Name of the Statins drugs:
- Rosuvastatin
- Simvastatin
- Atorvastatin
- Pravastatin
Mechanism of Action:
- Inhibition of HMG CoA reductase, preventing the hepatic conversion of mevalonic acid to cholesterol.
- Reduced cholesterol synthesis in the liver results in decreased plasma LDL.
Indications:
- Prevention of cardiovascular events in patients with atherosclerotic disease or diabetes mellitus.
- Primary hyperlipidemia
| Rosuvastatin |
| Availability: Tablets: 5 mg, 10 mg, 20 mg, 40 mg. |
| Administration/handling: PO: Give without regard to food. May give at any time of day |
| Hyperlipidemia, Dyslipidemia, Atherosclerosis, Dysbetalipoproteinemia, Primary Prevention of Cardiovascular Disease PO: Adults, elderly: Usual starting dosage is 10–20 mg/day, with adjustments based on lipid levels; monitor q2–4wks until desired level is achieved. Lower starting dose of 5 mg is recommended in pts of Asian ancestry. Maximum: 40 mg/day. Range: 5–40 mg/day. |
| HoFH : PO: Adults, elderly: Initially, 20 mg/day. Range: 5–40 mg/day. Maximum: 40 mg/day. Children 7 yrs and Older: 20 mg once daily. |
| HeFH : PO: Children 10–17 yrs: Initially, 20 mg once daily. Range: 5–20 mg once daily. Maximum: 20 mg. 8–9 YRS: 5–10 mg once daily. Maximum: 10 mg. |
| Concurrent Cyclosporine Use: PO: Adults, elderly: 5 mg/day maximum. |
| Concurrent Gemfibrozil, Atazanavir/Ritonavir, Lopinavir/Ritonavir or Simeprevir Therapy PO: Adults, elderly: Initially, 5 mg/day. 10 mg/day maximum. |
| Simvastatin |
| Availability: Oral Suspension: 20 mg/5 mL, 40 mg/5 mL. Tablets: 5 mg, 10 mg, 20 mg, 40 mg, 80 mg |
| Administration/handling: PO: Give without regard to food. • Administer in evening for maximum efficacy. Shake suspension well for 20 sec before administering. |
| Note: Limit 80-mg dose to pts taking simvastatin longer than 12 months without evidence of myopathy. |
| Prevention of Cardiovascular Events: PO: Adults, elderly: 10–20 mg once daily. Range: 5–40 mg/day. |
| Hyperlipidemias : PO: Adults, elderly: Initially, 10–20 mg once daily. Pts with CHD or CHD risk equivalents: Initially, 40 mg/day. Range: 5–40 mg/day |
| Homozygous Familial Hypercholesterolemia (HoFH) : PO: Adults, elderly: 40 mg once daily in evening. |
| Heterozygous Familial Hypercholesterolemia (HeFH) : PO: Children 10–17 yrs: 10 mg once daily in evening. May increase to 20 mg once daily after 6 wks. May further increase to 40 mg once daily after additional 6 wks. Maximum dose: 40 mg/day. |
| Dosing Adjustment with Medications (cyclosporine, gemfibrozil): Do not exceed 10 mg/day. (Amiodarone, amlodipine, ranolazine): Do not exceed 20 mg/day. (diltiazem, dronedarone, verapamil): Do not exceed 10 mg/day. (Lomitapide): Reduce simvastatin dose by 50% when initiating lomitapide. Do not exceed 20 mg/day. |
| Atorvastatin |
| Availability: Tablets: 10 mg, 20 mg, 40 mg, 80 mg |
| Administration/handling: PO : Give without regard to food or time of day. • Do not break, crush, dissolve, or divide film-coated tablets. |
| Do not use in pts with active hepatic disease. Note: Individualize dosage based on baseline LDL/cholesterol, goal of therapy, pt response. Maximum dose with strong CYP3A4 inhibitors: 20 mg/day |
| Dyslipidemias : PO: Adults, elderly: Initially, 10–20 mg/day (40 mg in pts requiring greater than 45% reduction in LDL-C). Range: 10–80 mg/day. |
| Heterozygous Hypercholesterolemia: PO: Children 10–17 yrs: Initially, 10 mg/day. Maximum: 20 mg/day. |
| Pravastatin |
| Availability: Tablets: 10 mg, 20 mg, 40 mg, 80 mg. |
| Administration/handling: PO : Give without regard to food. Prior to initiating therapy, pt should be on standard cholesterol-lowering diet for 3–6 months. Low-cholesterol diet should be continued throughout pravastatin therapy |
| Hyperlipidemia, Prevention of Coronary/Cardiovascular Events: PO: Adults, elderly: Initially, 40 mg/day. Titrate to desired response. Range: 10–80 mg/day |
| Heterozygous Familial Hypercholesterolemia : PO: Children 14–18 yrs: 40 mg/day. Children 8–13 yrs: 20 mg/day |
| Dosage with Clarithromycin: Maximum: 40 mg/day. Dosage with Cyclosporine: Adults, elderly: Initially, 10 mg/day. Maximum: 20 mg/day |
Cautions and Contraindications:
- Active liver disease (caution needed in patients with alcohol dependence).
