Question

PN 105 Fundamentals of Nursing I Case Study - Myocardial Infarction- gemfibrozil Jim Hart had a myocardial infarction (M1) three years ago. He was orde 600 mg twice daily before meals. His cholesterol remained between 22 LDL was 140 mg/dL. His anticholesterol medication was changed t per day in the evening 0 and 240 mg/dL, and his to simvastatin (Zocor) 20 mg How does simvastatin differ from gemfibrozil? 1. 2. Why do you think Mr. Hart's cholesterol drug, gemfibrozil was changed to simvastatin? While Mr. Hart is on simvastatin, which group of serum levels should be monitored? 3. 4. How long after Mr. Hart stated simvastatin should his cholesterol and lipoproteins be checked? What is the maximum dose for simvastatin? 5. lains of muscle pain and muscle weakness. What condition might this 6. Mr. Hart comp indicate? 7. Could Mr. Hart receive both gemfibrozil and simvastatin at the same time? Explain your answer. 8. Mr. Hart is on vacation and does not have enough simvastatin tablets. What should he do? Reviewed 3/19

Answer 1

1.Lopid is used to treat abnormal lipid values whereas simvastin is a lipid lower drug classified under statin.Lopid has high side effects and not the preferred chouce of medication whereas simvastin has the most minimal side effects and the preferred choice of drug.It reduces th chance of getting cardiovascular problems like heart attack and stroke.

2.The patient who had an episode of MI is at high risk of getting it agai due to very high cholesterol level.Gemfibrozil is a choice of drug here because it can prevent from formation of abnormal lipid level by increasing the high density Lipid and simultaneously lowering the low density lipids.The drug is prescribed for a period of three months if the expected changes doesn't occur (the patient had a LDL of 140mg which is considered to be borderline in a patient who already has heart problems).This sjoukd be the Read on for the physician to change the drug to simvastin

3.The following serum levels has to be monitored

• Lipid levels to assess the changes
• LFT ,it has effects on the liver
• CBC,there will be a rise of BBC in these patients
• CPK to rule out any muscle wasting

4.It has to be checked at 4th to 6th week after startingthe medication to get the maintainace dosefollowed by tor 6 months to rule out its effects.

5.The maximum dose recommended and approved by the FDA is 40mg/day

6.The condition is termed to be rhabdomylosis where there is skeletal muscle loss

7.Taking both the medications simultaneously is dangerous as its interaction can lead to death.

8.At times if patient doesn't have the medication he can try the following

• Going to pharmacy with the prescription to get the medicine
• Have a strict diet control
• If unable to take the medication and near to the next dose,skip the previous one and take the current dose if the time is less than 3 hours.