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Drugs - CPT Sem 4 > Statins > Flashcards

Statins Flashcards

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1
Q

Give 4 examples of statins

A
  • Atorvastatin
  • Pravastaitn
  • Rosuvastatin
  • Simvastatin
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2
Q

What is the mechanism of action of statins?

A
  • Competitively inhibit HMG CoA reductase through melavolanate pathway
  • Upregulate hepatic LDL receptors so increased hepatic clearance of circulating LDL
  • So reduces serum cholesterol
  • Also causes an increase in HDL cholesterol
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3
Q

What is the route of delivery of statins?

A

PO

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4
Q

When should statins be taken?

A

Some statins work better in evening, whereas others can be taken at any time

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5
Q

What are the indications for statins?

A
  • Primary prevention of CVD
  • Secondary prevention of CVD
  • Hypercholesterolaemia
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6
Q

What are the contraindications to statins?

A

Pregnancy and breastfeeding

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7
Q

When should statins be discontinued in pregnancy?

A

3 months prior to conception

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8
Q

Why should statins be discontinued in pregnancy?

A

Risk of congenital abnormalities

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9
Q

When should statins be used with caution?

A
  • Renal or hepatic impairment
  • High alcohol intake
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10
Q

What should be done with statins in renal or hepatic impairment?

A

Prescribe lower doses

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11
Q

Why should statins be used with caution in people with high alcohol intake?

A

Increased risk of hepatic damage

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12
Q

What might interact with statins?

A
  • CYP450 inhibitors
  • Clarithromycin
  • Amlodipine
  • Fusidic acid
  • Grapefruit and its juice
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13
Q

What should be done if a patient on statins needs clarithromycin?

A

Statin should be withheld during clarithromycin course

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14
Q

What should be done if a patient on statins needs amlodipine?

A

Dose adjustment of simvastatin may be required, as the maximum dose of simvastatin with amlodipine is 20mg

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15
Q

When might statins interact with fusidic acid?

A

If used at the same time, or within 7 days of last dose of fusidic acid

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16
Q

What might happen if statins are given with fusidic acid?

A

Increased disk of fatal rhabdomyolysis

17
Q

What statins are known to interact with grapefruit and its juice?

A

Simvastatin and atorvastatin

18
Q

What monitoring is required with statins?

A
  • Full lipid profile (HDL, non-HDL + triglycerides) before statin
  • Check TFTs before starting statins
  • Check LFTs after 3 months of therapy and after 1 year
19
Q

Why should you check baseline lipids before starting statin therapy?

A

To monitor clinical effect of statin therapy

20
Q

Why should you check TFTs before starting statin therapy?

A

Hypothyroidism is a reversible cause of hyperlipidaemia

21
Q

Why should you check LFTs when on statin therapy?

A

To look for decline in hepatic function

22
Q

When should statins be stopped, regarding abnormal LFTs?

A

If serum transaminases are 3x the upper limit of normal value

23
Q

What are the common side effects of statins?

A
  • Headache
  • GI disturbance
  • Mild muscle aches to severe muscle toxicity
  • Rise in serum liver enzymes, especially ALT
24
Q

What are the rare side effect of statins?

A

Rhabdomyolysis

25
Q

What patient counselling is required with statins?

A
  • Side-effects and rhabdomyolysis
  • Alcohol
26
Q

What counselling is required regarding side-effects and rhabdomyolysis with statins?

A

Although statins are well tolerated by most people, side effects should be explained to patients. Tell patient to report any muscle symptoms to their GP. Warn patient to seek medical help urgently if they have rust-coloured urine

27
Q

What are the symptoms/signs of rhabdomyolysis?

A
  • Severe muscle pain
  • Weakness
  • Myoglobinuria
28
Q

What should be done if the patient has any symptoms of rhabdomyolysis, or you suspect it?

A

Check CK

29
Q

What counselling is required regarding alcohol with statins?

A

Advice patients to keep alcohol intake low

30
Q

Why are statins recommended to be taken at night?

A

Most cholesterol is produced overnight

31
Q

Why is statin not recommended during pregnancy?

A

Cholesterol important for fetal development

32
Q

How does grapefruit juice interact with statins?

A

CYP3A4 inhibition so plasma statin levels increase

33
Q

What is another fruit that interacts with statins similarly to grapefruit?

A
  • Lime
  • Other citrus fruits (containing furanocoumarins)
34
Q

Name some high intesnity statins

A

atorvastatin and rosuvastatin

35
Q

What are some low-medium intensity statins?

A

Pravastatin
Fluvastatin
Simvastatin

36
Q

What to do if patient cannot tolerate statins?

Or cholesterol not adequately controlled?

A
  • Offer ezetimibe instead

or add ezetimibe if statin dose increase is not possible

37
Q

What is the nocebo effect with regard to statins?

A
  • Pt stops taking statin due to perceived side effects (MSK pain)
  • Side effects likely not actually caused by statin = nocebo effect
38
Q

Why is bempedoic acid used with statins?

A
  • Slows excretion of statin

Drugs - CPT Sem 4 (81 decks)

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