Question

PN 105 Fundamentals of Nursing I Case Study - Myocardial Infarction -gemfibrozil (Lopid) Jim Hart had a myocardial ifarction (Mt) three years ago. He was ordered is rwice daily before meals. His cholesterol remained between 220 and 240 mg/dL, and his D was 140 mg/dL. His anticholesterol medication was changed to simvastatin (Zocor) 20 mg per day in the evening. 1. How does simvastatin differ from gemfibrozil? 2. Why do you think Mr. Hart's cholesterol drug, gemfibrozil was changed to simvastatin? S. While Mr. Hart is on simvastatin, which group of serum levels should be monitored? How long after Mr. Hart stated simvastatin should his cholesterol and lipoproteins be checked? 4. What is the maximum dose for simvastatin? 5. Mr. Hart complains of muscle pain and muscle weakness. What condition might this 6. indicate? Could Mr. Hart receive both gemfibrozil and simvastatin at the same time? Explain your 7. answer. Mr. Hart is on vacation and does not have enough simvastatin tablets. What should he 8. do? Reviewed 3/19

Answer 1

1.Both are lipids lowering drugs but simvastin belongs to statin group and is the most safer drug preventing heart attack and stroke by decreasing the low density lipoprotein. Whereas Lopids increase the level of good cholesterol and decrese the level of very low density and LDL.But having major side effects like rhabdomylosis,muscle pain,cancer.

2.The drug has brought his blood cholesterol near to normal ranges ,so continuing Lopids at this stage is dangerous to the patient ,so the prescription change of medication to statin will help the patient to prevent adverse side effects.

3.The following test may be required

• Creatinine phosphokinase test
• CBC (increased wbc) is noted when administering simvastin
• Lipid profile
• LFT

4.The blood investigation as to be done at 6 to 8 weeks after starting the medications to assess its effects and to get the maintainace dose. It is repeated in 4 to 6 months again to make any adjustments

5.The maximum dosage is 40mg per day as recommended by the FDA

6.It is a side effect of the medication where the skeletal system breaks down and muscle pain occurs and is called as rhabdomylosis

7.it is not recommended in the same time because of its dangerous site effects