HMG-CoA Inhibitors (Statins)

Question 1

HMG-CoA Drugs

Answer 1

-statin
* Atorvastatin
* Lovastatin
* Pravastatin
* Rosuvastatin
* Simvastatin

Question 2

HMG-CoA Method of Action

Answer 2

• HMG–CoA reductase (an enzyme) is needed to synthesize cholesterol in the liver
• If this enzyme is blocked, serum cholesterol and LDL decrease
  since the liver cannot produce cholesterol

Question 3

HMG-CoA Indication

Answer 3

Treats elevated cholesterol, triglycerides, and LDL

Question 4

HMG-CoA Caution/Absolute Contraindication

Answer 4

Caution:
* Renal impairment
* can be worsened if rhabdomyolysis occurs
* Impaired endocrine function

Contraindication:
* Absolute: Allergy and pregnancy
* Relative: Liver disease

Question 5

HMG-CoA Adverse Drug Effects

Answer 5

Adverse Drug Effects:
* GI system: flatulence, abdominal pain

• Liver: elevated liver enzymes (ALT/AST) and acute liver failure Muscle soreness, aches, cramps
• Rhabdomyolysis: breakdown of muscles which releases waste products that can injure the glomerulus and result in acute renal failure

Drug Interactions:
* Antibiotics, antifungals, immunosuppresants:
* May increase drug levels of the statin
* Increased adverse effects

• Grapefruit juice: Increased risk of toxicity
• St. John’s Wort: Decrease statin effectiveness

Question 6

HMG-CoA ADPIE 1

Answer 6

Assessment -
History:
* Allergy, pregnancy, lactation, liver disease,
impaired endocrine function, renal impairment

Physical:
* Abdomen: bowel sounds (BS) & elimination patterns

Labs:
* Renal and hepatic function; lipid levels
* Possible pregnancy test

Nursing Conclusions -
* Injury risk related to (r/t) liver and renal effects
* Impaired comfort r/t myalgia
* Knowledge deficit r/t drug therapy

Question 7

HMG-CoA ADPIE 2

Answer 7

Implementation:
* Administer at bedtime
* Monitor serum cholesterol, LDLs, LFTs
* Lifestyle modifications
* Withhold in any acute/serious medical condition
* Use of barrier contraception for those of childbearing age
* Comfort measures for adverse effects
* Provide thorough patient teaching

Evaluation:
* Evaluate response to drug
* Evaluate the effectiveness of the teaching plan
* Evaluate the effectiveness of comfort and safety measures
* Evaluate the compliance with the regimen

Question 8

HMG-CoA Memory Technique

Answer 8

Memory technique: STAT
* Sore MUSCLES
* Toxic Liver (ALT/AST)
* AVOID Grapefruit & St Johns Wart
* Take at NIGHT