Why do most statins work better if taken in the evening Quizlet

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2. Inform the patient that this drug may cause nausea.
Patients who are treated with simvastatin may have adverse effects such as nausea, vomiting, and fever. The nurse should teach the patient about the possible adverse effects of the drug therapy and instruct him or her to immediately report any signs of toxicity, including muscle soreness, changes in urine color, fever, malaise, nausea, or vomiting.

The nurse should not instruct the patient to administer aspirin for pain relief. Any pain should be reported, because it can indicate rhabdomyolysis, which may cause renal failure and even death. Simvastatin is contraindicated in patients with a known drug allergy. The nurse should not advise the patient to discontinue the medication without consulting the health care provider.

statins + erythromycin, azole antifungals, quinidine, verapamil, amiodarone, grapefruit juice, HIV and hepatitis C protease inhibitors, cyclosporine, clarithromycin, diltiazem, amlodipine

(Zocor)- Lowers total and LDL cholesterol levels, & triglyceride levels. Modestly raises HDL levels.

Pregnancy category X

CONTRAINDICATIONS: use w/ itraconazole, ketoconazole, posaconazole, erythromycin, clarithromycin, HIV protease inhibitors, nefazodone, femfibrozil, cyclosporine, danazol

CAUTION: Don't start on 80 mg.
Use w/ verapamil & diltiazem- don't exceed Simvastatin 10 mg.
Use w/ amiodarone, amlodipine, ranolazine- don't exceed 20 mg.

GI: N/V/D, gallstones

GU: Impotence, decreased urine output, hematuria

O/: Drowsiness, dizziness, rash, pruritus, vertigo, headache, blurred vision, prolonged PTT. Increased liver enzyme levels.

Statin medications are taken orally. Depending on the specific medication administered, 30% to 90% of the drug is bioavailable. Statins undergo first pass metabolism through the liver, where the majority of the drug is removed from the bloodstream. The liver is the principal site of statin activity. Only a small portion of each dose enters the systemic circulation.

Statins are quickly metabolized in the liver and then excreted, largely, in the bile. The exceptions to this include lovastatin, pitavastatin, pravastatin, and simvastatin. Ten to 20 percent of the metabolites of these four statins are excreted in the urine.

Atorvastatin, lovastatin, and simvastatin are metabolized by CYP3A4 (the 3A4 isoenzyme of cytochrome P450). Based on this, drug levels of these three statins can be lowered by agents that induce the CYP3A4 system. This induction increases the rate at which the drugs are metabolized and inactivated. The opposite effect is also observed. Agents that inhibit the CYP3A4 system will cause a slowing of statin metabolism, resulting in increased drug levels.

Rosuvastatin, when used in patients of Asian descent, causes abnormally high drug levels. Following a typical therapeutic dose, rosuvastatin levels in this group are observed to be twice that observed in Caucasians. To manage this effect, the dosage of rosuvastatin should be reduced when prescribed to this population.

Expect a persistent dry cough

Avoid potassium salt substitutes

Report difficulty in breathing immediately

Salt substitutes contain potassium and may increase the risk of hyperkalemia with ACE inhibitors. A persistent, dry, nonproductive cough may develop. Angioedema includes edema of the tongue, glottis, and pharynx that may cause difficulty breathing, which requires immediate medical attention. Captopril must be taken at least 1 hr before meals.