McKenna's Pharmacology for Nursing, 2e

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P A R T 8  Drugs acting on the cardiovascular system

TABLE 47.3

DRUGS IN FOCUS Lipid-lowering drugs (continued)

Drug name

Dosage/route

Usual indications

HMG-CoA reductase inhibitors (continued) pravastatin (Cholstat, Pravachol)

10–40 mg/day PO taken at bedtime; start with 10 mg/day in elderly people and people with hepatic or renal impairment Children (8–13 years): 20 mg/day PO, (14–18 years): 40 mg/day PO

Only statin with outcome data to show effectiveness in decreasing CAD and incidence of MI; prevents first MI even in people who do not have a documented increased cholesterol concentration (an effect possibly related to blocking of the formation of foam cells in injured arteries); adjunctive therapy for reduction of increased cholesterol and LDL levels; approved for use with children >8 years of age with genetically linked hyperlipidaemia, as an adjunct to diet and exercise Adjunctive therapy for reduction of increased cholesterol, LDL levels and triglycerides; with diet to slow the progression of atherosclerosis; raises HDL slightly better than the other statins and at a lower price Prevention of first MI in people with known hypercholesterolaemia and CAD; adjunctive therapy for reduction of increased cholesterol and LDL levels; approved to lower cholesterol levels in children 10–17 years of age who meet specific criteria with genetic hyperlipidaemias Adjunct to diet and exercise to reduce cholesterol as monotherapy or combined with an HMG-CoA inhibitor or a bile acid sequestrant; adjunct to diet to reduce elevated sitoterol and campesterol levels in homozygous sitosterolaemia (to reduce elevated sitosterol and campesterol levels, the enzymes that are elevated when people have this rare disorder); used in combination with atorvastatin or simvastatin as treatment for homozygous familial hypercholesterolaemia

rosuvastatin (Crestor)

10 mg/day PO initial dose range; 5–40 mg/day

simvastatin (Simvar, Zocor)

5–80 mg/day PO taken once a day in the evening; start with 5 mg/day in elderly people and in people with hepatic or renal impairment Children (10–17 years): 10 mg/day PO, up to 40 mg/day based on response

Cholesterol absorption inhibitor ezetimibe (Ezetrol)

10 mg/day PO

Other lipid-lowering agents Fibrates fenofibrate (Lipidil)

145 mg/day PO given with a meal; may be increased up to 67 mg PO t.d.s. as needed; monitor people with impaired renal function and the elderly very carefully 1200 mg/day PO divided into two doses and taken before the morning and evening meals

Treatment of very high triglyceride levels in adults who are at risk for pancreatitis if not responsive to dietary measures

gemfibrozil (Jezil, Lipazil, Lopid)

Treatment of very high triglyceride levels with abdominal pain and potential pancreatitis in adults

Vitamin B nicotinic acid (generic)

250 mg PO t.d.s. gradually increased to 3–4.5 mg/day PO

Treatment of hyperlipidaemia not responding to diet and weight loss; to slow progression of coronary artery disease when combined with a bile acid sequestrant