Pharmacology, part 22.1: Cardiovascular Medications - Statins

Hi, I'm Cathy with Level Up RN. In this video, I will be discussing statins. And at the end of the video, I'm going to give you guys a little quiz to test your understanding of some of the key facts I'll be covering, so be sure to stay for that.

Statins are the most common drug class used to treat high cholesterol or hypercholesteremia. They are also prescribed for patients who are at high risk for cardiovascular disease. Some common statins include atorvastatin, which is brand name Lipitor, simvastatin, which is brand name Zocor, and rosuvastatin, which is brand name Crestor. And as you can see, all statins end in statin, which makes it easy to identify medications that fall within this drug class. In terms of mode of action, statins decrease production of LDL, which is low-density lipoprotein, and increased production of HDL, which is high-density lipoprotein. And as a reminder, LDL is our bad cholesterol, so L for LDL and L for lousy. HDL is our good cholesterol, so H for HDL and H for happy.

The most common adverse effect of statins is muscle pain. In addition, rare but important possible side effects to know include hepatotoxicity, which is liver damage, as well as rhabdomyolysis. So rhabdomyolysis is the breakdown of muscle tissue, which releases a protein called myoglobin into the bloodstream. And this protein causes damage to the kidneys, among other issues. In terms of nursing care, you'll want to monitor your patient's liver function throughout therapy, which includes their ALT and AST levels. In addition, you may also need to monitor their creatine kinase levels or CK levels, particularly if they experience muscle pain. So increased CK levels is an indicator of muscle damage, which may indicate that the patient is experiencing rhabdomyolysis.

In terms of patient teaching, you should advise your patient to avoid alcohol and grapefruit juice while taking their statin. This is because combining alcohol with statins increases the risk for liver issues, and then grapefruit juice interferes with the breakdown of the medication in the body, which can lead to excessive levels of the drug in the bloodstream. And then you should advise your patient to report muscle pain and/or cola-colored urine immediately, as these are signs that the patient may be experiencing rhabdomyolysis.

In terms of time of administration, statins with a shorter half-life, such as simvastatin and lovastatin, should be taken in the evening because cholesterol is synthesized at night. Our cool chicken hint to help you remember this is statin kind of looks like satin, so you take your statin before you crawl into your satin sheets at night. Statins with a longer half-life, such as atorvastatin, can be taken at any time during the day. However, some providers may still recommend that the patient take it in the evening.

All right. It's quiz time, and I have three questions for you.

Question number one, what rare side effect of statins causes the breakdown of muscle tissue and the release of myoglobin in the bloodstream?

The answer is...rhabdomyolysis.

Question number two, why do ALT and AST levels need to be monitored during statin therapy?

The answer is.... due to the risk for hepatotoxicity.

And question number three, what time of day should a short-acting statin be taken?

The answer is... in the evening.

All right. That's it for this video. I hope it was helpful. Take care and good luck with studying.

[BLOOPERS]

Good cholesterol. So H for HA and/or cola-colored urine.