Rosuvastatin (Crestor)

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Drug class:
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Antihyperlipidemia: HMG-CoA reductase inhibitor
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Dosage:
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A: PO: 5-40 mg/d; max: 40 mg/d
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Contraindications:
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Active liver dx, pregnancy Caution: Hx/of liver dx, increased ETOH ingestion, trauma, severe metabolic DM, uncontrolled seizures
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Drug-Lab-Food interactions:
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Drug: decrease effect w/ antacids, phenytoin, and propranolol. May increase digoxin level, oral contraceptives. Increase effects with macrolide, antibiotics, antifungals.
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Thereapeutic Effects/Uses:
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To decrease cholesterol levels and to decrease serum lipids, especially LDL and triglycerides. Mode of Action: inhibits HMG-CoA reductase, the enzyme necessary for hepatic production of cholesterol.
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SE:
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Rare. HA, rash/pruritis, constipation, diarrhea.
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Adv Rxns:
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Rhabdomyolysis, myalgia, photosensitivity, hyperglycemia, elevated liver enzymes
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Nursing Process: Antihyperlipidemics (Statins)
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Assessment: Assess VS and baseline serum chemistry values (cholesterol, triglycerides, aspartate aminotransferase [AST], alanine aminotransferase [ALT], and creatine phosphokinase [CPK]). Obtain a med hx. Statin drugs are contraindicated for pts w/ a liver d/o. Pregnancy category: X.
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Planning:
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Pt’s cholesterol level will be <200 mg/dL in 6-8 weeks. Pt will be able to choose foods low in fat, cholesterol, and complex sugars.
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Interventions:
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-Monitor pt’s blood lipid levels (cholesterol, triglycerides, LDL, and high-density HDL) every 6-8 wks for the first 6 mos after statin therapy, then every 3-6 mos. For lipid profile, pt should fast for 12-14 hrs. Desired cholesterol value is <200 mg/dL; triglyceride value is <150 mg/dL (can vary); LDL is 6o mg/dL.. Cholesterol levels >240 mg/dL, LDL levels >160 mg/dL, and HDL levels <35 mg/dL can lead to severe cardiovascular event or cerebrovascular accident (CVA). -Monitor lab tests for liver function (ALT, ALP, and gamma-glutamyl transferase [GGT]). Antihyperlidemic drugs may cause liver d/o -Observe for S&S of GI upset. Taking the drug w/ sufficient water or with meals may alleviate some of the GI discomfort.
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Evaluation:
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effectiveness of drug–pt’s cholesterol level is w/in normal range. -Determine that pt is on a low-fat, low-cholesterol diet.
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Patient teaching:
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-Emphasize need to comply w/ drug regimen to lower blood lipids. -Inform pt that it may take several wks before blood lipid levels decline -Explain that lab tests for blood lipids (cholesterol, triglycerides, LDL, and HDL) are usually ordered every 3-6 mos. -Advise pt to have serum liver enzymes monitored as indicated by HCP. -Instruct pt to have annual eye examination and to report changes in visual acuity. -Instruct pts to take nicotinic acid w/ meals to decrease GI discomfort DIET -instruct pt that GI discomfort is a common problem with most antihyperlipidemics. Suggest increasing fluid intake when taking medication. -encourage pt to maintain low-fat diet by eating foods that are low in animal fat, cholesterol, and complex sugars.

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