Statins

Statins Nursing Pharmacology Study Guide

Statins NCLEX Nursing Pharmacology Review

Nursing Pharmacology Study Guide for Statins

Statins are chemically modified drugs that are prescribed to lower low-density lipoprotein (LDL) or “bad cholesterol” levels in the body.

They are also known as hydroxymethylglutaryl-CoA (HMG-CoA) reductase enzyme inhibitors and are synthesized from the products of fungi.

Statins are widely used in the treatment of cardiovascular conditions in conjunction with diet and exercise. They are preferred drugs in lipid-lowering management due to their effectiveness and cost-effectivity.

It is recorded that statins can reduce LDL by 50% or more and boost high-density lipoprotein (HDL) or “good cholesterol” levels by 15%. Their effects are typically noted after 2 to 4 weeks of starting the treatment.

Statins typically come in oral form. They are metabolized in the liver and excreted into the bile and feces. Statins have a half-life of 14 hours and a peak effect of 1 to 2 hours after ingestion.

They are recommended to be taken once daily at the same time every day. Some statins can be taken any time during the day, while other statins are advised to be taken in the evening. 

Indications for Statins

Statins are indicated for use in several conditions including the following:

  • To slow the progression of coronary artery disease
  • To serve as prophylaxis treatment for myocardial infarction in patients with multiple risk factors for the development of coronary artery disease.
  • In children, statins can also be used for familial hypercholesterolemia. However, a tight diet with low fat and calories is the first line of treatment because lipids are still considered important for the development of the nervous system in this age group.
  • To lower the serum levels of low-density lipoprotein (LDL) or “bad cholesterol”. High cholesterol levels can lead to serious cardiovascular diseases such as the following:
    • Coronary heart disease
    • Heart attacks

Actions of Statins

Statins generally reduce lipid levels in the blood by blocking the enzyme HMG-CoA reductase. This enzyme catalyzes an early, rate-limiting step by converting to mevalonate in cholesterol biosynthesis.

This rate-limiting step may occur anywhere in the body although special attention is given to its occurrence in the liver. Due to the reduction of cholesterol in the blood and lack of cholesterol in hepatocytes, the body triggers a response that catalyzes LDL to extract cholesterol from them.

The inhibition of cholesterol synthesis, combined with the catabolism of LDL, leads to a further reduction in blood cholesterol level.

Side Effects and Adverse Reactions of Statins

Statins are generally well-tolerated drugs. However, side effects and adverse effects may still occur, which include:

  • Central nervous system:
    • Headache
    • Dizziness
    • Insomnia
    • Blurred vision
  • Cardiovascular: A form of statin can increase the risk for cardiovascular disease when given at 80mg as initial treatment.
  • Gastrointestinal:
    • Flatulence
    • Nausea and vomiting
    • Cramping
    • Abdominal pain
  • Hepatobiliary
    • Increased liver enzymes
    • Acute liver failure

Other uncommon side effects of statin intake include the following:

  • Memory problems
  • Hair loss
  • Flu-like symptoms
  • Pancreatitis
  • Skin problems including acne and an itchy red rash
  • Loss of libido or erectile dysfunction

The adverse side effects of statins may include:

  • Myopathy or muscle weakness
  • Peripheral neuropathy – a sensation of pins and needles on the fingertips or other parts of the extremities
  • Problems with tendons

Contraindications and Cautions for Statins

The following are the contraindications and precautions necessary when taking the drug:

  • Allergy to statins and any contents of the drugs
  • Active liver disease – statins can worsen the liver condition and can cause severe liver failure.
  • Pregnancy and lactation – statins are contraindicated in pregnancy and lactation. They can cause serious adverse effects on the fetus or newborn.
  • Impaired endocrine function – statins must be used in caution in the presence of altered endocrine function as they may alter the formation of steroid hormones in the body.
  • An underactive thyroid (hypothyroidism) – hypoactive thyroid can cause high cholesterol levels. Treating this condition may correct the problem without the need for taking lipid-lowering agents. Muscle damage is also linked with statin use in people with hypoactive thyroid.
  • Renal impairment – statins must also be used with caution in people with impaired renal function.
  • High risk of developing myopathy – rhabdomyolysis, a condition characterized by skeletal muscle breakdown, is linked with statin use. The drug will need to be used with extreme caution when the following risk factors are present:
    • 70 years of age and above
    • History of liver or renal disease
    • Large alcohol consumption
    • Diabetes or other diseases with impaired glucose regulation
    • Musculoskeletal disorders
    • Family history of myopathy or rhabdomyolysis

Drug Interactions with Statins

  • A calcineurin inhibitor drug, macrolide antibiotics, other antihyperlipidemic drugs, and antifungals – intake of statins in combination with these drugs can increase the risk for rhabdomyolysis. 
  • Digoxin and warfarin – these drugs increase the serum levels of statins, causing drug toxicity.
  • Oral contraceptives – when taking both statins and oral contraceptives, it is important to note that serum estrogen levels may increase.
  • Grapefruit juice – can increase serum statin levels, which may lead to drug toxicity.

