statins Flashcards
simvastatin max dose with bezafibrate or ciprofibrate
10mg
simvastatin max dose with amiodarone, amlodipine, ranolazine, verapamil, diltiazem
20mg
simvastatin max dose with ticagrelor
40mg
max dose of simvastatin with bempedoic acid or bempedoic acid with ezetimibe
20mg
max dose simvastatin in pt with severe hypercholesterolaemia and at high risk of CV complications
20mg
MHRA advice for all statins - very infrequent reports of this condition …
myasthenia gravis
(v small reports of new onset, or exacerbation of pre existing, or ocular myasthenia)
MHRA advice about all statins - myasthenia gravis
- v small reports of new onset, or exacerbation of pre existing, myasthenia gravis or ocular myasthenia
- most cases: pt recovered after stopping
- minority: continue to experience symptoms
- refer to neurologist if suspected
- symptoms: droopy eyelids, double vision, difficulty facial expressions, problems chewing, difficulty swallowing, slurred speech, weak limbs and neck, SOB
MHRA has released advice about the very small risk of myasthenia gravis with all statins. Tell patients to inform their factor if they experience the following symptoms:
weakness in the arms or legs that worsens after activity, double vision, drooping of the eyelids, difficulty swallowing, or shortness of breath;
seek immediate medical attention if they develop severe breathing or swallowing problems.
true or false - caution with hypothyroidism
true
manage adequately before starting treatment with statin
simv max dose 10mg with beza/ciprafibrate. why?
increases the risk of rhabdomyolysis
clarithromycin, erythromcyin interaction with simvastatin
C predicted to increase exposure to S.
Avoid
Patient is on simvastatin 20mg ON and amlodipine 10mg OD. They have just had an episode of acute gout. Is there anything that should be considered when treating it?
Colchicine has been reported to cause rhabdomyolysis when given with Simvastatin. Manufacturer advises caution or monitor.
all statins are ….toxic
hepato
Avoid this fruit with SOME statins; increased exposure to statins.
Name which statins are unaffected (2)
Grapefruit
rosuvastatin and pravastatin
Itraconazole, fluconazole, isavuconazole, ketoconazole etc interaction with simvastatin (2)
hepatotoxicity
more severe: increases exposure to simvastatin, monitor and adjust dose
A patient comes in with oral thrush. They would like to purchase daktarin oral gel. They take amlodipine 5mg OD, simvastatin 20mg OD. is this safe to sell?
Miconazole (including the oral gel) is predicted to increase the exposure to Simvastatin. Manufacturer advises avoid.
Pt with diabetes taking a statin. They have increased BGC. Should you stop statin?
Statins should not be discontinued if there is an increase in the blood-glucose concentration as the benefits continue to outweigh the risks.
Conception and contraception for all statins
Adequate contraception is required during treatment and for 1 month afterwards.
Use of statins in pregnancy and when attempting to conceive
Statins should be avoided in pregnancy (discontinue 3 months before attempting to conceive) as congenital anomalies have been reported and the decreased synthesis of cholesterol possibly affects fetal development.
monitoring for all statins in pt at high risk of DM
fasting blood-glucose concentration or HbA1C checked before starting statin treatment, and then repeated after 3 months.
True or false - need to measure CK in all pt before statin started
false
only in pt who have had persistent, generalised unexplained muscle pain
if baseline conc if >5x ULN, repeat measurement after 5 days
if repeat conc remains >5x ULN, do not start statin
if conc still raised but <5x ULN, start statin at lower dose
results of CK when you measure in pt who have had persistent, generalised, unexplained muscle pain (whether associated or not with previous lipid-regulating drugs) - how to interpret
if baseline conc if >5x ULN, repeat measurement after 5 days
if repeat conc remains >5x ULN, do not start statin
if conc still raised but <5x ULN, start statin at lower dose
some patients may present with extremely elevated baseline creatine kinase concentration, for example because of a physical occupation or rigorous exercise. How should you commence therapy in these pt
specialist advice should be sought regarding consideration of statin therapy in these patients.
LFTs monitoring for statins
before treatment
repeat within 3 months and at 12 months of starting treatment
unless indicated at other times by signs or symptoms suggestive of hepatoxicity
