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Prentice Hall Nurse’s Drug Guide. (2019). Robholland.com. http://www.robholland.com/Nursing/Drug_Guide/

Monograph. (n.d.). Www.robholland.com. Retrieved September 13, 2021, from http://www.robholland.com/Nursing/Drug_Guide/data/monographs/monoframe.html?vfile=P092.html

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Assessment & Drug Effects

Do not use protamine if only minor bleeding occurs during heparin therapy because withdrawal of heparin will usually correct minor bleeding within a few hours.

Monitor BP and pulse q15–30min, or more often if indicated. Continue for at least 2–3 h after each dose, or longer as dictated by patient's condition. Be prepared to treat patient for shock as well as hemorrhage.

Lab tests: Monitor effect of protamine in neutralizing heparin by aPTT or ACT values. Coagulation tests are usually performed 5–15 min after administration of protamine, and again in 2–8 h if desirable.

Observe patients undergoing extracorporeal dialysis or patients who have had cardiac surgery carefully for bleeding (heparin rebound). Even with apparent adequate neutralization of heparin by protamine, bleeding may occur 30 min to 18 h after surgery. Monitor vital signs closely. Additional protamine may be required in these patients.

Patient and Families Education:

Protamine Pregnancy Warnings- Protamine has been assigned to pregnancy category C by the FDA. Animal reproductive studies have not been conducted. There are no controlled data in human pregnancy. Protamine should be used during pregnancy only when need has been clearly established.

Nursing Mothers
It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when protamine sulfate is administered to a nursing woman.

Pediatric Use
Safety and effectiveness in children have not been established.

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CV: Abrupt drop in BP (with rapid IV infusion), bradycardia.
Body as a Whole: Urticaria, angioedema, pulmonary edema, anaphylaxis, dyspnea, lassitude; transient flushing and feeling of warmth.
GI: Nausea, vomiting.
Hematologic: Protamine overdose or "heparin rebound" (hyperheparinemia).

THERAPEUTIC EFFECT:

-Because protamine is strongly basic, it combines with strongly acidic heparin to produce a stable complex; thus anticoagulant effect of both drugs is neutralized.

EVALUATION OF DRUG EFFECTIVENESS:
-No signs of heparin toxicity.
-No signs of blood coagulation.
-Lab tests: such as aPTT or ACT are in normal values.

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-Antidote for heparin calcium or heparin sodium overdosage (after heparin has been discontinued). Causes direct myocardial suppression when used to reverse heparin anticoagulation and to reverse the effects of heparin during delivery and heart surgery.

CONTRAINDICATIONS:

-Hemorrhage not induced by heparin overdosage; pregnancy (category C).

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-Protamine possesses weak anticoagulant effects when administered alone; however, upon contact with heparin, it forms a salt, neutralizing the anticoagulant effect of both drugs. Protamine, a strongly basic compound, forms complexes with heparin sodium or heparin calcium, which are acidic compounds. Formation of this complex can result in disruption of the heparin-antithrombin III complex responsible for the anticoagulant activity of heparin. The protamine-heparin complex does not possess anticoagulant properties. Protamine's anticoagulant effect usually is clinically insignificant and is likely the result of thromboplastin inhibition, which diminishes thrombin activity.

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-Administer protamine 10 mg/mL solution undiluted via slow intravenous injection.

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-Sanofi-AventisTM

CLASSIFICATIONS:

-ANTIDOTE
-Pregnancy Category: C

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2. PROTAMINE SULFATE                                        (proe'ta-meen)                            

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2. PROTAMINE SULFATE                                        (proe'ta-meen)                            

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Protamines are simple proteins of low molecular weight that are rich in arginine and strongly basic.  They occur in the sperm of salmon and certain other species of fish.

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Assessment & Drug Effects

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.

Patient & Family Education

Report promptly any of the following: Unexplained muscle pain, tenderness, or weakness, especially with fever or malaise; yellowing of skin or eyes; stomach pain with nausea, vomiting, or loss of appetite; skin rash or hives.

Do not take drug during pregnancy because it may cause birth defects. Immediately inform physician of a suspected or known pregnancy.

Inform physician regarding concurrent use of any of the following drugs: erythromycin, niacin, antifungals, or birth control pills.

Minimize alcohol intake while taking this drug.

Do not breast feed while taking this drug

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Body as a Whole: Back pain, asthenia, hypersensitivity reaction, myalgia, rhabdomyolysis.
CNS: Headache.
GI: Abdominal pain, constipation, diarrhea, dyspepsia, flatulence, increased liver function tests.
Respiratory: Sinusitis, pharyngitis.
Skin: Rash.

THERAPEUTIC EFFECT:

-Atorvastatin reduces LDL and total triglyceride (TG) production as well as increases the plasma level of high-density lipids (HDL).

EVALUATION OF DRUG EFFECTIVENESS:
-lower total cholesterol by 30-46%,
-triglycerides by 30-56%,
-variable increases seen in HDL.

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-Atorvastatin is used to treat high cholesterol, and to lower the risk of stroke, heart attack, or other heart complications in people with type 2 diabetes, coronary heart disease, or other risk factors. May treat Cardiovascular disease, Angina · Coronary Artery Disease, and Atherosclerosis.

CONTRAINDICATIONS:

-Hypersensitivity to atorvastatin, myopathy, active liver disease, unexplained persistent transaminase elevations, pregnancy (category X), lactation.

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Atorvastatin (Lipitor) competitively inhibit HMG coenzyme A reductase, a rate-limiting step in cholesterol synthesis. Reduce cholesterol synthesis results in a compensatory increase in uptake of plasma cholesterol mediated by an increase in the number of LDL receptors. therefore LDL level in plasma reduces.

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Usual Adult Dose for Prevention of Cardiovascular Disease:

-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

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BRAND NAME:                                                                                

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BRAND NAME:                                                                                

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-Lipitor

CLASSIFICATION:

-CARDIOVASCULAR AGENT;
ANTILIPEMIC AGENT;
HMG-COA;
REDUCTASE INHIBITOR (STATIN)

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1. ATORVASTATIN CALCIUM                                               (a-tor-va'sta-tin)                                       

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1. ATORVASTATIN CALCIUM                                               (a-tor-va'sta-tin)                                       

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A statin medication used to prevent cardiovascular disease in those at high risk and to treat abnormal lipid levels. For the prevention of cardiovascular disease, statins are a first-line treatment.