1. DYSLIPIDEMIA STEP 5

2. Simvastatin: Effects of the Drug An HMG-CoA reductase inhibitor (statin) Used together with lifestyle changes (smoking cessation, diet, weight-loss, exercise) Slows the production of cholesterol in the body Emphasize: Target reduction of LDL by 30-40% or LDL <77 mg/dl

3. Simvastatin: Effects of the Drug Reduces LDL cholesterol and triglycerides in the blood Increases HDL cholesterol in the blood Decreases the risk of heart attacks, strokes, and death Decreases the need for surgery to improve blood flow in people who have medical conditions that put them at high risk of developing heart and blood vessel problems

4. Simvastatin: Effects of the Drug Peak time: 1-2 hours Half-life: 3 hours Full Benefit of the Drug: 4 weeks What will happen if the drug is taken incorrectly or not at all? – Progressive increase in cholesterol levels – Higher risk for cardiovascular events

5. Simvastatin: Side Effects Constipation Stomach pain Nausea Headache

6. Simvastatin: Danger Signs Muscle pain, tenderness, or weakness Dark red urine Lack of energy, tiredness, or weakness Fever Fever or chills Flushing Blisters Rash Hives Itching Swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs Difficulty breathing or swallowing Hoarseness Joint pain Sensitivity to light

7. Simvastatin: Instructions How the drug should be taken – Initial dose is 40 mg once daily, taken at night. Adjusted not earlier than 4 weeks after initiation – Should not exceed maximum dose of 80 mg daily – Can be taken with or without food – Avoid drinking large quantities (more than 1 quart [1 liter] a day) of grapefruit juice while taking simvastatin.

8. Simvastatin: Instructions How long the treatment should continue – Continue to take drugs even if you feel well – Do not stop taking drugs without consulting the doctor – To be sure this medication is helping your condition, lipid levels will need to be checked on a regular basis – Liver function may also need to be tested – Do not miss any scheduled visits to your doctor

9. Simvastatin: Warnings Tell your doctor and/or pharmacist if you: – Are 65 years of age or older – Are Asian, especially if you are Chinese – Have or have ever had an underactive thyroid gland or kidney disease – Have liver disease – Drink large amounts of alcohol – Are allergic to simvastatin, any other medications, or any of the ingredients in simvastatin tablets

10. Simvastatin: Warnings Tell your doctor and/or pharmacist if you: – Are pregnant or plan to become pregnant You should not become pregnant during your treatment with simvastatin. Simvastatin can harm the fetus. – Are breast-feeding You should not breast-feed while you are taking simvastatin. – Are having surgery, including dental surgery Ask your doctor about the safe use of alcoholic beverages while you are taking simvastatin. – Alcohol can increase the risk of serious side effects.

11. Simvastatin: Drug Interactions Antifungal medications such as itraconazole (Sporanox) and ketoconazole (Nizoral) Clarithromycin (Biaxin) Erythromycin (E.E.S., E-Mycin, Erythrocin) HIV protease inhibitors such as indinavir (Crixivan), ritonavir (Norvir) and saquinavir (Invirase, Fortovase) Nefazodone (Serzone) Telithromycin (Ketek)

12. Simvastatin: Drug Interactions Prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products Amiodarone (Cordarone, Pacerone) Anticoagulants ('blood thinners') such as warfarin (Coumadin) Cyclosporine (Sandimmune, Neoral) Danazol Digoxin (Lanoxin) Other cholesterol-lowering medications such as fenofibrate (Tricor), gemfibrozil (Lopid), and niacin (nicotinic acid, Niacor, Niaspan); and verapamil (Calan, Covera, Isoptin, Verelan)

13. Simvastatin: Dietary Instructions Eat a low-cholesterol, low-fat diet – Cottage cheese, fat-free milk, fish, vegetables, poultry, and egg whites Increase the amount of soluble fiber in your diet with foods such as oatmeal, kidney beans, and apples. Use monounsaturated oils. Avoid foods with excess fat. Fat intake reduced to 35-40g/day.

14. Simvastatin: Lifestyle Modification Smoking cessation and avoidance of passive smoking – Smoking about doubles the risk for coronary heart disease Start exercise regimen (vigorous, aerobic, habitual, continuing) Proper weight management if needed – Weight reduction reduces BP, LDL, HDL, and increases HDL and glucose tolerance – Use waist circumference (> 90 cm) and BMI

15. Simvastatin: Missed A Dose? Take the missed dose as soon as you remember it.

16. Simvastatin: Future Consultations Future Consultations – When to come back Come back for follow-up after 2-4 weeks – When to come earlier Serious side effects, allergic reactions, etc. – What information will the doctor need for next appointment? Repeat lipid profile after 6 weeks Liver function tests prior to treatment, 2-3 months after, and annualy thereafter

17. Simvastatin: Future Consultations Regular blood pressure monitoring – She is also at risk for hypertension and adverse cardiovascular events Check for other co-morbid conditions like diabetes mellitus and obesity – Obesity is associated with higher risk for CVD, stroke, and all-cause mortality

18. Simvastatin: Everything Clear? Whether everything is understood Repeat the most important information Whether the patient has any more questions

19. Reference http://www.nlm.nih.gov/medlineplus/druginf o/meds/a692030.html http://www.nlm.nih.gov/medlineplus/druginf o/meds/a692030.html