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Antihyperlipidemics - Statins: Nursing Pharmacology

Notes

Notes

ANTIHYPERLIPIDEMICS: STATINS
DRUG NAME
simvastatin (Zocor, FloLipid), rosuvastatin (Crestor), atorvastatin (Lipitor), lovastatin (Altoprev), pravastatin
CLASS
HMG-CoA reductase inhibitors (statins)
MECHANISM OF ACTION
Bind and inhibit HMG-CoA reductase → decrease cholesterol synthesis → decrease cholesterol and LDL levels
INDICATIONS
  • Hypercholesterolemia
  • Increased LDL levels
  • Coronary artery disease
ROUTE(S) OF ADMINISTRATION
  • PO
SIDE EFFECTS
  • Headache, dizziness, insomnia, fatigue
  • Blurred vision, cataracts
  • Abdominal cramps, diarrhea, constipation, flatulence, heartburn, nausea
  • Liver dysfunction
  • Pancreatitis
  • Myalgia, rhabdomyolysis
  • Skin rash
  • Rosuvastatin: renal failure, pancytopenia
CONTRAINDICATIONS AND CAUTIONS
  • Active liver disease
  • Pregnancy
  • Breastfeeding
  • Drug interactions:
    • Cyclosporine, niacin, gemfibrozil, amiodarona, macrolides, antifungals: ↑ risk of rhabdomyolysis
    • Digoxin or warfarin: ↑ levels and toxicity
    • Oral contraceptives: ↑ estrogen levels
    • Protease inhibitors, erythromycin, gemfibrozil, grapefruit: statin toxicity
NURSING CONSIDERATIONS for ANTIHYPERLIPIDEMICS: STATINS
ASSESSMENT AND MONITORING
Assessment
  • Vital signs, cardiovascular status
  • Laboratory test results: CK, hepatic function and lipid panel; with female clients, negative pregnancy test

Monitoring
  • Periodic hepatic function, CK, lipid profile tests
  • Side effects
  • Therapeutic response: decreased LDL and triglyceride levels; improved cardiovascular health
CLIENT EDUCATION
  • Purpose of medication: decrease their LDL and triglyceride levels, decrease risk of coronary artery disease
  • Bedtime administration preferred
  • Avoid grapefruit and grapefruit juice
  • Limit alcohol
  • Female clients of childbearing age: use reliable contraception during treatment; inform healthcare provider if they become pregnant
  • Side effects
    • Gastrointestinal discomfort: eat small, frequent meals
    • Constipation: increase fluid and fiber intake
    • Symptoms to report
      • Rhabdomyolysis: unexplained muscle pain, weakness; brown urine
      • Liver impairment: fatigue, anorexia, nausea, dark urine, or yellowing of eyes or skin
      • Pancreatitis: abdominal pain that occurs after eating, especially pain in the upper abdomen; may radiate to their back
  • Lifestyle modifications
    • Smoking cessation weight control, physical activity, diet high in complex carbohydrates and fiber and low in saturated fat and cholesterol
Transcript

Antihyperlipidemics are medications used to treat clients with increased blood levels of lipids, like cholesterol, by decreasing the levels of low- density lipoproteins or LDLs, which is sometimes referred to as “bad” cholesterol; and to an extent, antihyperlipidemics can also decrease blood triglycerides.

In addition, they’re indicated to treat clients with coronary artery disease and prevent myocardial infarction.

Antihyperlipidemics include different classes of medications, among which some of the most commonly used are HMG-CoA reductase inhibitors, also called statins.

Statins include simvastatin, rosuvastatin, atorvastatin, lovastatin, and pravastatin, which are administered orally.

Once absorbed into the bloodstream, statins travel to the liver, where they inhibit the enzyme HMG-CoA reductase. As a result, there’s a decrease in cholesterol synthesis. This also causes hepatic cells to increase the number of LDL receptors on their surface.

This facilitates the uptake of cholesterol-rich LDLs, and VLDLs to a smaller degree, which provides a moderate decrease in triglyceride level. So ultimately, statins help lower overall lipid levels.

Luckily, statins are very well tolerated. The most common side effects include gastrointestinal symptoms like abdominal cramps, diarrhea or constipation, flatulence, heartburn, and nausea.

Especially with rosuvastatin, clients can develop a skin rash, and may experience headache and dizziness. Other side effects include blurred vision, cataracts, fatigue, and insomnia.

Some of the more serious side effects of statins include myalgia, and rhabdomyolysis, or muscle breakdown.

Next, although rare, statins can cause hepatotoxicity, especially in clients who already have a hepatic disease. Finally, simvastatin and atorvastatin can cause pancreatitis, while rosuvastatin can cause renal failure, and pancytopenia.

As far as contraindications go, statins are teratogenic, so they should be avoided during pregnancy. These medications are also contraindicated during breastfeeding and in clients with active hepatic disease, and should be used with caution in clients with a history of previous hepatic disease.

Regarding interactions, statins are metabolized in the liver by the enzyme cytochrome p450, so clients should avoid taking medications that enhance or inhibit this enzyme’s activity.

Special caution should be taken when combining statins with cyclosporine, niacin, gemfibrozil, amiodarone, macrolides, and antifungal medications, since they can increase the risk of rhabdomyolysis.

In addition, statins can also increase levels of digoxin and warfarin, as well as estrogen when taken with oral contraceptives.

Finally, clients on statins must avoid taking protease inhibitors, erythromycin, or gemfibrozil, as well as consuming grapefruit, as their interaction can increase the levels of statin and result in toxicity.

Okay, if a client with familial hypercholesterolemia is prescribed atorvastatin, start by performing a baseline assessment, including vital signs and cardiovascular status, noting any signs of coronary artery disease, including chest pain or shortness of breath.

Next, review recent laboratory results, specifically CK, hepatic function, and a lipid profile, which includes total cholesterol, triglycerides, HDL, and LDL, levels.

Sources
  1. "Focus on Nursing Pharmacology" LWW (2019)
  2. "Pharmacology" Elsevier Health Sciences (2014)
  3. "Mosby's 2021 Nursing Drug Reference" Mosby (2020)
  4. "Saunders Comprehensive Review for the NCLEX-RN Examination" Saunders (2016)
  5. "Saunders Comprehensive Review for the NCLEX-RN Examination" Saunders (2019)
  6. "Lewis's Medical-Surgical Nursing" Mosby (2019)