Drug Study Date Ordered: September 6, 2012 Ordering Physician: Generic Name: Simvastatin Brand Name: Zocor Dosage,

Route and Frequency: 40mg 1 tab OD Mechanism of Action: Simvastatin inhibits the enzyme 3-hydroxy-3-methylglutarylcoenzyme A (HMG-CoA) reductase which is responsible for catalyzing an early step in the synthesis of cholesterol which causes decrease in levels of total and LDL cholesterol and triglycerides and slowing down the progression of atherosclerosis. Desired Effect: The drug is given to the patient to lower the total and LDL cholesterol and triglycerides since her condition is CVD with a probability of infarction which may be caused by atheromatous plagues. Nursing Responsibilities: Nursing Responsibility Explain the need for the drug therapy. Assess for renal functioning and monitor urine output throughout the therapy. Assess for liver functioning prior to the administration of the drug. Obtain diet history and monitor fat consumption throughout the therapy. Monitor serum cholesterol and triglyceride levels before initiating and throughout the therapy. Instruct patient to avoid large amounts of grapefruit juice during the course of therapy. Instruct patient not to chew the drug. Provide patient with low fat diet, low cholesterol, low carbohydrate diet. Rationale To promote understanding and allay anxiety. The drug is excreted through the kidneys and urinary insufficiency is a contraindication of simvastatin therapy. The drug may cause increased alkaline phosphatase and bilirubin levels and may aggravate liver failure. Drug therapy must be combined with proper diet to potentiate and achieve desired effects. The serum levels of cholesterol and triglyceride are the basis of the need of the drug therapy. Grapefruit juice increases blood levels of simvastatin and may cause toxicity and increases risk for rhabdomyolysis. The drug is an extended-release tablet and is intended to be absorbed in the lower GIT for better absorption. The drug helps control but does not cure elevated serum cholesterol levels and therefore must be used in conjunction with diet restrictions. These are considered serious side effects that are indicative of drug toxicity. To allay anxiety of the patient.

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Monitor patient and instruct to report muscle pain, tenderness, or weakness with fever or flu symptoms and dark colored urine. 10. Instruct patient that constipation, heartburn, stomach gas, pain and upset are expected side effects of the drug but instruct to report immediately if it persists,