McKenna's Pharmacology for Nursing, 2e

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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. ■ ■ 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. Implementation with rationale

■ ■ 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).