Statins

Question 1

How do statins work on cholesterol synthesis?

Answer 1

Inhibit HMG-CoA reductase

HMG-CoA can not be metabolised into Mevalonate therefore cholesterol synthesis in the liver is not possible

Question 2

How do statins work on LDL levels?

Answer 2

Statins cause a reduction in cholesterol synthesis and because of this the liver increases LDL receptor synthesis
More LDLs are taken up to try and increase cholesterol levels
As a result LDL levels and cholesterol levels in the serum are reduced
There is also a decrease in plasma triglyceride concentration

Question 3

What are the three main indications for the use of statins?

Answer 3

1. Primary prevention of CVD: those >40 with a QRISK >20%
2. Secondary prevention of CVD: those with a previous CV event (give statin along with lifestyle changes)
3. Hyperlipidaemias

Question 4

When should you use statins with caution?

Answer 4

Pregnant women (fatal development requires cholesterol)
Breast feeding women
Hepatic insufficiency
Renal insufficiency
If someone is at risk of myopathies/rhabdomyolosis

Question 5

What are the side effects of statins?

Answer 5

Headache
Nausea
Abdo cramps
Rarely: myopathies/rhabdomyolsis or rise in liver enzymes and thus drug induced hepatitis

Question 6

What interactions do statins have with other drugs?

Answer 6

Cytochrome p450 inhibitors e.g. amioldearone, diltazem , macrolide's and itrazonozole
Grapefruit juice (inhibits CYP450)

Question 7

How are statins eliminated from the body?

Answer 7

Metabolised by the liver

Excreted by the kidneys

Question 8

Name some statins?

Answer 8

Simvastatin, artovostatin and pravastatin

Question 9

When should you recommend the patent to take their statin?

Answer 9

In the evening

Question 10

Advice to patient?

Answer 10

Come back for cholesterol monitoring in 3 and 12 months
Reduce alcohol intake
Avoid grapefruit juice