Chapter 27: Statin Therapy (antilipemic Drugs)

Question 1

What are statins

Answer 1

First line of drugs for management of hyperlipidemia. They lower LDL and total cholesterol levels. May improve HDL.

Metabolized first in the liver then removed from the blood stream.

Majority of statins are excreted in the feces.

Question 2

Peak concentration of atorvastatin?

Answer 2

In 1 to 2 hours

Question 3

what is statin’s mechanism of action?

Answer 3

Inhibition of the enzyme hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase

Question 4

what is the pharmacokinetics of statins?

Answer 4

Statins undergo first-pass metabolism through the liver, the primary site of statin activity.

Question 5

Contraindications With Statins

Answer 5

Statin drugs are contraindicated in the following:

Patients with a known drug allergy
Patients who are pregnant
Patients who are breastfeeding
Patients with a liver disorder, including those patients with a history of alcohol abuse or with elevated liver enzyme levels

Question 6

Drug Interactions With Statins

Answer 6

• use with warfarin inhibits warfarin metabolism and increases risk for bleeding.
• use with fibrates increases risk for myopathies.

Question 7

Side/Adverse Effects of Statins

Answer 7

Side Effects: muscle cramps, HA, GI upset, N/V/D, liver dysfunction.

Adverse Effects: myopathies, muscle pains, mild increase of CK levels (creatine Kinase)

Question 8

Patient Teaching for Statins

Answer 8

• Lipid levels may not be lowered to their maximum extent until 6 to 8 weeks after the start of therapy.

-Side effects and adverse effects, especially any muscle aches or pains, darkening of urine, nausea, or vomiting, should be reported to a health care provider.

• Gastrointestinal distress associated with statins may be reduced by taking the drug with meals or with at least 6 to 8 oz of water

Question 9

which drug may contract with statins?

Answer 9

Amlodipine. because amlodipine is both a substrate and an inhibitor of CYP3A4 which may cause elevated levels of simvastatin when both drugs are taken.

Question 10

which lab values should be checked before initiation of statin?

Answer 10

• Lipid panel (to assess for lipid baseline)
• Liver enzymes (statins can cause elevated liver enzymes)
• Creatine Kinase (CK) due to potential myopathies

Question 11

when should a patient take an immediate release lovastatin?

Answer 11

take it in the evening with a meal.

Question 12

Which statins are significantly metabolized by CYP3A4?

Answer 12

atorvastatin, lovastatin, simvastatin

Question 13

Which parameters are expected to decrease with statins?

Answer 13

triglycerides
total cholesterol
apolipoprotein B-100
LDL

Question 14

Which statements regarding pharmacodynamics and pharmacokinetics of statins are accurate?

Answer 14

1. Statins reduce cholesterol production through inhibition of hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase
2. Hepatocytes increase the number of low-density lipoprotein (LDL) receptors in response to decreased cholesterol synthesis by statins to remove cholesterol from circulation.

Question 15

Which patients would a nurse determine can safely receive treatment with a statin in the absence of any other factors?

Answer 15

A 48-year-old patient with hyperthyroidism

a 55 yr old with DM 2

Question 16

A patient taking atorvastatin is experiencing the adverse effect of myositis. Which manifestations would a nurse expect to see in this patient?

Answer 16

muscle pain
muscle inflammation
CK elevation

Question 17

Which teaching points would a nurse share with a 33-year-old female patient who was prescribed statin therapy?

Answer 17

avoid pregnancy,
GI distress can be minimized by taking it with food and 8 oz water.
excercise and diet rich in fiber.

Question 18

why grapefruit juice should not be taken with lovastatin?

Answer 18

it increases risk for rhadomyolysis because lovastatin levels will increase

Question 19

Which statins and doses are therapeutically equivalent to pitavastatin 2 mg?

Answer 19

Pravastatin 40mg
Simvastatin 20mg
Rosuvastatin 5 mg

Question 20

Which factors would increase a patient’s risk for rhabdomyolysis if on simvastatin?

Answer 20

Advanced age
Hypothyroidism

Question 21

Most common used NON- statin agent

Answer 21

Ezetimibe (inhibits cholesterol)

Question 22

Important note when taking Bile Acids Sequestrants

Answer 22

This medication prevents absorption of cholesterol in the intestines.

*take other meds 1 hour before OR 4-6 hours after

Question 23

Gemfibrozil & Fenofibrate

Answer 23

Lowers Triglyceride and increase HDL

Question 24

Niacin B3

Answer 24

Helps lower cholesterol by blocking the liver from making cholesterol (lipolysis).

S/E: flushing of face from prostaglandin release.