increasing the rate every ½ hr
according to response.  
Renal impairment Maintenance of
fluid excretion in acute renal
failure Initially, 40 mg inj, may be
given as continuous IV infusion w/ a
rate of 50-100 mg/hr if desired
increase in fluid excretion is not
attained. 
 
Route:
 P.O.
 I.V.
 
Illustration: