Rosuvastatin, known as Crestor, lowers cholesterol Assessment Answer

Introduction

Rosuvastatin belongs to a group of statins. It lowers the increased cholesterol. Rosuvastatin is also known as crestor. The government of New Zealand decided to fund this medicine from 1 December 2021 (Pharmac, 2021). The U.S. Food and Drug Administration has approved this medicine. Pharmac is a pharmaceutical management agency which is governed by the government of New Zealand. The role of Pharmac is to manage the list of vaccines, medicines and devices that are funded in the community (Pharma, n.d. ). Rosuvastatin is a competitive inhibitor of hydroxymethylglutaryl-CoA (HMG-CoA). The dose for this drug depends on the patient’s requirement although for adults the normal dose is 20 mg once a day and for children the maximum dose is 20 mg per day (Medsafe, 2022). This report will focus on the background of Pharmac company. In addition to this, the discussion on medication will be focused on the mode of action, side effects and dosage of the drug. The report will also highlight the risk profile of rosuvastatin and alternatives that can be used in place of rosuvastatin. At last, the recommendation will be discussed that are comprehensive and based on nursing practices.

Background

Pharmac is also known as a pharmaceutical management agency which is governed by a government-appointed board. Pharmac is the government agency that determines medicines and interconnected products that are funded in Aotearoa New Zealand (New Zealand Government, 2020). Pharmac's role is to promote the use of medicines responsibly. In addition to this, it also manages the list of vaccines, devices and medicines that are sponsored in the community (Pharmac, n.d.). Some part of the cost is paid by the government and hence it is cheaper for the consumers. Moreover, Phamac also manages the funding of the hospitals and national contracts for the devices that are used in public hospitals (Pharmac, n.d.). Pharmac is the only agency in the world that makes decisions about medicine funding and the fixation of the budget for those medicines. Within the budget, Pharmac decides the funding of the medicines in New Zealand (Pharmac, 2022). Due to the increasing cost of pharmaceuticals, Pharmac was created in 1993. The aim of Pharmac is to provide medicines across New Zealand at an affordable and cheap price. Pharmac also manages the Named Patient Pharmaceutical Assessment (NPPA) policy that takes care of the patients whose needs can’t be achieved by the Pharmaceutical Schedule process (Pharmac, 2022).

Discussion of Medication

Rosuvastatin is approved by the U.S. Food and Drug Administration under the category of statins. It is a lipid-lowering agent and comes under the statin class and is a selective and competitive inhibitor of HMG-CoA reductase. Statin treatment reduces the production rate for hepatics. Statins also inhibit the production of transitions that are required for the activation of signalling proteins ( Sizar et al., 2022). Rosuvastatin plays an important role in cholesterol synthesis. It is not considerably metabolised and its half-life is 19 hours ( Medsafe, 2022). The dose of 20 mg once daily is found to decrease the risk for cardiovascular events. The dosage also varies from patient to patient. Patients who are at high cardiovascular risk can be given 40 mg of Rosuvastatin once daily which will control the condition. It is advised to give a 40 mg dose to only those patients whose regular follow-up is planned with the physician (Medsafe, 2022). For high cholesterol 5- 10 mg can be given to the patient once a day. For children, the maximum dose is 20 mg a day. It is recommended to take Rosuvastatin at the same time daily with or without food (NHS, 2022). Rosuvastatin is used when medicines like atorvastatin or simvastatin do not work properly (Health Navigator New Zealand, 2021). Like any other medicine, Rosuvastatin also has side effects that include pain in the stomach, headaches and constipation. Moreover, there is detection of protein in the urine and the person feels weak. Serious side effects are limited but include cramps and muscle pain. The whites of the eye turn yellow in colour which shows signs of liver problems. There can be allergic reactions like skin irritation or rashes due to Rosuvastatin. Rosuvastatin can react with other medicines and cause allergies, therefore it is recommended to take advice from a doctor and then only take the medicine (Health Navigator New Zealand, 2021). Intake of Rosuvastatin is not recommended for females who are pregnant (NHS, 2022). Rosuvastatin tablets are taken daily with or without food. Cholesterol and medical history determine the dose. Rosuvastatin is a subsidised drug in New Zealand for people who match certain criteria and are prescribed it by a doctor. From December 1, 2021, it was decided by the government of New Zealand that Rosuvastatin will be fully funded. It is expected that approximately 75000 people will be benefited. Rosuvastatin costs may vary from brand to brand. The cost for funded Rosuvastatin is roughly $6 million over 5 years (Pharmac, 2021). 

