1 Hypersensitivity;Activeliverdiseaseorunexplainedpersist ...

1 Name /bks_53161_deglins_md_disk/pravastatin 03/04/2014 11:26AM Plate # 0-Composite pg 1 # 1. 1 Contraindications/Precautions Contraindicated in: Hypersensitivity; Active liver disease or unexplained persist- PDF Page #1. pravastatin (pra-va-sta-tin) entqin AST and ALT; OB, Lactation: Pregnancy or lactation. Pravachol Use Cautiously in: History of liver disease; Alcoholism; Renal impairment; Pedi: Children 8 yr (safety not established); Women of childbearing age. Classification Therapeutic: lipid-lowering agents Adverse Reactions/Side Effects Pharmacologic: HMG-CoA reductase inhibitors (statins) CNS: amnesia, confusion, dizziness, headache, insomnia, memory loss, weakness. Pregnancy Category X EENT: rhinitis. Resp: bronchitis. CV: chest pain, peripheral edema. GI: abdomi- nal cramps, constipation, diarrhea, flatus, heartburn, altered taste, drug-induced hepatitis, dyspepsia,qliver enzymes, nausea, pancreatitis.

2 GU: erectile dysfunction. Indications Derm: rash, pruritus. Endo: hyperglycemia. MS: RHABDOMYOLYSIS, arthralgia, ar- Adjunctive management of primary hypercholesterolemia and mixed dyslipidemias. thritis, immune-mediated necrotizing myopathy, myalgia, myositis. Misc: hypersen- Primary prevention of coronary heart disease (myocardial infarction, coronary re- sitivity reactions. vascularization, cardiovascular mortality) in asymptomatic patients with increased Interactions total and low-density lipiprotein (LDL) cholesterol and decreased high-density lipo- Drug-Drug: Cholesterol-lowering effect may beqwith bile acid sequestrants protein (HDL) cholesterol. Secondary prevention of myocardial infarction, coronary (cholestyramine, colestipol). Bioavailability may bep by bile acid seques- revascularization, stroke, and overall mortality in patients with clinically evident cor- trants; administer pravastatin 1 hr before or 4 hr after bile acid sequestrants.

3 Risk onary heart disease. of myopathy isqby concurrentcyclosporine, fibrates, colchicine, erythromy- cin, clarithromycin, or large doses of niacin; concurrent use with gemfibrozil Action should be avoided; consider lower dose of pravastatin with niacin. Mayqeffects of Inhibits 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase, an enzyme warfarin. Levels may be significantlyqbyazole antifungals (temporarily discon- which is responsible for catalyzing an early step in the synthesis of cholesterol. Ther- tinue HMG-CoA reductase inhibitor, effect is less than with other statins). Saquinavir apeutic Effects: Lowering of total and LDL cholesterol and triglycerides. Slightly and ritonavir mayplevels and effectiveness. increases HDL cholesterol. Slows the progression of coronary atherosclerosis with Route/Dosage resultant decrease in coronary heart disease-related events.

4 PO (Adults): 10 20 mg once daily at bedtime, may be adjusted at 4-wk intervals as needed (usual range 10 40 mg/day); Concurrent cyclosporine therapy Dose Pharmacokinetics should not exceed 20 mg/day; Concurrent clarithromycin therapy Dose should Absorption: Poorly and variably absorbed following oral administration. not exceed 40 mg/day. Distribution: Unknown. PO (Children 14-18 yrs): 40 mg once daily. Metabolism and Excretion: Extensively metabolized by the liver, most during PO (Children 8-13 yrs): 20 mg once daily. first pass; excreted in bile and feces. 20% excreted unchanged by the kidneys. PO (Geriatric Patients): 10 20 mg once daily at bedtime, may be adjusted at 4-wk Half-life: hr. intervals as needed (usual range 10 20 mg/day). TIME/ACTION PROFILE (cholesterol-lowering effect) Hepatic Impairment ROUTE ONSET PEAK DURATION Renal Impairment PO (Adults): 10 20 mg once daily at bedtime, may be adjusted at 4-wk intervals as PO days 2 4 wk unknown needed (usual range 10 20 mg/day).

5 Canadian drug name. Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough Discontinued. Name /bks_53161_deglins_md_disk/pravastatin 03/04/2014 11:26AM Plate # 0-Composite pg 2 # 2. 2 Advise patient to notify health care professional of all Rx or OTC medications, vita- mins, or herbal products being taken and to consult with health care professional NURSING IMPLICATIONS before taking other medications. PDF Page #2. Assessment Advise patient to notify health care professional of medication regimen prior to Obtain a diet history, especially with regard to fat consumption. treatment or surgery. Lab Test Considerations: Evaluate serum cholesterol and triglyceride levels Instruct female patients to notify health care professional promptly if pregnancy is before initiating, after 4 6 wk of therapy, and periodically thereafter.

6 Planned or suspected. Monitor liver function tests prior to initiation of therapy and as clinically indicated. Emphasize the importance of follow-up exams to determine effectiveness and to If symptoms of serious liver injury, hyperbilirubinemia, or jaundice occurs should monitor for side effects. be discontinue pravastatin and do not restart. May also causeqalkaline phospha- tase and bilirubin levels. Evaluation/Desired Outcomes Decrease in LDL and total cholesterol levels. If patient develops muscle tenderness during therapy, CPK levels should Increase in HDL cholesterol levels. be monitored. If CPK levels are markedlyqor myopathy occurs, therapy should be discontinued. Decrease in triglyceride levels. Slowing of the progression of coronary artery disease. Potential Nursing Diagnoses Noncompliance (Patient/Family Teaching) Why was this drug prescribed for your patient?

7 Implementation PO: Administer once daily in the evening. May be administered without regard to food. Avoid grapefruit and grapefruit juice during therapy; may increase risk of toxicity. If administered in conjunction with bile acid sequestrants (cholestyramine, colestipol), administer 1 hr before or 4 hr after bile acid sequestrant. Patient/Family Teaching Instruct patient to take medication as directed, not to skip doses or double up on missed doses. Advise patient to avoid drinking more that 200 mL/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 restric- tions (fat, cholesterol, carbohydrates, alcohol), exercise, and cessation of smok- ing. Instruct patient to notify health care professional if unexplained muscle pain, tenderness, or weakness occurs, especially if accompanied by fe- ver or malaise.

8 Advise patient to wear sunscreen and protective clothing to prevent photosensitiv- ity reactions (rare). 2015 Davis Company