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Generic Name: Atorvastatin

Brand Name: Lipitor, Caduet

Stock Dosage: Initial dose: 10 mg or 20 mg orally once a day

An initial dose of 40 mg may be used in patients who require a larger reduction in low density lipoprotein (e.g. more than 45%)

Individualize dose based on goals of therapy and response

Maintenance dose: 10 mg to 80 mg orally once a day

Maximum dose: 80 mg/day

Classification: Lipid-lowering agent

Mechanism of Action: Atorvastatin is a lipid-lowering drug included in the statin class of medications. By inhibiting the endogenous production of cholesterol in the liver, statins lower abnormal cholesterol and lipid levels, and ultimately reduce the risk of cardiovascular disease. More specifically, statin medications competitively inhibit the enzyme hydroxymethylglutaryl-coenzyme A (HMG-CoA) Reductase, which catalyzes the conversion of HMG-CoA to mevalonic acid.

Indication/s:
-  Statins is an inhibitor of hydroxymethylglutaryl-CoA reductase, and it is identified to have pleiotropic effects, such as anti-inflammatory and antithrombotic properties and antioxidant effects. Therefore, statins are regarded as an important agent for the prevention of MI.
- Used to treat high cholesterol, lower the risk of stroke, heart attack, or other heart complications in people with type 2 diabetes, coronary heart disease, or other risk factors.

Contraindications:

Contraindicated in patients with atorvastatin hypersensitivity or hypersensitive to any components of the product selected.

Contraindicated in patients with active hepatic disease (including cholestasis, hepatic encephalopathy, hepatitis, and jaundice) or unexplained persistent elevations in serum aminotransferase concentrations.

Atorvastatin should be used with caution in patients who consume substantial quantities of alcohol (alcoholism) and/or have a history of liver disease.

Side Effects and Adverse Effects:

Gastrointestinal symptoms such as diarrhea

Cold symptoms such as a runny or stuffy nose

Joint pain

Insomnia

Urinary tract infection

Nausea

Loss of appetite

Indigestion symptoms such as stomach discomfort or pain

Increased transaminases

Muscle spasms with or without pain

Musculoskeletal pain (pain that affects the muscles, ligaments, tendons bones, land joints, muscle pain, limb pain, mouth and throat pain

Chest pain (angina)

Lightheadedness and fainting, shortness of breath or other breathing problems

Muscle weakness or loss of muscle strength

Severe allergic reaction (anaphylaxis)

Stevens-Johnson syndrome

Muscle inflammation, with or without pain

Nursing Responsibilities:

Assess any muscle pain, tenderness, or weakness, especially if accompanied by fever, malaise, and dark-colored urine. Advise patient that these symptoms may represent drug-induced myopathy, and that myopathy can progress to severe muscle damage (rhabdomyolysis).

Monitor for therapeutic effectiveness which is indicated by reduction in the level of LDL-C.

Lab tests: Monitor lipid levels within 2–4 wk after initiation of therapy or upon change in dosage; monitor liver functions at 6 and 12 wk after initiation or elevation of dose, and periodically thereafter.

Assess for muscle pain, tenderness, or weakness; and, if present, monitor CPK level (discontinue drug with marked elevations of CPK or if myopathy is suspected).

Monitor carefully for digoxin toxicity with concurrent digoxin use.

Instruct patient to take medication as directed. If a dose is missed, omit and resume the usual schedule with the next dose. Do not double up on missed doses. Advise patient to avoid drinking more than one quart of grapefruit juice or 2 glasses of alcohol per day 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 restrictions (fat, cholesterol, carbohydrates, alcohol), exercise, and cessation of smoking. Atorvastatin/ezetimibe does not assist with weight loss.

In patients with drug-induced myopathy, implement gradual strengthening and other therapeutic exercises to facilitate recovery from muscle pain and weakness.

Reference:

Hodgson, K. J. & Kizior, R.J. (2019). Saunders Nursing Drug Handbook. Elsevier. Wilson, B., Shannon, M., Shields, K., & Stang, C. (2007). Prentice Hall Nurse’s Drug Guide.

