Cardiovascular (HMG CoA Reductase Inhibitors)

Question 1

Examples of drug (HMG CoA Reductase Inhibitors)

Answer 1

• Simvastatin
• Atorvastatin
• Pravastatin

Question 2

Mechanism of action (HMG CoA Reductase Inhibitors)

Answer 2

• Competitively inhibits HMG CoA Reductase; the rate-determining enzyme in the mevalonate pathway synthesis of cholesterol.
• This causes an increase in LDL-receptor expression, on the surface of hepatocytes.
• Increases hepatic uptake of cholesterol, reducing plasma cholesterol levels.
• Reduces development of athersclerotic plaques.
• Statins may have additional pleotropic effects.

Question 3

Indications (HMG CoA Reductase Inhibitors)

Answer 3

• Familial hypercholesterolaemia

- Prevention of cardiovascular events in high-risk patients.

Question 4

Side-effects (HMG CoA Reductase Inhibitors)

Answer 4

• Myalgia (5-7% of patients)
• Myopathy (with creatine kinase elevation) and rhabdomyolysis are rare.
• GI disturbances (Varied symptoms; up to 6% of patients affected)
• Liver abnormalities – deranged LFT’s

Question 5

Important pharmacokinetics/pharmacodynamics (HMG CoA Reductase Inhibitors)

Answer 5

• Myalgia and Rhabdomyolysis are dose-related, begin with low dose, especially in patients with previous side-effects.

Question 6

Patient information (HMG CoA Reductase Inhibitors)

Answer 6

• Report any unexplained muscle pains to their GP, who will check a creatine kinase blood level.
• Diarrhoea and abdominal pain may be present initially.

Question 7

Other information (HMG CoA Reductase Inhibitors)

Answer 7

• Hypothyroidism should be corrected before assessing need for statin use.