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INTRODUCTION

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pitavastatin (pit-av-a-stat-in)

Livalo

Classification

Therapeutic: lipid-lowering agents

Pharmacologic: HMG CoA reductase inhibitors (statins)

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Indications
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Treatment of primary hyperlipidemia and mixed dyslipidemia (adjunctive therapy to diet); to reduce elevated total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), apolipoprotein B (Apo B), and triglycerides (TG); and to increase high-density lipoprotein cholesterol (HDL-C).

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Action
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Inhibits 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase, an enzyme which is responsible for catalyzing an early step in cholesterol synthesis Therapeutic Effects: Lowering of TC, LDL-C, Apo B, and TG; increasing HDL-CI conjunction with multiple risk factor interventions, lowering of cardiovascular risk.

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Adverse Reactions/Side Effects
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GI: constipation, diarrhea, ↑ liver enzymes. Derm: pruritus, rash, urticaria. MS: RHABDOMYOLYSIS, arthralgia, myalgia, myositis, back pain, extremity pain, myalgia. Misc: hypersensitivity reactions.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Assess any muscle pain, tenderness, or weakness, especially if accompanied by fever, malaise, and dark-colored urine. Advise patient that these symptoms may represent drug-induced myopathy, and that myopathy can progress to severe muscle damage (rhabdomyolysis). Report any unexplained musculoskeletal symptoms to the physician immediately, and suspend exercise and gait training until these symptoms can be evaluated.

  • Assess any back, joint, or extremity pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug-induced rather than caused by anatomical or biomechanical problems.

  • Monitor signs of hypersensitivity reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician immediately if these reactions occur.

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Interventions
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  • In patients with drug-induced myopathy, implement gradual strengthening and other therapeutic exercises to facilitate recovery from muscle pain and weakness. Use caution during early stages to avoid fatigue of affected muscles, and implement assistive devices (walker, cane, crutches) as needed to prevent falls and assist mobility. Increase exercise intensity as tolerated; recovery from myopathy typically takes 4–6 wk, but can be longer in older patients or people with comorbidities.

  • Design and implement aerobic exercise and endurance training programs to improve cardiovascular function and help reduce the risk of coronary heart disease.

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Patient/Client-Related Instruction
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  • Remind patients to take medication as directed to control hyperlipidemia even though they are asymptomatic.

  • Counsel patients about additional interventions to help control lipid disorders and improve cardiovascular health, including dietary modification, regular exercise, moderation of alcohol consumption, and smoking cessation.

  • Instruct patient to report other bothersome side effects such as severe or prolonged skin reactions (rash, hives, itching) or GI problems (constipation, diarrhea).

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Pharmacokinetics
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Absorption: Well absorbed (51%) following oral administration.

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Distribution: unknown.

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Protein Binding: >99%.

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Metabolism and Excretion: Mostly metabolized by the liver; 15% excreted in ...

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