Drug therapy protocol for the administration of atorvastatin in the treatment of high cholesterol levels
|Clinical Indication for Use|| |
Reducing amount of Low Density Lipoproteins (LDL), increasing the amount of High Density Lipoprotein (HDL), and lowering triglycerides level (Ramrakha, 2013.chapter 5, page 236)
· Heart disease
· Heart complications in people with type 2 diabetes
· Coronary heart disease
· Adults and children above 10 years
· Allergy to atorvastatin
· Liver disease
· Thyroid disorder
· Kidney disease
· Heavy alcoholic drinker
· Not recommended for breastfeeding mothers
· Not recommended for pregnant women
(Frandsen and Pennington, 2013. Chapter 8.p 136)
|Pharmacodynamics (Mechanism of Action)|
Atorvastatin is a selective and active inhibitor of the hepatic enzyme hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase. HMG-CoA reductase converts HMG-CoA to mevalonate in the pathway of the biosynthesis of cholesterol. In the event where HMG-CoA reductase is inhibited by atorvastatin, there is a successive decrease in the levels of the hepatic cholesterol. Consequently, decrease in the levels of hepatic cholesterol stimulates the upregulation of hepatic Low-Density Lipoproteins Cholesterol (LDL-C) receptors thereby leading to an increase in hepatic uptake of LDL-C and reduces the concentrations of serum LDL-C (Moscou and Snipe, 2012. Chapter 24, p.393)
Administration and absorption
Atorvastatin is rapidly absorbed after oral administration with or without food. The medication can be taken at any time every day but it is advisable to take it at around the same time every day. Atorvastatin is absolutely bioavailable at about 14% while the systemic availability of HMG-CoA inhibitory activity is at about 30%.
Maximum concentration of plasma is accomplished in 1-2 hours after administration. The mean distribution volume is approximately 381litres and it is about 98% protein bound to the plasma membrane
Atorvastatin is metabolized to its ortho and para hydroxylated derivative and to its several products of beta oxidation. About 70% of HMG-CoA reductase inhibitory activity has been accredited to the active metabolites of atorvastatin
Atorvastatin is eliminated in bile after extrahepatic or hepatic metabolism. Less than 2% of the orally administered dose of atorvastatin is recovered in urine (Frandsen and Pennington, 2013. Chapter 8.p 134).
· Antibiotics such as erythromycin- the serum concentration of atorvastatin may be increased
· Antifungal medications such as fluconazole- the risk of severity of adverse effects is likely to be increased when fluconazole is combined with atorvastatin
· Ciprofloxacin- the risk of severity of adverse effects is likely to be increased when ciprofloxacin is combined with atorvastatin
Ciprofibrate-the severity of myopathy, myoglobulin, and rhabdomyolysis can be increased when ciprofibrate is combined with atorvastatin (Moscou and Snipe, 2012. Chapter 24, p.394).
|Dose, Route, Duration of Therapy Adult:|
|Dose and Route |
Initial dose: 10mg or 20mg orally once a day. Initial dose of 40mg to be used in patients who need LDL-C reduction of more than 45% (Frandsen and Pennington, 2013. Chapter 8.p 134)
Maintenance dose: 10mg to 80mg orally once a day
Duration of therapy
2-4 weeks and evaluation of lipids levels done
Diarrhoea, heartburn, gas, joint pain (Frandsen and Pennington, 2013. Chapter 8.p 136)
Allergic reactions such as hives, difficulty in breathing, swelling of the throat, tongue, lips, face (Roberts, 2014)
Adverse side effects
Confusion and memory problems, unexplained muscle pain or tenderness, dark coloured urine, urinating less than normal or not urinating at all, dry mouth, fruity breath odour (Frandsen and Pennington, 2013.chapter 8.p. 136-137)
|Response to Adverse Event (this is directed at the practitioner to respond to an adverse event occurring)|
· Stop the medication immediately
· Identify the cause of the adverse effect whether overdose, hypersensitivity, or drug interactions
· Give an alternative solution based on the cause of the adverse effect
· Document the adverse event
Clinical decision making in nursing care is very key in ensuring safe and quality use of medications and principles of drug therapy (Standing, 2017. Chapter 1, p. 7). The purpose of this paper is to discuss the management of medication prescribed to a diabetic patient, Mavis, regarding the safety and proper use of the medication.
In light of this, the paper deliberates on the application of clinical decision-making process of assessment, implementation and evaluation with regards to the medication listed for Mavis. The paper also discusses patient education and cultural requirements as nursing responsibilities with respect to the patient and her medications.
During assessment, the patient should be able to understand the treatment and the medications given. In understanding her medication and treatment, Mavis should be made aware that she is suffering from diabetes type two and that she has very high levels of cholesterol and triglycerides which may potentially lead to a heart disease. The medications prescribed for the Mavis in this case are metformin, glibenclamide, and atorvastatin. Mavis already had been taking metformin, and therefore assessment should be done on whether she understands any side effects of the medication and any hypersensitivity to the drugs being administered. If she needs any more clarification, then that should be communicated so that teaching can be done.
Due to the fact that Mavis had not used both atorvastatin and glibenclamide, understanding of these medications are essential for her. It is also necessary to note that both metformin and glibenclamide are indicated for the treatment of type two diabetes and the side effects tend to be similar. Mavis should be made aware that if she notices any adverse reaction of any of the medications, she should call the doctor right away. Mavis has already put on extra weight and so monitoring should be done since one of the side effects of glibenclamide is weight gain.
