Hypercholesterolemia

Shock - shock is state of inadequate tissue pefusion

Clinical manifestations- clinical manifestations of shock are variable and non-specific

Signs and symptoms of shock include-

Skin- pallor, cyanosis, cold ana clammy , sweating

CNS- agitation,confusion, disoreientation, coma

Cardiovascular- tachycardia, arrhythmias, wide pulsepressure, gallop rhythm, hypotension

Pulmonary - tachypnea, pulmonary edema

Renal -oliguria ( < 0.5ml/kg/hr )

Metabolic-  acidosis. hypoglycemia, or hyperglycemia

Indication-
Hypercholesterolemia

Dosage-
Recommended initial dose - 1 to 4 weeks- 500mg daily for 4 weeks
after 4 weeks  5 to  8 weeks - 1000mg daily

After 8 weeks - titrate to patient response and tolerance
If response to 1000mg daily is inadequate increase dose to 1500mg
May subsequently increase dose to 2000mg

Daily dose should not be increased more than 500mg in a 4 week period
Doses higher than 2000mg daily are not recommended

Interruption  of therapy- if niacin extended release /simavastain therapy is discontinued for
an extended period of time ( more than 7 days ) retitration as tolerated is recommended