Risk Profile

The access to funded medication in New Zealand has a great impact that comes from a cultural and socio-economic point of view. The availability of the medicines impact the health outcomes of the people living in New Zealand. It also impacts the quality of life of people living there. The consumers are affected by the cessation of the medication especially the socio-economic background people. As rosuvastatin is fully funded by the government of New Zealand, the people will be critically affected and will also struggle to afford the cost of the medicine that is related to the healthcare. The medication cannot be afforded by al, the people and hence have a great impact on socio-economic perspectives. The medicines that are fully funded help the people who are not able to afford the medication and are also affected by some chronic disease (Pharmac, n.d.). The patients who need assistance for long term treatment will be greatly impacted by the cessation of medication. Taking into consideration the cultural perspective, fully funded medication will ensure that society members receive the healthcare they need irrespective of their cultural background. The diverse population of New Zealand and availability of healthcare to everyone is important regardless of their beliefs, cultural practice and ethnicity. Medicine access equity is one such initiative by Pharmac to make sure that everyone gets an even chance to access the funded medicines so that the people attain full health potential. The study conducted by Chauhan et al (2020), shows that the patients who belong to ethnic minority backgrounds have difficulty in accessing safe and quality healthcare. In order to make sure that the people belonging to minority backgrounds have less access to healthcare, the healthcare system should take initiative to enhance equity in the safety of healthcare.

If the government of New Zealand were to stop providing financing for Rosuvastatin, it is quite likely that this would have an effect on both the availability of the drug and the price at which it is sold to patients (Pharmac, 2021). Patients who are currently using Rosuvastatin and who depend on government subsidies will have to buy the drug may be required to pay higher out-of-pocket costs or may be required to switch to a different medication that is available at a lower cost. The cessation of the fully funded drug will impact the consumers in a negative manner or may have negative consequences. This will become challenging for the people as they will have to pay from their own pocket. The resistance in the availability of fully funded medicine will largely impact on the population who are already financially unstable. In terms of the risk profile, if patients are unable to afford fully funded medicines or are forced to move to a different prescription, this might potentially have an influence on their cholesterol levels and increase their risk of cardiovascular disease. People not using Rosuvastatin have more chances of myopathy (Best Practice Advocacy Centre, 2022). The cessation will lead people not taking their medicines and will have significant impact on their health outcomes.

Alternative Options

There are alternatives that are implicated to reduce high cholesterol. The change in dietary plan will lower the cholesterol level. The best way is to decrease the intake of saturated and trans fat in the diet. This will include reduction in uptake of red meat and dairy products in the diet. The people who smoke are more likely to have high cholesterol and hence they should quit smoking as it increases the risk of coronary heart disease (American Heart Association, 2020). The study conducted by Janapala & Reddivari (2022), highlights that according to the current guidelines it is advised that saturated fats should be less than 1-0 per cent of the calorie that is taken daily by an individual. If the patient is already having high cholesterol then 5-6 percent of saturated fat is advised in daily diet. There should be reduced consumption of processed meat which is high in trans fat as it contributes to high serum cholesterol levels. Alterations to the lifestyle, including but not limited to dietary changes, physical activity, and weight loss, in addition to the use of medication, have been shown to be beneficial in lowering cholesterol levels and reducing the risk of cardiovascular disease. Patients and their healthcare providers should collaborate to build a complete treatment plan for the patient that takes into consideration all of these different elements. There are some organic and traditional ways to reduce cholesterol. One such organic method is the use of Rongoa Maori. Traditional Mori medicine, also known as Rongoa Maori, makes use of herbs, natural materials, and spiritual practices in order to foster health and well-being in its patients. Rongoa Maori dates back to ancient times. The Maori rongoa has been played in Aotearoa, now known as New Zealand) for hundreds of years, and it remains an essential component of Maori culture and identity. The practitioners of Mori rongoa use a variety of natural materials and plants to cure a broad variety of illnesses. For example, kawakawa leaves are used to treat coughs and colds, harakeke (flax) is used to treat wounds, and mamaku is used to treat stomach difficulties. These plants are often collected from their natural habitats and then processed in a variety of methods, including the creation of infusions, poultices, and ointments, among other things (New Zealand, n.d.). The Maori belief system of Rongoa is predicated on the idea of whakapapa, which emphasises the interconnectedness of all things as well as the interaction that exists between people, plants, animals, and the surrounding environment. Practitioners of Rongoa Maori medicine regard health and well-being as a holistic notion that incorporates all elements of a person's existence, including their body, mind, emotions, and spirit (Health Navigator New Zealand, 2018). It is essential to keep in mind that Rongoa Maori is not a replacement for standard medical treatment; rather, it is intended to be used in conjunction with Western medicine in situations when such treatment is deemed acceptable.