Nursing Care Plans for Patients on Statins

Possible Nursing Diagnoses

  • Constipation
  • Fatigue
  • Acute Pain (Abdominal)
  • Risk for Sleep Deprivation related to side effect of drug therapy
  • Risk for Liver Impairment
  • Deficient Knowledge related to drug action and side effects

Nursing Assessment

InterventionsRationales
Check the patient’s blood test results, particularly the LDL and HDL levels. Assess the patient for signs and symptoms of hypercholesterolemia.To confirm the indication for administering statins.
Check the patient’s allergy status.Previous allergic reaction to statins or any of its contents may render the patient unable to take them. Alternatives to statins should therefore be considered in case of allergy.
Assess if the patient is pregnant or lactating.                                                        Contraindication: Statins should not be prescribed to a pregnant woman or lactating mother as these drugs can potentially harm the fetus or newborn, as there can be a disruption in infant lipid metabolism. If the patient really requires statin treatment, breastfeeding should be avoided.
If administering oral statins, assess the patient’s mucous membranes and his/her ability to swallow.To check for any potential problems with administration, hydration, and absorption.
To ensure that the right form of statins is given through the right route.
Assess for signs of renal impairment.Statins can increase liver enzyme levels. They must be used with caution in people with impaired renal function.  
Check medical history for:70 years of age and aboveHistory of liver or renal diseaseLarge alcohol consumptionMusculoskeletal disordersDiabetes myopathy or rhabdomyolysis (or family history of such)  Statins may cause myopathy, liver or renal impairment, and high blood glucose levels, and therefore should be prescribed with caution in patients included in the listed risk groups.
Check for history of hypothyroidism. Collect bloods for thyroid function tests as indicated.Hypoactive thyroid can cause high cholesterol levels. Treating this condition may correct the problem without the need for taking statins.
Check the patient’s list of current medications for digoxin, warfarin, or oral contraceptives.•           Digoxin and warfarin – these drugs increase the serum levels of statins, causing drug toxicity. •           Oral contraceptives – when taking both statins and oral contraceptives, it is important to note that serum estrogen levels may increase.

Nursing Planning and Intervention

InterventionsRationales
 Instruct the patient to avoid grapefruit juice while on statins.Grapefruit juice can increase serum statin levels, which may lead to drug toxicity.  
Inform the patient that he/she can take statins with or without meals, but preferably with or after meals.To ensure optimal absorption and therapeutic action by statins. Some statins work best if they are taking with meals.
Advise the patient to take the statin at night.The enzyme that it needs to target is more active at night.
Educate the patient about the action, indication, common side effects, and adverse reactions to note when taking statins. Instruct the patient on how to self-administer oral statins.To inform the patient on the basics of statins, as well as to empower him/her to safely self-administer the medication.
Perform a pregnancy test for the female patient.Statins should not be prescribed to a pregnant woman as these drugs can potentially harm the fetus or newborn, as there can be a disruption in infant lipid metabolism
Collect bloods for liver function tests (LFTs). Check the patient’s liver enzymes.Statins can increase liver enzyme levels. They must be used with caution in people with impaired renal function.  
Check the patient’s blood glucose level.Statins may cause increased blood glucose level and must be used with caution in patients with impaired glucose regulation.

Nursing Evaluation

InterventionsRationales
Ask the patient to repeat the information about statins.To evaluate the effectiveness of health teaching on statins.
Monitor the renal and liver function of the patient through performing regular blood tests.To ensure that the statins did not cause any adverse effects to the patient’s kidneys or liver. Patients on a long-term statin treatment should have an appointment for liver function tests at 3 months and 12 months of starting statins.
Monitor the patient’s response to statins.To check if the statins are effective, the dose needs to be adjusted, or the drug should be stopped and changed to an alternative treatment.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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