742
P A R T 8
Drugs acting on the cardiovascular system
by-products to avoid hypersensitivity reactions;
active liver disease or history of alcoholic liver
disease
, which could be exacerbated by the effects
of these drugs
; current status of pregnancy or
breastfeeding
because of potential adverse effects
on the fetus or neonate
; and impaired endocrine
function,
which could be exacerbated by effects on
steroid hormones.
■
■
Perform a physical assessment
to establish a
baseline before beginning therapy and during
therapy to determine its effectiveness and evaluate
for any potential adverse effects.
■
■
Weigh the person
to establish a baseline and
evaluate for changes reflecting lifestyle changes
that accompany drug therapy.
■
■
Assess the person’s neurological status,
including level of orientation, affect and
reflexes, which show early changes related to
CNS function,
to evaluate for possible CNS
effects of the drug.
■
■
Obtain vital signs, including pulse and blood
pressure,
to identify changes
.
■
■
Inspect the abdomen for distension and auscultate
bowel sounds
for changes in gastrointestinal
motility.
■
■
Assess bowel elimination patterns, including
frequency of stool passage and stool characteristics,
to identify possible constipation.
■
■
Monitor the results of laboratory tests, including
renal and liver function tests,
to identify possible
toxicity and serum lipid levels to evaluate the
drug’s effectiveness.
Implementation with rationale
■
■
Administer the drug at bedtime
because the highest
rates of cholesterol synthesis occur between
midnight and 5 a.m., and the drug should be taken
when it will be most effective
; give atorvastatin at
any time during the day.
■
■
Monitor serum cholesterol and LDL levels before
and periodically during therapy
to evaluate the
effectiveness of this drug.
■
■
Arrange for periodic ophthalmic examinations
to
monitor for cataract development.
■
■
Monitor liver function tests before and periodically
during therapy
to monitor for liver damage
;
consult with the prescriber to discontinue the drug
if the aspartate aminotransferase (AST) or alanine
aminotransferase (ALT) level increases to three
times normal.
■
■
Ensure that the person has attempted a cholesterol-
lowering diet and exercise program for at least 3 to
6 months before beginning therapy
to ensure the
need for drug therapy.
■
■
Encourage the person to make the lifestyle changes
necessary
to decrease the risk of CAD and to
increase the effectiveness of drug therapy.
■
■
Withhold atorvastatin or fluvastatin in any
acute, serious medical condition (e.g. infection,
hypotension, major surgery or trauma, metabolic
endocrine disorders, seizures)
that might suggest
myopathy or serve as a risk factor for the
development of renal failure.
■
■
Suggest the use of barrier contraceptives for women
of childbearing age
because there is a risk of severe
fetal abnormalities if these drugs are taken during
pregnancy.
■
■
Provide comfort measures
to help the person
tolerate drug effects.
These include small, frequent
meals
to minimise nausea and vomiting
; access
to bathroom facilities
to ensure adequate bowel
evacuation
; bowel program as needed
to address
constipation
; use of food with the drug if GI
upset is severe
to decrease direct irritating effects
;
environmental controls, such as temperature and
lighting controls,
to help deal with headaches
; and
safety precautions, such as lighting control and
activity restrictions,
to protect the person if vision
changes and muscle effects occur
.
■
■
Offer support and encouragement
to help the
person deal with the diagnosis, needed lifestyle
changes and the drug regimen.
■
■
Provide thorough teaching, including the name of
the drug, dosage prescribed and administration at
bedtime for best effectiveness; measures to avoid
adverse effects, warning signs of problems and the
need for follow-up laboratory testing to monitor
cholesterol and lipid levels; importance of follow-
up renal and liver function testing; dietary and
lifestyle changes for risk reduction; and monitoring
and evaluation,
to enhance knowledge about drug
therapy and to promote compliance
.
See the Critical thinking scenario for discussion of a
person receiving an HMG-CoA inhibitor.
Evaluation
■
■
Monitor response to the drug (lowering of serum
cholesterol and LDL levels, prevention of first MI,
slowing of progression of CAD).
■
■
Monitor for adverse effects (headache, dizziness,
blurred vision, cataracts, GI upset, liver failure,
rhabdomyolysis).
■
■
Monitor the effectiveness of comfort measures and
compliance with the regimen.
■
■
Evaluate the effectiveness of the teaching plan
(person can name drug, dosage, adverse effects
to watch for and specific measures to avoid
them; individual understands the importance of
continued follow-up).
