statins Flashcards
statin
reduce LDL synthesis in liver by inhibit HMG-COA
- in return reduce TG and increases HDL
when to take a statin
take at night, except atorvastatin thats in morning
as cholesterol synth greater ay night
s/e
1)myopathy, myositis , rhabdomylosis (reports signs , muscle weakness tender and pain) dark urine , rnhabdomylosis (5x upper limit creatinine kinases)
high risk of muscle toxicity; renal impairment, family history muscle problems, alcohol use, hypothyroid
2) increase risk myopathy ; concomitant drugs i.e ezetimibe or fibratesi.e gemfibrizil . if take with fusidic acid only take statin 7 days after last dose as inc risk of rhabdomylolosis
3)interstitial lung diesese; cough, short breath, weight loss
4) diabetes increase hba1c or bg so caution
what do high intensity statins do
reduce LDL by 40%
monitoring statin
LFT before tx, 3months after then 12 months after (caution in hepatic impairment avoid I. active disease or elevated transaminisse
2) baseline lipid profile3)RFT, 4) TFT 5) hba1c if diabetic risk
discontinue if 3 x liver transaminase or
stop if 5x upper limit of creatinine kinase (can reintroduce if levelslower )
statin and preg
teratogenic so have effective contraception during and 1 month after tx
stop taking 3 months before pregnancy and restart after breast feeding finish
What substrates are statins
P450, however simvastatin is a cyp3a4 and so is atorvastatin to a lesser extent
every other statin is not
food interaction with statin
dont take grapefruit juice with simvastatin , and limit or avoid with atorvastatin
drug interaction and statin
CYP3A4 inhibitor inc simvastatin levles= myopathy (SICKFACES.COM)
CY3A4 inducers= lower dose
important interaction+
macrolide antibiotic= stop statins until course complete
fusidic acid= stop statin and start 7 days after complete
ezetimibe/fibrates i.e gemfibrozil avoid with statins
WARFARIN - regular monitoring inr all statins effect except pravastatin
dose adjustments with statins
simvastatin
- max 10mg with fibrate
- max 20mg with amiodarone , amlodipine and rate limit ccb
atorvastatin /simvastatin
max 10mg with ciclospproin
rosuvastatin
5mg with clopidogrel initial max 20mg
c/I of simvastatin
all CYP3A4 inhibitors
rosuvastatin c/I
ciclosporin
what to address before starting statins
hypothyroid , liver disease i.e cirrhosis , nephrotic syndrome , uncontrolled dm
2 types of dyslipidameia
primary inherited = primary heterozygous FH, or high risk premature chd give all high intensity statin i.e atorvastatin 20mg0D
secondary prevention (another cause i.e diabetes) - do q risk if high risk >10% = primary prevention(atorvastatin 20mg 0d ) or if established cvd give i.e atorvastatin 80mg od
other high intensity statin = rosuvastatin 10mg
simvastatin 80mg- avoid due to myopathy high risk
1st line for dyslipidaemia
1) statins , if c/I give ezetimibe ) in primary,familial hypercholestramia
to step this up only under specialist : can add statin +ezetimibe if TG still high after LDL reduced can add fibrate or nicotinic acid
2) if moderate hYPERtriglycdamia (severe= >10mmol) in practice = if statin not tolerated or c/I give fibrate
gemfibozil never ever use with statin due to rhabdomyolysis