- Pregnancy and breast feeding
Side-Effects:
- Rhabdomyolysis (rare but may manifest as myalgia, myositis or myopathy.)
- Altered liver function test.
- GI disturbance.
- Headache
- Dizziness
Metabolism and Half- Life:
- Metabolized by cytochrome P450 (except pravastatin and rosuvastatin); clinical effects largely due to active metabolites.
- T ½ is variable- 2h for simvastatin; 14 h for atorvastatin.
NURSING CONSIDERATIONS
Baseline assessment
- Obtain dietary history, esp. fat consumption.
- Question for possibility of pregnancy before initiating therapy.
- History of hypersensitivity to statins.
- Assess baseline lab results: serum cholesterol, LDL, VLDL, HDL, triglycerides, LFT.
Intervention/evaluation
- Monitor serum cholesterol, HDL, LDL, triglycerides for therapeutic response.
- Lipid levels should be monitored within 2–4 weeks of initiation of therapy or change in dosage.
- Monitor LFT at 12 weeks following initiation of therapy, at any elevation of dose, and periodically (e.g., semi-annually) thereafter.
- Be alert for myalgia, weakness. Monitor CPK if myopathy is suspected.
- Monitor daily pattern of bowel activity, stool consistency.
- Assess for headache, sore throat. Assess for rash, pruritus, malaise.
Patient/family teaching
- Periodic lab tests are essential part of therapy.
- Maintain appropriate diet. Avoid grapefruit products. (important part of treatment).
- Report unexplained muscle pain, tenderness, Weakness, esp. if associated with fever, malaise.
- Use appropriate contraceptive measures.
- Do not take other medications without consulting physician.
- Do not chew, crush, dissolve, or divide tablets.
- Report dark urine, muscle fatigue, bone pain.
- Avoid excessive alcohol intake.
- Avoid tasks that require alertness, motor skills until response to drug is established (potential for dizziness)
Drug Interactions:
- Increased risk of myopathy with fibrates, amiodarone and calcium channel blockers. Plasma concentration increased by grapefruit juice and macrolides.
- Plasma concentration reduced by rifampicin.
Important Points:
- Statins are more effective than any other lipid- lowering agents.
- The greatest reduction of LDL is achieved with atorvastatin and rosuvastatin (60- 65% reduction at maximum dose).
REFERENCES
- Robert Kizior, Keith Hodgson, Saunders Nursing Drug handbook,1st edition 2024, Elsevier Publications. ISBN-9780443116070
- McGraw Hill- Drug Handbook, Seventh Edition, 2013, McGraw Hill Education Publications,9780071799430.
- April Hazard, Cynthia Sanoski, Davi’s Drug Guide for Nurses -Sixteenth Edition 2019, FA Davis Company Publications,9780803669451.
- Jones and Bartlet, Pharmacology for Nurses, Second Edition, 2020, Jones and Bartlet Learning Publications, ISBN 9781284141986.
- Nursebro.com, Search – Nursebro
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