Hypercholesterolemia: Elevated lipids in the blood.
Lipid Synthesis: Occurs in the liver.
Treatment: Involves anti-pilimeic medications or therapies to lower lipid levels.
HMG CoA Reductase Inhibitors (Statins)
Identification: Drug names end in '-statin'.
Mechanism of Action:
Inhibits HMG-CoA reductase enzyme activity in the liver.
Reduces cholesterol synthesis by decreasing necessary enzyme in the liver.
Aim: Decrease total cholesterol, affecting HDL and LDL.
Indications and Precautions
Indications: Primarily for hypercholesterolemia.
Precautions:
Hyperglycemia.
Pre-existing muscle weakness.
Altered neurostatus (confusion, dementia).
Liver dysfunction (monitor liver function tests).
Contraindications
Pregnancy: Category X due to potential fetal abnormalities.
Liver Issues: Dysfunction or elevated liver enzymes.
Side Effects
Hyperglycemia: Unclear pathway affecting glucose.
Myopathy and Rhabdomyolysis:
Muscle damage leads to release of CPK (creatinine phosphokinase), myoglobin, and protein. Statins are known to break down muscle. So they damaged muscle releases CPK, myoglobin, and protein but they are too big for the kidneys to filter resulting in damage to the kidneys eventually.
Can cause kidney failure (myoglobinuria) with dark reddish-brown urine.
Treatment involves flushing patients with fluids.
Other Side Effects:
Headache, memory loss, confusion.
GI disturbances.
Liver dysfunction.
Nursing Considerations and Administration
Optimal Dosing Time: At night due to lower dietary intake and the body makes fat at night.
Patient Education:
Monitor narrow function, muscle weakness, glucose control, GI symptoms, and urinary changes.
Grapefruit interactions: Can interfere with metabolism, increasing statin blood levels.
Lipid panel, glucose, and liver function tests (LFTs) monitoring.
Importance of compliance: Takes 6-8 weeks for cholesterol changes.
Examples of Statin Drugs
Atorvastatin
Simvastatin
Both are HMG CoA reductase inhibitors, identified by '-statin' suffix.