Pharm Statin Therapy

Which administration information will a nurse provide to a patient who is newly prescribed immediate-release lovastatin 20 mg?

Take it in the evening with a meal. Immediate-release lovastatin must be taken with an evening meal. The timing and conditions of the statin administration are important to ensure the patient receives maximal lipid-lowering effects.

Which parameters are expected to decrease with statins?

TriglyceridesStatins are expected to reduce triglyceride levels. Total cholesterolStatins are potent drugs for decreasing total cholesterol. Apolipoprotein B-100Because the production of apolipoprotein is reduced by statins, the levels of apolipoprotein B-100 would subsequently be decreased. Low-density lipoprotein (LDL) cholesterolStatins are potent drugs for decreasing LDL cholesterol.

When is atorvastatin expected to achieve its peak concentration?

1 to 2 hr Atorvastatin reaches its peak concentration in 1 to 2 hours.

Which patients would a nurse determine can safely receive treatment with a statin in the absence of any other factors?

A 48-year-old patient with hyperthyroidism There is no concern with administering a statin to a patient with concomitant dyslipidemia and hypothyroidism. A 55-year-old patient with type 2 diabetes mellitus Patients with type 2 diabetes can safely receive therapy with a statin and are often prescribed a drug in this class based on risk factors for cardiovascular disease.

An obese 84-year-old patient is taking simvastatin 10 mg PO each evening. In addition to dyslipidemia, the patient has hypertension, diabetes, and hypothyroidism. Which factors increase this patient's risk for rhabdomyolysis?

Advanced ageAdvanced age, in this case 84 years old, is considered a risk factor for rhabdomyolysis and warrants close monitoring in this patient. HypothyroidismHypothyroidism is considered a risk factor for rhabdomyolysis.

A 51-year-old male patient has been prescribed lovastatin 40 mg PO each evening to help lower his low-density lipoprotein (LDL) cholesterol. In addition to lovastatin, this patient also takes pantoprazole for gastroesophageal reflux disease (GERD), amiodarone for atrial fibrillation, tamsulosin for benign prostatic hyperplasia, and lisinopril for hypertension. Which medication could cause a potential drug interaction with lovastatin?

Amiodarone Amiodarone is an inhibitor of CYP3A4, which is extensively involved in the metabolism of lovastatin. When taken together, this combination can increase the level of lovastatin, placing the patient at increased risk for side effects and adverse effects.

Which medication that Mrs. Harrison is currently taking may cause a potential drug interaction with simvastatin?

Amlodipine Because amlodipine is both a substrate and an inhibitor of CYP3A4, it may cause elevated levels of simvastatin when the two drugs are taken concomitantly. A nurse might contact the health care provider to suggest an alternative statin such as rosuvastatin, fluvastatin, pitavastatin, or pravastatin, which are not significantly metabolized through CYP3A4 and are not expected to interact.

A patient taking atorvastatin is experiencing the adverse effect of myositis. Which manifestations would a nurse expect to see in this patient?

Creatine kinase (CK) elevation Patients with myositis are expected to have moderate elevations in CK levels. Muscle inflammation Muscle inflammation would be expected in a patient with myositis. The suffix itis implies inflammation. Muscle pain Muscle pain is anticipated in a patient experiencing myositis.

A patient who has received a prescription for lovastatin asks the nurse why grapefruit and grapefruit juice should ideally be avoided. Which explanation would the nurse provide?

Increases risk for rhabdomyolysis Grapefruit juice causes inactivation of CYP3A4, an isoenzyme involved in lovastatin's metabolism. As such, lovastatin levels increase, which increases the risk for rhabdomyolysis. In general, patients should ideally avoid grapefruit juice or at least limit intake to less than 1 quart per day.

Which phrase accurately describes a statin's mechanism of action?

Inhibition of the enzyme hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase Statins work to decrease cholesterol production through inhibition of the enzyme HMG-CoA reductase.

Which laboratory values will a nurse ensure are ordered for a patient before initiation of a statin?

Lipid panel Because statins are initiated to lower cholesterol parameters, it is prudent to assess the patient's lipid panel at baseline so it can be reassessed in 4 to 12 weeks to determine how the statin has affected the levels. Liver enzymes Because statins may cause an elevation in liver enzymes, it is important to attain baseline values before initiation for appropriate monitoring. Creatine kinase (CK) Because a statin therapy can potentially cause myopathies, it is important to ensure a patient has a baseline assessment of the CK level in the event it becomes elevated with statin therapy.

Which statins are significantly metabolized by CYP3A4?

Lovastatin Lovastatin is significantly metabolized by CYP3A4 and may cause important drug-drug interactions. SimvastatinSimvastatin is significantly metabolized by CYP3A4 and may cause important drug-drug interactions. AtorvastatinAtorvastatin is significantly metabolized by CYP3A4 and may cause important drug-drug interactions.

An insurance company is requiring a patient receiving pitavastatin 2 mg to switch to another statin to receive coverage. Which statins and doses are therapeutically equivalent to pitavastatin 2 mg?

Pravastatin 40 mgPravastatin 40 mg is therapeutically equivalent to pitavastatin 2 mg. Simvastatin 20 mgSimvastatin 20 mg is therapeutically equivalent to pitavastatin 2 mg. Rosuvastatin 5 mgRosuvastatin 5 mg is therapeutically equivalent to pitavastatin 2 mg.

Which statements regarding pharmacodynamics and pharmacokinetics of statins are accurate?

Statins reduce cholesterol production through inhibition of hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase.Statins are effective at lowering LDL and total cholesterol through inhibition of the enzyme HMG-CoA reductase. Hepatocytes increase the number of low-density lipoprotein (LDL) receptors in response to decreased cholesterol synthesis by statins to remove cholesterol from circulation.Because statins decrease cholesterol synthesis, the hepatocytes respond by increasing the number of LDL receptors on their surface to promote cholesterol removal from circulation.

Which statement regarding the pharmacokinetics of statins is accurate?

Statins undergo first-pass metabolism through the liver, the primary site of statin activity. Statins are involved in first-pass metabolism in the liver. The liver is the principal site of statin activity.

Which teaching points would a nurse share with a 33-year-old female patient who was prescribed statin therapy?

The patient should avoid pregnancy while receiving therapy with a statin. Statins are teratogenic. Therefore any female patient receiving statin therapy should be amply counseled about the avoidance of pregnancy while receiving statin therapy. Gastrointestinal distress can be minimized by taking with food and/or with at least 6 to 8 oz of water.Statins may cause gastrointestinal distress; however, patients can take the statin with a meal or with 6 to 8 oz of water to minimize the distress. Ensure she is getting plenty of exercise and a diet rich in vegetables, fruits, and fiber to help lower cholesterol levels.Patients with high cholesterol should be advised to engage in exercise and dietary intake of fruits, vegetables, and fiber to help reduce cholesterol levels.