HMG-CoA Reductase Inhibitors

Question 1

What class are the following drugs apart of: atorvastatin, simvastatin, lovastatin, rosuvastatin, and pravastatin?

Answer 1

HMG-CoA Reductase Inhibitor

Question 2

What are the brand names for the following: 
atorvastatin
lovastatin
pravastatin
rosuvastatin
simvastatin

Answer 2

atorvastatin: lipitor
lovastatin: altoprev
pravastatin: pravoachol
rosuvastatin: crestor, ezallor
simvastatin: zocor

Question 3

What is the mechanism of action of HMG-CoA Reductase Inhibitor?

Answer 3

HMG-CoA Reductase Inhibitors work by completely inhibiting the conversion of HMG-CoA to mevalonate, which is an early rate-limiting step in cholesterol synthesis. results in a compensatory increase in LDL receptors which binds and remove circulating LDL-cholesterol. ALSO production of LDL cholesterol can decrease because of the decreased production of VLDL-cholesterol along with removal of LDL receptors

Question 4

Atorvastatin Dosage forms

Answer 4

Tablets; 10mg, 20mg, 40mg, and 80mg

Question 5

Atorvastatin Indications

Answer 5

Hyperlipidemia (10-20mg qd but can increase to 80 mg qd)

Primary and secondary prevention of atherosclerotic cardiovascular disease (10-20 mg qd, may increase to 80mg qd for patients requiring high intensity therapy (LDL>190/high ASCVD risk)

Secondary Prevention of cardio events in pt w/ or @ high risk of CAD (80mg qd, may reduce to 40mg if high dose is not tolerated)

Familial hypercholesterolemia homozygous: children boys and girls (10-17) 10 mg qd (may take up to 40 mg qd ; adults 10-80 mg qd

Question 6

atorvastatin contraindications

Answer 6

hypersensitivity to atorvastatin
use in breastfeeding
active liver disease
unexplained persistent elevation of serum transaminases

Question 7

Atorvastatin ADR

Answer 7

Common: myopathy (muscle weakness), diarrhea, headache, nasopharyngitis

Less common: increased liver enymzes, indigestion, insomnia, musculoskeletal pain, myalgia, nausea, increased A1C

Serious: rhadbomyolysis, and tendon rupture

Question 8

Efficacy Monitoring parameters for HMG-CoA Reductase Inhibitors

Answer 8

check total cholesterol, LDL cholesterol, and triglycerides levels as well as HDL cholesterol levels

With pravastatin, repeat 4–12 wks after initiation or dose adjustment

With simvastatin: obtain baseline fasting panel 4-12 wks after initiation and 3-12 months following

Question 9

Atorvastatin Key counseling points

Answer 9

Avoid excessive alcohol, grapefruit, and grapefruit juice consumption

Healthy lifestyle changes including diet and exercise to lower levels

notify your provider if explained muscle tenderness or weakness occurs

Question 10

Lovastatin dosage forms

Answer 10

tablet: 10mg, 20mg, 40mg

tablet ER: 20mg, 40mg, 60mg

Question 11

Lovastatin Indications

Answer 11

coronary arteriosclerosis, hypercholesterolemia primary and mixed: initial 20mg qd, maintenance 10-80mg qd with evening meal (MAX 80mg/d); ER 20-60 po qhs

Familial hypercholesterolemia, heterozygous: children 10-17 initial 10 po daily, maintenance 10-40mg po qd (MAX 40mg/d)

Question 12

Lovastatin contraindications

Answer 12

hypersensitivity to lovastatin
active liver disease
use in breastfeeding
concomitant use with strong CYPA4/5 inhibitors
unexplained persistent elevation of liver enymes

Question 13

lovastatin ADR

Answer 13

common: none

less common: abdominal pain, constipation, diarrhea, headache, increased liver enzymes, myalgia, nausea, rash, hyperglycemia

serious: rhabdomyolysis, hepatotoxicity, increased risk of diabetes

Question 14

Lovastatin Key counseling points

Answer 14

Immediate- release tablets should be taking in the evening with meals

ER should be taking at bedtime

Avoid grapefruit, grapefruit juice, and alcohol

Report signs of rhabdomyolysis, jaundice, or renal failure

Many drug interaction, so consult with provider for new rx and otc medications

lifestyle changes

Question 15

Pravastatin dosage forms

Answer 15

tablet: 10mg, 20mg, 40mg, 80mg

Question 16

Pravastatin indications

Answer 16

Cerebrovascular accident (prevention), coronary arteriosclerosis (primary or secondary prevention): 40 mg po daily

