HMG-COA REDUCTASE INHIBITORS (STATINS) AND FIBRATES

what are the medications of HMG-CoA Reductase Inhibitors (statins)?

suffix - statin

• lovastatin

• simvastatin

• pravastatin

• atorvastatin

• rosuvastatin

what is the mechanism of action for HMG-CoA Reductase Inhibitors (statins)?

• inhibits HMG-CoA Reductase in liver (enzyme is a key in cholesterol synthesis)

• statins inhibit the enzyme and prevent cholesterol synthesis

  • decrease in cholesterol synthesis causes statins to be very effective

• decrease in cholesterol stimulated production of more LDL receptors in liver and removes LDLs from circulation

  • additional decrease in circulating cholesterol

what are the indications of HMG-CoA Reductase Inhibitors (statins)?

• primary and secondary prevention of

  • coronary artery disease

  • stoke

  • peripheral arterial disease

• effects

  • decrease LDL levels

  • decrease TG levels

  • increase HDL levels

what are the adverse effects of HMG-CoA Reductase Inhibitors (statins)?

• hepatotoxicity

  • elevated liver enzymes

  • jaundice

• myalgias/myopathy

  • rhabdomyolysis

• glucose disturbances

  • new onset diabetes

  • worsening diabetes

what are interventions for HMG-CoA Reductase Inhibitors (statins)?

• take medication in the evening

• adherence important - lifelong therapy

• lifestyle modifications (diet, exercise)

• monitor

  • lipid profile

  • report symptoms of liver dz (RUQ pain, jaundice)

  • report muscle pain, cramps, weakness (monitor CK)

  • blood glucose in diabetics

• avoid grapefruit juice (increases plasma statin levels and causes organ dysfunction)

• avoid during pregnancy

what are the fibrates and omega-3 fatty acids medications?

• fibrates

  • fenofibrate

  • gemfibrozil

• omega-3 fatty acids

  • fish oils

what are the indications for fibrates and omega-3 fatty acids medications?

• moderate to severe hypertriglyceridemia

• the goal is to prevent

  • pancreatitis

  • atherosclerosis

• effects:

  • lower triglycerides

  • increase HDL levels

what are the adverse effects of fibrates?

similar to statins

• hepatotoxicity

  • elevated liver enzymes

  • jaundice

• myalgias/myopathy

  • rhabdomyolysis