STATINS Flashcards
1
Q
MOA
A
- They competitively inhibit 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA)
reductase - This enzyme is involved in cholesterol synthesis
2
Q
When should statins be taken? i.e. what part of the day
A
- Atorvastatin can be taken anytime during the day
- Simvastatin, pravastatin, and fluvastatin should be taken in the evening
3
Q
Cautions
A
- Elderly
- High alcohol intake
- History of liver disease
- Hypothyroidism (because of higher risk of muscle toxicity)
- Those with increased risk of muscle toxicity (e.g Rhabdomyolosis) due to FHx
4
Q
Which patients are at high risk of muscle toxicity (rhabdomyolysis)
which requires caution when using a statin?
A
- Personal or family history of muscular disorders
- previous history of muscular toxicity
- high alcohol intake
- renal impairment
- hypothyroidism
5
Q
Side effects - common
A
- Headache
- Gl disturbances
- Myalgia (just muscle pain/ ache)
- Hyperglycaemia
6
Q
Side effects - rare
A
- Muscle effects (Myopathy, myositis, rhabdomyolysis)
- Interstitial lung disease: dyspnoea, cough, weight loss
RED FLAG
7
Q
Pregnancy
A
AVOID
- congenital abnormalities
- decreased synthesis of cholesterol affects foetal development
8
Q
Statins and conception
A
- Statins needs to be discontinued 3 months before attempting to conceive
9
Q
Statins and women of childbearing potential?
A
- Contraception required during treatment and 1 month after stopping statins (not necessarily the pill but at least condom)
10
Q
Breastfeeding
A
NO
11
Q
Hepatic impairment
A
- Caution in Hx of liver disease
- Avoid in active liver disease
- Avoid when there are unexplained persistent elevations in serum transaminases
12
Q
Why should statins be used with caution in history of liver disease
A
Statins can cause hepatoxicity
13
Q
What are the monitoring requirements for statins?
A
- One full lipid profile (non-fasting)
- Thyroid stimulating hormone (TSH)
- Renal function
- Liver function tests (LFTs)
- Creatinine kinase
- HbA1c (for patient at high risk of diabetes)
14
Q
Monitoring - full lipid profile
A
- Total cholesterol, HDL-cholesterol, non-HDL and triglycerides
- Before treatment
- 3 months after in prevention of CVD to assess reduction
15
Q
Monitoring - Renal function
A
- renally excreted requiring dose adjustment or avoidance