16. You are visiting Mrs. N., a homebound patient who is being treated for hyper

Question

16. You are visiting Mrs. N., a homebound patient who is being treated for hyperlipidemia and hyperten sion. During your visit, Mrs. N. takes her antihyper- tensive medication and then begins to mix her dose of cholestyramine into a glass of orange juice. What patient teaching does Mrs. N. require? CASE STUDY Read the scenario, and answer the following questions on a separate sheet of paper. Mr. M. has been diagnosed with type lla hyperlipidemia and has been given a prescription for atorvastatirn (Lipitor). He acts thrilled with the news, and says "Great! Now I don't have to worry about watching my diet because I'm on this medicine!" of 1. Is he right? What type of dietary guidelines should he follow while on this therapy? 2. What therapeutic effects do you hope to see as a result of his taking this medication? 3. After 2 months of therapy, you note that Mr. M.'s liver enzyme levels are slightly elevated. Is this a concern? What other laboratory values will be moni- tored while Mr. M. is taking atorvastatin? 4. Mr. M. calls the office to complain about some mus- cle pain. He thought he had pulled a muscle duringa tennis match, but the pain has not lessened in 3 days. Is this a concern?

Explanation / Answer

No, he is not right. Along with medication, the diet should also be taken care of. The diet should be free from saturated, trans unsaturated fats, and food high in cholesterol; diet should have high amount of fibers. The intake and expenditure of calories should be balanced. Weight should be in control. Vitamins and herbal supplements should be avoided while taking atorvastatin. Atorvastatin decreases the level of LDL cholesterol and triglycerides and increases the HDL cholesterol in blood. It is a HMG-CoA reductase inhibitor and decreases the formation of cholesterol in the body. Slight increase in the levels of liver enzymes is common with atorvastatin use. But liver tests are performed to monitor liver damage due to the drug. Renal functioning is also tested. Occurrence of other adverse effects should be tested. The muscle pain is of concern as it may occur due to adverse effect of atorvastatin therapy. Statin therapy can lead to myopathy, myalgia or other muscle related complications. If there is occurrence of myopathy, the therapy should be stopped.

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