Statins

Question 1

What are common indications?

Answer 1

-Primary prevention of major adverse events

-Secondary prevention of major adverse CV events.

-Dyslipidaemia

Question 2

What is the mechanism of action?

Answer 2

Statins work by slowing the atherosclerotic process and may even reverse it.

it competitively inhibits HMG CoA reductase. this reduces cholesterol production by liver and stimulates a compensatory increase in LDL.

Also indirectly reduces triglycerides and slightly increase HDL

Question 3

What are side effects?

Answer 3

Generally well tolerated but:
Headaches
GI upset
muscle aches
raised in live enzymes

Rare-
myopathy
rhabdomyolysis
Myasthenia gravis
drug-induced hepatitis

Question 4

What group of patients should you have caution over?

Answer 4

-hepatic impairment
-reduced dose in renal impairments
-contraindicated in pregnant women
-avoided in breastfeeding

Question 5

which statin is NOT dependent on kidneys for elimination of their metabolites?

Answer 5

Rosuvastatin

Question 6

Important interactions?

Answer 6

Metabolism is impaired by CYP450 inhibitors.

This leads to accumulation of statins and/or metabolites which may increase the risk of side effects

Question 7

What are dosages for all indications?

Answer 7

Primary prevention
medium intensity
Simvastatin- 40mg ON
Atorvastatin-10mg OD

Secondary prevention-

High intensity therapy
Atorvastatin 80mg

Question 8

Why should simvastatin be taken in the evening?

Answer 8

It has a short half life and cholesterol synthesis is greatest in the early hours of the morning.

Question 9

How would you ensure the efficacy and the safety of statins?

Answer 9

Efficacy- check target cholesterol levels are achieved

Safety- check liver enzymes at baseline and again at 3 and 12 months

Question 10

what monitoring should be done when statin is indicated for primary prevention?

Answer 10

check lipid profile before starting treatment and at 3 months aiming for reduction of 40% non-HDL levels,

Question 11

When would you monitor creatine kinase ?

Answer 11

Before starting therapy if the person has experienced persistent, generalised, unexplained muscle pain

or

during therapy if statin induced myopathy is suspected.

Question 12

Why should you also assess thyroid status?

Answer 12

Hypothyroidism is a cause of hyperlipidaemia (reversible) and should be corrected before reassessing need of statin.

Question 13

How is high intensity defined?

Answer 13

Can reduce LDL by greater than 40%

Atorvastatin >20mg
Rosuvastatin >10mg
Simvastatin 80mg (greatest risk of myopathy)

Question 14

What is considered low intensity?

Answer 14

Fruvastatin
Pravastain
Simvastatin 10mg