Antihyperlipidemics - Statins

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. Lastly, if your client is assigned female at birth and of childbearing age, remember to obtain a negative pregnancy test.

Next, explain to your client that their medication will help to lower their LDL and triglyceride levels, as well as decrease their risk for coronary artery disease. Instruct your client to take their medication once each day, with or without food, consistently at the same time of day, and preferably in the evening. Be sure to stress the importance of avoiding grapefruit and grapefruit juice, and to limit the amount of alcohol they consume.

Then, let your client know about common side effects that they may experience during therapy and how to manage them. If your client experiences gastrointestinal discomfort, recommend small, frequent meals. In addition, teach them that the risk of constipation can be reduced by increasing their daily intake of fluid and fiber.

Lastly, stress the importance of immediately reporting symptoms of myopathy and rhabdomyolysis, such as unexplained muscle pain or weakness, or brown urine; as well as symptoms of liver impairment, such as fatigue, anorexia, nausea, dark urine, or yellowing of their eyes or skin; and symptoms of pancreatitis that could manifest as nausea, abdominal pain that occurs after eating, and especially pain in the upper abdomen that can radiate to their back.

Then, review with your client the lifestyle modifications that can reduce the risk of cardiovascular events, including smoking cessation, weight control, physical activity as tolerated, as well as a diet high in complex carbohydrates and fiber, and low in saturated fats and cholesterol. Lastly, caution your clients assigned female at birth to use reliable contraception during treatment, and to let their healthcare provider know right away if they become pregnant.

Finally, during treatment with atorvastatin, be sure to obtain periodic hepatic function, CK, and lipid profile tests; also, be sure to watch closely for side effects, and evaluate for the desired therapeutic effect of decreased LDL and triglyceride levels, as well as improved cardiovascular health.

Alright, as a quick recap… Statins are a type of antihyperlipidemic medication that works by inhibiting the enzyme HMG-CoA reductase, which leads to decreased cholesterol synthesis in the liver. Clients taking a statin may experience side effects like gastrointestinal symptoms, skin rash, and headaches, as well as more serious side effects, including rhabdomyolysis, hepatotoxicity, and pancreatitis.

Statins are contraindicated during pregnancy or breastfeeding, and in clients with active hepatic disease. When caring for a client prescribed statin therapy, nursing considerations include a baseline assessment, as well as monitoring for side effects and for therapeutic effect. Client teaching is focused on safe self-administration, lifestyle modifications, and learning to recognize side effects that should be reported to the healthcare provider.