Statins lecture

Question 1

Best statins are called what?
atorvastatin(lipitor) and rosuvastatin (crestor)

Question 2

Benefit of statin
Inhibit ___________ synthesis
Increase __________receptors
plaque stabilization
(Pleiotropic: having more than one effect)

Answer 2

inhibit cholesterol synthesis

increase LDL receptors

Question 3

High intensity statin
Atorvastatin 80 mg (40 if can’t tolerate 80- 40 not a high)
*Rosuvastatin 20 & 40 mg

Lowers LDL by how much?

Answer 3

Lowers LDL ≥50%

Question 4

Moderate intensity statin
Atorvastatin 10 & 20 mg
Rosuvastatin 5 & 10 mg
Simvastatin 20 & 40 mg
Pravastatin 40 & 80 mg
Lovastatin 40 mg
Fluvastatin XL 80 mg
Fluvastatin 40 mg bid
Pitavastatin 2–4 mg

Lowers LDL by how much?

Answer 4

Lowers LDL ≥30% but <50%

Question 5

Low intensity statin
Simvastatin 10 mg
Pravastatin 10–20 mg
Lovastatin 20 mg
Fluvastatin 20–40 mg
Pitavastatin 1 mg

Lowers LDL by how much?

Answer 5

Lowers LDL <30%

Question 6

What do patients complain about most often?
Myalgia…statin associated muscle symptoms (SAMS)

Question 7

Myalgia
Muscle pain, stiffness, cramps
___________ CK
______or ______ exercise
(Similar to flu symptoms)

Answer 7

Normal CK

with or after exercise

Question 8

Rhabdomyolysis

Severe muscle pain
* Muscle necrosis
* Significant CK elevation
* AKI
* Red, brown urine

Question 9

What to do for myalgia…
Stop statin and wait until sx resolve
Determine cause and correct: Most common reasons for myalgia…
1. ________interactions
2. low ________ (check TSH, adherence to levothyroxine)
Once corrected restart same statin. If returns, try different statin.
If fails atorvastatin and rosuvasatatin, try pravastatin OR
fluvastatin.
Also, try every other day or once weekly rosuvastatin.

**If returns, patient is statin intolerant. **

Answer 9

drug interactions

low thyroid

Question 10

What to do for rhabdo…

Stop statin and provide support ____________

Determine cause… was it statin alone or was there a DDI, condition(hypothyroid) or an illness that
contributed?

If identifiable cause can cautiously restart with close monitoring once kidney function normal

If no cause do not restart statin

Answer 10

hydration

Question 11

Statins: Muscle toxicity

Symptoms and CK return to normal within days to weeks of D/C
statin
Pravastatin and fluvastatin lowest risk
Risk increases with…
Multiple drugs (DDI)
Hypothyroidism
Acute or chronic renal failure
Obstructive liver disease
Asian descent