When you see this Cool Chicken, that indicates one of Cathy's silly mnemonics to help you remember. The Cool Chicken hints in these articles are just a taste of what's available across our Level Up RN Flashcards for nursing students!
In this article, we cover a class of antilipemic medications called statins, including a background on cholesterol; and the indication, mode of action, side effects, nursing care and patient teaching for statins.
The Nursing Pharmacology video series follows along with our Pharmacology Flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.
Background on cholesterol
Lipids are fats, and the lipids you need to know about are cholesterol (high density, and low density) and triglycerides.
Cholesterol is a waxy, fat-like substance. Excess cholesterol in the blood can combine with other substances to form plaque and lead to atherosclerosis. There are several different kinds of cholesterol. Total cholesterol is simply the combined amount of triglycerides, LDL, and HDL cholesterol in your body.
The expected range for total cholesterol is under 200 mg/dL. Total cholesterol greater than 200 mg/dL indicates increased risk for atherosclerosis (clogged arteries), heart disease, and myocardial infarction (heart attack).
The lab value ranges for total cholesterol, HDL, LDL and triglycerides, are just some of the key lab values covered in our lab values flashcards for nursing students, which we created to make remembering these levels easy!
Low-density lipoprotein (LDL)
LDL cholesterol is usually referred to as the “bad” cholesterol because it collects in the walls of blood vessels, increasing the risk of health problems such as heart attack or stroke. Cathy’s favorite way to remember that LDL is the bad cholesterol is to remember “L is for Lousy.”
The expected range for LDL cholesterol is less than 130 mg/dL. The level should be less than 100 mg/dL for patients at high risk for cardiovascular disease.
LDL cholesterol levels over 130 mg/dL indicates increased risk for atherosclerosis, heart disease, and myocardial infarction.
Learn about dietary sources of LDL vs. HDL cholesterol in our Nutrition series, which follows along with our Nutrition Essentials for Nursing Flashcards.
High-density lipoprotein (HDL)
HDL cholesterol is known as the “good” cholesterol because it helps remove other forms of cholesterol from the bloodstream via the liver. Higher levels of HDL cholesterol are associated with a lower risk of heart disease.
The expected range for HDL cholesterol is greater than 45-55 mg/dL depending on sex. Decreased levels are associated with increased risk of heart disease.
Triglycerides
Triglycerides are a type of fat in your body. After eating, your body converts any calories it doesn’t use right away into triglycerides that are then stored in your fat cells. High triglycerides can contribute to the hardening of arteries, which increases the risk of stroke, heart attack and heart disease.
The expected range for triglycerides is between 35 and 160 mg/dL depending on sex. Elevated levels indicate increased risk for atherosclerosis, heart disease, and myocardial infarction.
Statins
Statins, including atorvastatin (Lipitor), simvastatin (Zocor), and rosuvastatin (Crestor) are the most common drug class used to treat hypercholesterolemia (high cholesterol). They help lower “bad” cholesterol and fats (LDLs, triglycerides) and raise “good” cholesterol (HDL) in the blood.
Statins are also prescribed for patients who are at high risk for cardiovascular disease.
Mode of action
Statins work by slowing the production of LDL cholesterol in the body to decrease the amount of cholesterol buildup on the walls of the arteries that can block blood flow to the heart, brain, and other parts of the body. They also increase the production of HDL cholesterol, which can help remove the LDL cholesterol in the body.
Side effects
The most common side effect of statins is muscle pain. Rare but important possible side effects include hepatotoxicity (liver damage) and rhabdomyolysis.
What is rhabdomyolysis?
Rhabdomyolysis is the breakdown of muscle tissue that releases the protein myoglobin into the bloodstream, which can go on to damage the kidneys.
Patient labs to monitor
When caring for a patient on statins, their liver function, including ALT and AST, should be monitored due to the risk of hepatotoxicity.
If a patient taking statins develops muscle pain, then creatine kinase (CK) levels should be checked. Elevated CK levels are indicative of muscle damage, which could indicate rhabdomyolysis.
Patient teaching
When administering short-acting statins (simvastatin, lovastatin), it’s important to advise patients to take these medications with their evening meal because cholesterol is synthesized at night.
Longer-acting statins like atorvastatin can usually be taken at any time, however, some providers may still advise taking it in the evening.
Patients on statins should avoid alcohol, because it increases the risk of hepatotoxicity which is already increased on this drug; and grapefruit juice, because it interferes with the breakdown of the drug in the body, which can lead to excessive drug levels in the bloodstream.
You must educate patients to immediately report any muscle aches or pain along with dark "tea" or "cola" colored urine, as these are signs of rhabdomyolysis.
