Atorvastatin

INTRODUCTION

Indications

Adjunctive management of primary hypercholesterolemia and mixed dyslipidemia. Primary prevention of coronary heart disease (myocardial infarction, stroke, angina, and coronary revascularization) in asymptomatic patients with increased total and low-density lipoprotein (LDL) cholesterol and decreased high-density lipoprotein (HDL) cholesterol.

Action

Inhibits 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase, an enzyme which is responsible for catalyzing an early step in the synthesis of cholesterol. Therapeutic Effects: Lowering of total and LDL cholesterol and triglycerides. Slightly increases HDL cholesterol. Reduction of lipids/cholesterol reduces the risk of myocardial infarction and stroke sequelae. Slows the progression of coronary atherosclerosis with resultant decrease in coronary heart disease–related events.

Adverse Reactions/Side Effects

CNS: dizziness, headache, insomnia, weakness. EENT: rhinitis. Resp: bronchitis. CV: chest pain, peripheral edema. GI: abdominal cramps, constipation, diarrhea, flatus, heartburn, altered taste, drug-induced hepatitis, dyspepsia, elevated liver enzymes, nausea, pancreatitis. GU: erectile dysfunction. Derm: rashes, pruritus. MS: RHABDOMYOLYSIS, arthralgia, arthritis, myalgia, myositis. Misc: HYPERSENSITIVITY REACTIONS, INCLUDING ANGIONEUROTIC EDEMA.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• 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.

• Monitor signs of angioneurotic edema and other hypersensitivity reactions, including rashes, raised patches of red or white skin (welts), burning/itching skin, swelling in the face, and difficulty breathing. Notify physician of these signs immediately.

• Assess dizziness and weakness that might affect gait, balance, and other functional activities (see Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

• Monitor chest pain or symptoms of bronchitis (cough, production of sputum, shortness of breath, wheezing). Report prolonged or severe symptoms to the physician.

Interventions

• 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 ...