Below is the information about the medication listed for Mavis and the important points that Mavis should be made aware of.
Metformin and glibenclamide
Both are used to treat type two diabetes. (Anwar, Ahmad, Karagianni & Lindow, 2018. P.404)
Both of them decrease the amount of sugar level in the blood
Nausea, heartburn, stomach upsets, diarrhoea, metallic taste in the mouth (Frandsen and Pennington, 2013. Chapter 8.p 136)
Adverse side effects
Mental and mood changes, dark urine, signs of infection such as sore throat, yellowing of eyes and skin, swelling of feet and hands, easy bleeding, excessive weight gain, blurred vision, dizziness, prolonged diarrhoea
Any other severe side effects should be reported to the doctor immediately.
Precautions when using the drugs
Both of the drugs must be supplemented with proper diet and exercise
Limit alcohol consumption
Do not drive or use any machinery when drowsy
Administration and dosage
Metformin should be taken orally 500mg twice a day in the morning and in the afternoon until the completion of the dose. (McGrath, Glastras, Scott, Hocking & Fulcher, 2018. p 9)
Glibenclamide should be taken orally 5mg once every morning until the dose is completed
Medication is used for the treatment of high cholesterol levels (Ramrakha, 2013.chapter 5, p.236)
Diarrhea, heartburn, gas, joint
Adverse side effects
Confusion and memory problems, dry mouth, unexplained muscle pain or tenderness, fruity breath, odour dark coloured urine, urinating less than normal or not urinating at all.
Avoid taking grape juice
Supplement with proper diet and exercise
Administration and dosage
Take orally 40mg once every night until the completion of the dose
In order to make sure that implementation of the assessment done is achieved, Mavis should be made aware that diet and exercise is key to her treatment process (Ramrakha, 2013 chapter 5, p. S52) Therefore, dieticians will be able to talk to her on the importance of checking her diet. A diet plan may also be appropriate for her and review done at least weekly.
There may also be need of formulating an exercise plan for her and inquire with any of the family members to be assisting with exercises. Monitoring of the proper administration and dosage of the medications is also necessary to ensure that Mavis has understood the dosage and administration of the drugs (Avorn, 2018, p.690). A care plan needs to be written up so that all the education done is implemented.
During evaluation, key things must be considered. Mavis should be able to verbally acknowledge that she understands the drugs and that she understands why she is taking the drugs (Olupeliyawa, 2017, p.59) She also has to acknowledge that she understands the side effects of the drugs and what precautions to take when taking the drugs. She also has to verbally acknowledge that she has had a dietician and a meal plan written down and that she is totally involved in all aspects of her illness and treatment process.
Knowing all these information from Mavis assures us that she is safe in terms of the medications and that she understands the medication she is taking (Konduru et al., 2017. p. 37). Evaluation should also be done to ensure the efficacy of the medication and if Mavis is not responding well, then the physician must be informed and this outcome documented.
Effective patient education enables the patient to be able to put into practice what was taught (Sherifali et al., 2018, p. S40). In performing patient education, Mavis must be involved in identifying what teaching strategy she may prefer to be used. According to her medical history she is not able to read the time in her watch anymore, this means teaching using printable materials may not be effective. An alternative is to assess whether other family members are available to help in teaching her using the printable materials while at home (Sherifali et al., 2018, p. S45)
To ensure safety in administering the medications to Mavis, any possible teaching strategy that she finds comfortable such as one-on-one should be employed and thorough patient education done since it is evident from the clinical history that she does not care about her condition. She needs to understand the risks factors involved when she does not take her medication and the importance of faithfully taking her medication. At the end of the education, Mavis should be able to explain everything that she has learned as pertains to diabetes such as diet and exercise and the correct administration of her medication (Wahowiak, 2017, p.240)
Mavis is an indigenous woman who holds to the values and the principles of her culture. In ensuring safe administration of medication to Mavis, it is extremely important to maintain a high level of knowledge about her culture in order to quickly asses her medical needs. It is also necessary to assess her attitude since culture plays a very important role in the way a person behaves and makes decisions (Blanchet-Cohen and Richardson/Kinewesquao, 2017. p. 140). Assessing her attitude will enable us to identify any stereotypes, and interaction rules or communication customs and hence assist in proper communication about her medication and treatment.
Clearly communicating to Mavis about her medication in layman’s terms is also crucial for the safe administration of her medications. Understanding medical terms may not be easy. Additionally, being extra sensitive about our actions to avoid any misconceptions is very important to the safe administration of medication to Mavis. Mavis will leave the hospital happy and satisfied that her wellbeing was taken care of and her cultural concepts and requirements were not overlooked (Clarke, 2017. pp 2-3).
Clinical decision-making process is very essential in providing nursing care to patients. The processes of assessment, implementation, and evaluation enables the nurse to concentrate on the finer details of the patient and the medication to be administered. The nurse is able to understand the patient better and finally evaluate if the patient is progressing well. Additionally, effective patient education and understanding of the cultural affiliations of a patient ensures safe administration of medication to the patients (Sherifali et al., 2018. Pp S39-40) and ensures that the patient is comfortable to interact with the nurses and talk about her needs freely.
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