Atorvastatin

U.S. Brand Names Lipitor®

Antilipemic Agent (HMG-CoA Reductase Inhibitor)

Use
Adjunct to diet for the reduction of elevated total and LDL cholesterol, apolipoprotein B, and triglyceride levels in
patients with hypercholesterolemia (Type IIA, IIB, and IIC); adjunctive therapy to diet for treatment of elevated
serum triglyceride levels (Type IV); treatment of primary dysbetalipoproteinemia (Type III) in patients who do not
respond adequately to diet; to increase HDL cholesterol in patients with primary hypercholesterolemia and mixed
dyslipidemia. Also may be used in hypercholesterolemic patients without clinically evident heart disease to reduce the
risk of myocardial infarction, to reduce the risk for revascularization, and reduce the risk of death due to
cardiovascular causes

Dietary Considerations
Before initiation of therapy, patients should be placed on a standard cholesterol-lowering diet for 3-6 months and the
diet should be continued during drug therapy.
May take with meals at any time of day. Maintain adequate hydration (2-3 L/day of fluids unless instructed to restrict
fluid intake). You will need laboratory evaluation during therapy. May cause headache (mild analgesic may help);
diarrhea (yogurt or buttermilk may help); euphoria, giddiness, confusion (use caution when driving or engaging in
tasks that require alertness until response to medication is known). Report unresolved diarrhea, excessive or acute
muscle cramping or weakness, changes in mood or memory, yellowing of skin or eyes, easy bruising or bleeding, and
unusual fatigue.

Lactulose
Use
Adjunct in the prevention and treatment of portal-systemic encephalopathy (PSE); treatment of chronic constipation.
Contraindications
Patients with galactosemia and require a low galactose diet, hypersensitivity to any component.
Warnings/Precautions
Use with caution in patients with diabetes mellitus; monitor periodically for electrolyte imbalance when lactulose is
used >6 months or in patients predisposed to electrolyte abnormalities (eg, elderly); patients receiving lactulose and
an oral anti-infective agent should be monitored for possible inadequate response to lactulose.
Mechanism of Action
The bacterial degradation of lactulose resulting in an acidic pH inhibits the diffusion of NH3 into the blood by causing
the conversion of NH3 to NH4+; also enhances the diffusion of NH3 from the blood into the gut where conversion to
NH4+ occurs; produces an osmotic effect in the colon with resultant distention promoting peristalsis.
Dietary Considerations
Contraindicated in patients on galactose-restricted diet; may be mixed with fruit juice, milk, water, or citrus-flavored
carbonated beverages
Patient Information
Not for long-term use. Take as directed, alone, or diluted with water, juice or milk, or take with food. Laxative results
may not occur for 24-48 hours; do not take more often than recommended or for a longer time than recommended. Do
not use any other laxatives while taking lactulose. Increased fiber, fluids, and exercise may help reduce constipation.
Do not use if experiencing abdominal pain, nausea, or vomiting. Diarrhea may indicate overdose. May cause
flatulence, belching, or abdominal cramping. Report persistent or severe diarrhea or abdominal cramping.
Nursing Implications
Dilute lactulose in water, usually 60-120 mL, prior to administering through a gastric or feeding tube