Statins

Definition

Statins are medications that inhibit HMG-CoA reductase, the rate-limiting enzyme in cholesterol synthesis. They lower LDL cholesterol, modestly raise HDL, and reduce cardiovascular events and mortality.

Common Drugs (end in '-statin')

• Atorvastatin (Lipitor) - high intensity
• Rosuvastatin (Crestor) - high intensity
• Simvastatin (Zocor)
• Pravastatin
• Lovastatin

Indications

• Primary prevention in high-risk patients (ASCVD risk calculator)
• Secondary prevention after MI, stroke, PCI
• Diabetes mellitus (age 40 to 75)
• Familial hypercholesterolemia

Side Effects

• Myalgia/myopathy: Muscle pain, weakness.
• Rhabdomyolysis: Rare but serious; muscle breakdown releasing myoglobin, causing AKI. Dark urine, severe muscle pain.
• Elevated liver enzymes
• GI upset
• New-onset diabetes (small risk)
• Memory/cognitive complaints (rare)

Nursing Considerations

• Administer in evening (cholesterol synthesis peaks at night) except for rosuvastatin and atorvastatin which can be any time.
• Monitor LFTs at baseline and if symptoms.
• Monitor CK if muscle pain.
• Teach to report unexplained muscle pain immediately.
• Avoid grapefruit juice (increases statin levels for most).
• Drug interactions: fibrates, macrolides, azole antifungals, cyclosporine increase rhabdomyolysis risk.

NCLEX Relevance

Muscle pain as a warning sign for rhabdomyolysis is the top test point.