Statins Nursing Considerations

Statins are a class of lipid-lowering medications that work by inhibiting HMG-CoA reductase, the key enzyme responsible for cholesterol synthesis in the liver. They are the most commonly prescribed medications for managing hypercholesterolemia and preventing cardiovascular disease.

Generic names: Atorvastatin, Simvastatin, Rosuvastatin, Pravastatin, Lovastatin, Fluvastatin, Pitavastatin

Brand names: Lipitor, Zocor, Crestor, Pravachol, Mevacor, Lescol, Livalo

Pharmacologic class: HMG-CoA Reductase Inhibitors

Therapeutic class: Antihyperlipidemic agents

Mechanism of action: Statins work by competitively inhibiting HMG-CoA reductase, which reduces cholesterol synthesis in the liver. This leads to increased LDL receptor expression and enhanced clearance of LDL cholesterol from the bloodstream.

Indications for use: Primary and secondary prevention of cardiovascular disease, hypercholesterolemia, mixed dyslipidemia, homozygous familial hypercholesterolemia, and atherosclerotic cardiovascular disease risk reduction.

Precautions and contraindications: Active liver disease, pregnancy, breastfeeding, unexplained persistent elevations in serum transaminases, known hypersensitivity to statins.

Drug Interactions

• Gemfibrozil and other fibrates increase the risk of myopathy
• Cyclosporine increases statin blood levels and the risk of myopathy
• Alcohol consumption may increase the risk of liver damage
• Grapefruit juice can increase statin blood levels (especially with atorvastatin, simvastatin, and lovastatin)
• Warfarin effects may be potentiated
• Antifungal medications can increase statin blood levels

Adverse Effects

• Muscle pain, weakness, and rhabdomyolysis
• Elevated liver enzymes
• Increased blood sugar levels and risk of diabetes
• Memory problems and confusion
• Digestive problems (nausea, diarrhea, constipation)
• Skin rash
• Sleep disturbances
• Headache
• Joint pain

Administration Considerations

Available preparations: Oral tablets, extended-release tablets

Common adult dosages:

• Atorvastatin: 10-80 mg once daily
• Simvastatin: 5-40 mg once daily
• Rosuvastatin: 5-40 mg once daily
• Pravastatin: 10-80 mg once daily
• Lovastatin: 10-80 mg daily
• Fluvastatin: 20-80 mg daily
• Pitavastatin: 1-4 mg once daily

Most statins should be taken in the evening to maximize effectiveness, as cholesterol production peaks overnight.

Nursing Considerations for Statins

Related Nursing Diagnoses

• Risk for injury related to myopathy
• Risk for impaired liver function
• Deficient knowledge related to medication regimen
• Risk for nonadherence
• Imbalanced nutrition: less than body requirements related to GI side effects

Nursing Assessment

1. Assess baseline lipid panel, liver function tests, and CK levels before initiating therapy.
2. Obtain comprehensive medication history to identify potential drug interactions.
3. Assess for muscle pain, weakness, or tenderness, especially during the initial weeks of therapy.
4. Monitor liver function tests periodically as recommended.
5. Assess for signs and symptoms of liver dysfunction (jaundice, dark urine, upper right quadrant pain).

Nursing Interventions

1. Monitor lipid levels regularly to evaluate medication effectiveness.
2. Assess for muscle pain or weakness at each visit.
3. Monitor liver function tests according to facility protocol.
4. Document and report any adverse effects promptly.
5. Encourage adherence to the prescribed medication schedule.
6. Provide education about lifestyle modifications to support cholesterol management.

Patient Teaching Associated with Statins

1. Take medication as prescribed, typically once daily. Some statins work better when taken in the evening.
2. Report any unexplained muscle pain, tenderness, or weakness immediately, especially if accompanied by fever or fatigue.
3. Avoid grapefruit juice while taking certain statins (especially atorvastatin, simvastatin, and lovastatin).
4. Maintain regular exercise and follow a heart-healthy diet while taking statins.
5. Avoid or limit alcohol consumption while taking statins.
6. Do not stop taking statins without consulting your healthcare provider, even if you are feeling better.
7. Inform all healthcare providers about statin therapy before starting new medications.
8. Women should avoid becoming pregnant while taking statins and notify healthcare providers immediately if pregnancy occurs.

This is not an all-inclusive list of possible drug interactions, adverse effects, precautions, nursing considerations, or patient instructions. Please consult further with a pharmacist for complete information.

References

1. Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. 
2. Horodinschi RN, Stanescu AMA, Bratu OG, Pantea Stoian A, Radavoi DG, Diaconu CC. Treatment with Statins in Elderly Patients. Medicina (Kaunas). 2019 Oct 30;55(11):721. doi: 10.3390/medicina55110721. PMID: 31671689; PMCID: PMC6915405.
3. Im, S., Lee, Y., Kim, S. H., Choi, J. W., Kim, K. H., & Hwang, H. Y. (2024). Impact of Perioperative High-Intensity Statin Use on New Onset Atrial Fibrillation After Aortic Valve Replacement. Annals of Thoracic Surgery Short Reports. https://doi.org/10.1016/j.atssr.2024.11.005
4. Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
5. Sirtori CR. The pharmacology of statins. Pharmacol Res. 2014 Oct;88:3-11. doi: 10.1016/j.phrs.2014.03.002. Epub 2014 Mar 20. PMID: 24657242.