HMG-CoA reductase inhibitors

Question 1

Statins MOA

(“steam punk pirate”)

Answer 1

HMG-CoA reductase inhibitors →reduce production of mevalonate from HMG-CoA → reduced levels of cholesterol in hepatocytes

(“steam punk pirate knocking over HMG crude ore reducer “)

-statins cause increased LDL receptor expression on hepatocytes, clearing LDL’s from circulation
(“Statin-punk threatening workers to pull in LDL ship”)

-statins are most effective drugs for lowering LDL’s (30-60%)
(“Sinking LDL ship”)

-statins can lower triglycerides (mild effect)
(“Statin-punk pirate kicking off trident passenger”)

-statins can increase HDL (mild effect)
(“Raised HDL submarine”)

Question 2

Name the Statins

Answer 2

• *Simva** statin
• *Atorva** statin
• *Rosuva** statin

Question 3

Statins are effective because they …

Answer 3

1ST LINE AGENT FOR HYPERCHOLESTEROLEMIA
(“Gold bar plunder”)

-Statin therapy initiated in setting of MI and other acute coronary syndromes (ACS)
(“broken heart strings”)

-are the most effective lipid lowering medication for preventing future cardiovascular events
(“Guardian angel”)

-statins are the only lipid lowering drug consistently proven to reduce risk of atherosclerotic heart disease
(“Yellow filled coronary crown”)

• reduce risk of cardiovascular events and mortality in high risk diabetics
  (“Candy jar”)

-reduce risk of cardiovascular events and mortality in patients with peripheral artery disease
(“Clogged pipe”)

-reduce risk of future vascular events in patients with history of TIA or stroke
(“Black paint stroke”)

Question 4

Statins side effects

(“steam punk pirate”)

Answer 4

-statins can cause myopathy weeks to months after starting therapy (proximal muscle weakness/soreness), difficulty raising arms above head

• can cause elevations in serum CK-myopathy
  (“Crispy chicken bucket”)

-statins may be teratogenic
(“Tarantula on HDL submarine “)

​-mild elevations in liver function tests (LFT’s) are
common -reversible with discontinuation of statin
(“Raised LFT flag”)

-all statins except pravastatin are metabolized by the cytochrome p450 (CYP-450) in the liver leading to an increased risk of developing myopathy
(“Chrome tank with CYP bumper”)

(“Bite out of crispy chicken”)