Familial hypercholesterolemia: Children 8-13 y of age, 20 mg po daily; Children 14-18 y of age, 40 mg po daily; Adults, 40 mg po daily, may titrate to 40-80 mg po daily

Hyperlipidemia: Children (boys and postmenarchal girls) 10-17 y of age, 10 mg po daily, may titrate to 20 mg/d; Adults, 40 mg po daily, may titrate to 40-80 mg po daily

Question 17

Pravastatin contraindication

Answer 17

hypersensitivity to pravastatin

use in breastfeeding

Question 18

Pravastatin ADR

Answer 18

common: none

Less common: Headache, heartburn, increased liver enzymes, influenza-like symptoms, musculoskeletal pain, myalgia, nausea, rash, vomiting

Serious: Rhabdomyolysis, tendon rupture

Question 19

Pravastatin Key counseling point

Answer 19

Take in the evening
avoid with heavy alcohol use
health lifestyle changes

Question 20

Rosuvastatin dosage form

Answer 20

tablet: 5mg, 10mg, 20mg, 40mg

Oral capsule, sprinkle: 5mg, 10mg, 20mg, 40mg

Question 21

Rosuvastatin indication

Answer 21

Hyperlipidemia: Adults, 10-20 mg po daily, may titrate to 40 mg po daily; Children 10-17 y of age, 5-20 mg po daily, may titrate to 20 mg po daily

Disorder of cardiovascular system, primary prophylaxis, familial hypercholesterolemia, homozygous, hypertriglyceridemia, mixed dyslipidemia: 10-20 mg po daily, may titrate to 40 mg po daily

Question 22

Rosuvastatin contraindication

Answer 22

hypersensitivity to rosuvastatin

use in breastfeeding

Question 23

Rosuvastatin ADR

Answer 23

Common: Arthralgia (muscle pain and aches)

Less common: Abdominal pain, asthenia (lack of energy), constipation, diarrhea, indigestion, headache, increased liver enzymes, influenza-like symptoms, myalgia *muscle pain and aches), nasopharyngitis, nausea, pharyngitis, rhinitis

serious: Rhabdomyolysis, tendon rupture

Question 24

Rosuvastatin key counseling points

Answer 24

Do not drink alcohol

healthy lifestyle changes such as diet and exercise

Question 25

Simvastatin dosage forms

Answer 25

Tablet: 5mg, 10mg, 20mg, 40mg, 80mg

Oral suspension: 20mg/5mL and 40mg/5mL

Question 26

Simvastatin indications

Answer 26

Hyperlipidemia: 20-40 mg po daily in the evening

Primary and secondary preventions of atherosclerotic cardiovascular disease: 20-40 mg po daily in the evening

Secondary prevention of cardiovascular events: 5-40 mg po daily in the evening

Familial hypercholesterolemia (homozygous): Children (boys and postmenarchal girls 10-17 y of age), 10 mg po daily, may titrate to 40 mg po daily in the evening; Adults, 20-40 mg po daily in the evening

Question 27

Simvastatin contraindication

Answer 27

hypersensitivity to simvastatin
active liver disease
use in breastfeeding

Question 28

Simvastatin ADR

Answer 28

Common: none

Less common: Abdominal pain, constipation, diarrhea, headache, increased liver enzymes, myalgia, nausea, rash

Serious: Rhabdomyolysis, myopathy, hepatotoxicity, tendon rupture, elevated HgA1c, immune-mediated necrotizing myopathy

Question 29

Simvastatin Key counseling points

Answer 29

Avoid excessive alcohol
many drug interaction, so consult w/ provider before starting any new medications including otc and rx
Lifestyle changes including diet and exercise

initial max starting dose is 40mg (80 mg limited to pts that previously maintained for over 12 months