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Generic Name: Morphine Sulfate

Brand Name: Roxanol

Stock Dosage:

Intravenous

Moderate to severe pain, Pain associated with myocardial infarction, Postoperative pain, Severe cancer pain

Adult: As morphine sulfate: Dosage is individualised based on the severity of pain, patient response and prior analgesic experience. As Patient-Controlled Analgesia (PCA): Loading dose: 1-10 mg (Max 15 mg) via IV infusion over 4-5 minutes, then 1 mg on demand with 5-10 minutes lockout time.

Elderly: Dose reduction needed.

Administration | Adults and adolescents over 12 years
Intravenously | 2.5-10mg
Subcutaneously, intramuscularly | 5 - 20 mg

Classification: Central Nervous System (CNS) Agent, Narcotic (Opiate) Agonist, Analgesic

Mechanism of Action: Morphine binding to opioid receptors blocks transmission of nociceptive signals, signals pain-modulating neurons in the spinal cord, and inhibits primary afferent nociceptors to the dorsal horn sensory projection cells. The major effects of morphine are on the central nervous system and the bowel. Opioids act as agonists, interacting with stereospecific and saturable binding sites or receptors in the brain and other tissues. Morphine is about two-thirds absorbed from the gastrointestinal tract with the maximum analgesic effect occurring 60 minutes post administration.

Indication/s:

Morphine sulfate is an opioid agonist indicated for the relief of moderate to severe acute and chronic pain where use of an opioid analgesic is appropriate.

Morphine to relieve pain during a myocardial infarction (MI)

Contraindications:

Morphine sulfate is contraindicated in patients with acute or severe bronchial asthma or hypercarbia.

Contraindicated in any patient who has or is suspected of having paralytic ileus. Respiratory depression is the primary risk of morphine sulfate.

Hypersensitivity to opiates, increased intracranial pressure, convulsive disorders, acute alcoholism, acute bronchial asthma, chronic pulmonary diseases, severe respiratory depression

Side Effects and Adverse Effects:

Body as a Whole: Hypersensitivity [Pruritus, rash, urticaria, edema, hemorrhagic urticaria (rare), anaphylactoid reaction (rare)], sweating, skeletal muscle flaccidity; cold, clammy skin, hypothermia.

CNS: Euphoria, insomnia, disorientation, visual disturbances, dysphoria, paradoxic CNS stimulation (restlessness, tremor, delirium, insomnia), convulsions

The most frequently observed adverse reactions include lightheadedness, dizziness, sedation, nausea, vomiting, and sweating. These effects seem to be more prominent in ambulatory patients and in those who are suffering severe pain. In such individuals, lower doses are available.

Nursing Responsibilities:

Monitor blood pressure prior to administration. Hold if systolic BP < 100 mm Hg or 30 mm Hg below baseline.

Monitor patient's respiratory rate prior to administration.

Reassess pain after administration of morphine.

Be alert to elevated pulse or respiratory rate, restlessness, anorexia, or drawn facial expression that may indicate need for analgesia.

Monitor carefully those at risk for severe respiratory depression after epidural or intrathecal injection: Older adult or debilitated patients or those with decreased respiratory reserve (e.g., emphysema, severe obesity, kyphoscoliosis).

Differentiate among restlessness as a sign of pain and the need for medication, restlessness associated with hypoxia, and restlessness caused by morphine-induced CNS stimulation (a paradoxical reaction that is particularly common in women and older adult patients).

Monitor for respiratory depression and hypotension frequently up to 24 hours after administration of morphine. Place call light signal close to the patient.

Monitor I&O ratio and pattern. Report oliguria or urinary retention. Morphine may dull perception of bladder stimuli; therefore, encourage the patient to void at least q4h. Palpate lower abdomen to detect bladder distention.

Reference:

Hodgson, K. J. & Kizior, R.J. (2019). Saunders Nursing Drug Handbook. Elsevier. Wilson, B., Shannon, M., Shields, K., & Stang, C. (2007). Prentice Hall Nurse’s Drug Guide.