Recommendations

There are different ways through which we can reduce the cholesterol level. Patient education about the medication is very important. Patients should be educated on the necessity of taking Rosuvastatin as recommended as well as the potential adverse effects of the medication. Encourage them to notify their healthcare professional of any unpleasant reactions they may have experienced. The dosage of the medicine is very crucial. The dosage depends on the patient’s requirements. The dosage should be carefully monitored so that no mishaps take place (NHS, 2022). Nurses can take interviews from the patient and their family members in order to know more about the patient. It is important to periodically monitor patients' cholesterol levels as well as tests that evaluate their liver function in order to evaluate the efficacy of Rosuvastatin and identify any potential adverse reactions. It is important to be aware of the potential for medicines to interact with any other medications that the patient may be taking. Advise patients to inform all of their healthcare providers about all prescriptions, including over-the-counter pharmaceuticals and herbal supplements, as well as any other medications they are taking. There can be some allergies like skin itching or rashes (Health Navigator New Zealand, 2021). In addition to this, it is important to ensure that patients are able to tolerate the medication. There is an increased chance of developing type 2 diabetes while taking rosuvastatin and hence regular follow-up will help in keeping track of the same (Best Practice Advocacy Centre, 2022). Analyse the risks and advantages of taking any medication for each patient on an individual basis, taking into account their medical history, their current health status, and any other relevant considerations. The nurses should make sure that patients are aware of both the potential benefits and hazards of the medicine so that they can make an educated choice about whether or not to take it. By sticking to these suggestions, nurses will be able to provide assistance in employing the use of any medication for patients who have high cholesterol levels.

References

American Heart Association. (2020). Prevention and Treatment of High Cholesterol (Hyperlipidemia). https://www.heart.org/en/health-topics/cholesterol/prevention-and-treatment-of-high-cholesterol-hyperlipidemia

Best Practice Advocacy Centre. (2022). Rosuvastatin: another option to lower cardiovascular disease risk. https://bpac.org.nz/2022/rosuvastatin.aspx#:~:text=Adverse%20effects%20of%20rosuvastatin,other%

Chauhan, A., Walton, M., Manias, E., Walpola, R. L., Seale, H., Latanik, M., & Harrison, R. (2020). The safety of health care for ethnic minority patients: a systematic review. International journal for equity in health, 19, 1-25. https://doi.org/10.1186/s12939-020-01223-2

Health Navigator New Zealand. (2018). Rongoā Māori.https://www.healthnavigator.org.nz/health-a-z/r/rongo%C4%81-m%C4%81ori/

Health Navigator New Zealand. (2021). Rosuvastatin. https://www.healthnavigator.org.nz/medicines/r/rosuvastatin/

Janapala, U. S., & Reddivari, A. K. R. (2022). Low Cholesterol Diet. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK551722/

Medsafe. (2022).New Zealand data sheet rosuvastatin viatris. https://www.medsafe.govt.nz/profs/datasheet/r/rosuvastatinviatristab.pdf

National Library of Medicine. (2020). Rosuvastatin.

https://medlineplus.gov/druginfo/meds/a603033.html

New Zealand Government. (2020). Pharmaceutical Management Agency, Pharmac. https://www.govt.nz/organisations/pharmaceutical-management-agency/

New Zealand. (n.d.). Māori medicine. https://www.tepapa.govt.nz/discover-collections/read-watch-play/maori/maori-medicine#:~:text=Rongo%C4%81%20M%C4%81ori%20is%20the%20traditional,spiritual%20healing

NHS. (2022). How and when to take rosuvastatin. https://www.nhs.uk/medicines/rosuvastatin/how-and-when-to-take-rosuvastatin/#:~:text=You'll%20usually%20take%20rosuvastatin,with%20a%20drink%20of%20water.

NHS. (2022). How and when to take rosuvastatin. https://www.nhs.uk/medicines/rosuvastatin/how-and-when-to-take-rosuvastatin/

NHS. (2022).Side effects of rosuvastatin. https://www.nhs.uk/medicines/rosuvastatin/side-effects-of-rosuvastatin/

Pharmac. (2021). Decision to fund rosuvastatin for people with high cholesterol. https://pharmac.govt.nz/news-and-resources/consultations-and-decisions/2021-08-17-decision-rosuvastatin/

Pharmac. (2021). Pharmac to fund new cardiovascular medicine with amended Special Authority criteria. https://pharmac.govt.nz/news-and-resources/news/2021-08-17-media-release-pharmac-to-fu

Pharmac. (2022). How Pharmac works. https://pharmac.govt.nz/about/what-we-do/how-pharmac-works/#:~:text=New%20Zealand%20is%20the%20only%20country%20with%20a%20government%20agency%20like%2

Pharmac. (2022). NPPA applications. https://pharmac.govt.nz/medicine-funding-and-supply/make-an-application/nppa-applications

Pharmac. (n.d.). About Te Pātaka Whaioranga – Pharmac. https://pharmac.govt.nz/about/#:~:text=Te%20P%C4%81taka%20Whaioranga%20%E2%80%93%20Pharmac%20is,funded%20in%20Aotearoa%20New%20Zealand.

Pharmac. (n.d.). Achieving medicine access equity in Aotearoa New Zealand towards a theory of change. https://pharmac.govt.nz/assets/achieving-medicine-access-equity-in-aotearoa-new-zealand-towards-a-theory-of-change.pdf

Pharmac. (n.d.). Who we are.https://pharmac.govt.nz/about/who-are-we/

Sizar, O., Khare, S., Jamil, R. T., & Talati, R. (2022). Statin medications. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430940/

Talreja, O., Kerndt, C. C., & Cassagnol, M. (2018). Simvastatin. https://europepmc.org/article/nbk/nbk532919

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