STATIN

Question 1

Statin - what type of drug is statin?

Answer 1

HMG-CoA reductase inhibitor

Question 2

Statin - examples

Answer 2

• Simvastatin
• Atorvastatin
• Pravastatin
• Rosuvastatin

Question 3

Statin - indications (treatment)

Answer 3

Primary hyperlipidaemia - such as:
→ Primary hypercholesterolaemia
→ Mixed dyslipidaemia
→ Familial hypercholesterolaemia

Question 4

Statin - indications (primary prevention)

Answer 4

Primary prevention of cardiovascular events

→ prevent CV events (e.g.- MI, stroke) in people >40 years old, with a 10 year CV risk >10% (assessed using QRISK3 tool)

Question 5

Statin - indications (secondary prevention)

Answer 5

Secondary prevention of cardiovascular events

→ first line, along with lifestyle changes, to prevent CV events in patients with established CV disease

Question 6

Statin - Administration

Answer 6

Orally

Simvastatin (short half-life) taken in evening

Other statins (longer half-life) can be taken at any time

Question 7

Statin - which statin has a short half-life and when does this specific statin need to be taken?

Answer 7

Simvastatin (short half-life) taken in evening

Question 8

Statin - MOA

Answer 8

Statins reduce cholesterol levels

The enzyme 3-hydroxy-3-methyl-glutaryl coenzyme A (HMG CoA) reductase is involved in the synthesis of cholesterol

Statins:
• Inhibit HMG CoA reductase
• Decrease cholesterol production by liver
• Increase clearance of LDL-cholesterol (“bad” cholesterol)
• Increase production of HDL cholesterol (good cholesterol)

Overall, statins slow the atherosclerotic process and may even reverse it

Question 9

Statin - adverse effects (common)

Answer 9

Most common
→ Headaches
→ GI disturbance: nausea, change in bowel habit (diarrhoea and constipation)

Common:
→ Muscle pain (aka Myalgia)
→ Myopathy

Question 10

Statin - adverse effects (rare, but serious)

Answer 10

→ Rhabdomyolysis

→ Drug-induced hepatitis
Rise in liver enzymes (e.g.- ALT);

Question 11

Statin - interactions

Answer 11

CAUTION with:
→ CYP 450 inhibitors 
Why? Inhibits statin metabolism = statin accumulation in body = increased risk of adverse effects 
Examples:
Amiodarone 
Diltiazem 
Itraconazole 
Macrolides (mycin)
Protease inhibitors 

→ Amlodipine
has a similar effect.

when using the above drugs with statins dosage may need to be reduced / paused.

Question 12

Statin - why is caution required when giving a statin with a cytochrome P450 inhibitor?

Answer 12

Inhibits statin metabolism = statin accumulation in body = increased risk of adverse effects

Question 13

Statin - why is caution required when giving a statin with amlodipine? what can be done to combat this?

Answer 13

Increased risk of adverse effects

To reduce risk with amlodipine, reduce statin dose or withhold statin treatment if the amlodipine is a short course and then use statin after this is completed

Question 14

Statin - Caution

Answer 14

CAUTION IN THESE PATIENTS:
→ Hepatic impairment
→ Renal impairment
Why? Statins are excreted by kidneys

Question 15

Statin - is there any specific food or drink patients should avoid when using statins

Answer 15

Advise patient to keep alcohol intake minimal

Patients taking simvastatin or atorvastatin should avoid grapefruit juice
Why? Reduces body’s ability to breakdown statin, therefore, may increase risk of adverse effects

Question 16

Statin - why should patients taking statins avoid grapefruit juice?

Answer 16

Grapefruit juice reduces body’s ability to breakdown statin, therefore, may increase risk of adverse effects

Question 17

Statin - contraindications

Answer 17

Avoid in women who are:
→ Pregnant
Why? Cholesterol is important for normal fetal development
→ Breastfeeding

Question 18

Statin - monitoring

Answer 18

• If patient experiences muscle symptoms to seek medical attention
• Come back in 3 months for blood tests:
  1) repeat lipid profile – should be at least <40% in non-HDL cholesterol
  2) ALT levels (at 3 months and 12 months) – if >3x more = stop statin