These criteria may be applied to pravastatin, simvastatin and fluvastatin by including their dosage ranges. However, because of drug-specific differences certain modifications may be needed. With the new NCEP ATP II guidelines, this group of agents is not relegated to patients failing niacin or bile acid binding resins. Criteria for other cholesterol lowering agents are not published to date. Key criteria for niacin include contraindications to use and patient education to minimize side effects and increase compliance.
Niacin dosage is crucial in initiation of therapy due to the associated flushing.
Initial dose and subsequent titration for this drug are highlighted in process criteria. Differences in the criteria for bile acid binding resins from that of niacin would be focused upon patient selection, excluding those with problems that would be worsened by addition of cholestyramine or colestipol such as constipation or concurrent therapy with interacting drugs. On the other hand, in pediatric patients these are drugs of proven safety. Monitoring and management of side effects and toxicities is often more problematic with these agents and should be included as an essential portion of the review. Clinical indicators Clinical indicators are quantitative measures useful as guides to monitor quality of patient care.