HMG-CoA Reductase Inhibitors

1. HMG-CoA Reductase Inhibitors
Joanne Ong
California State University, San Marcos
School of Nursing
Pharmacology and Pathophysiology
NURS 312
Gary Veale, RN, MSN, Ed.
July 16, 2015

2. HMG-CoA
Reductase Inhibitors
Prototype drug: Atorvastatin

3. Pharmacologic class:
HMG-CoA reductase inhibitors
Therapeutic class:
Lipid-lowering agents/statin
Pregnancy risk:
Pregnancy Category X
Contraindicated with pregnancy and lactation
due to its potential for adverse reactions on the
fetus or neonate (Karch, 2013, p. 789)

4. Examples include:
Atorvastatin (Lipitor) (Prototype)
Fluvastatin (Lescol)
Lovastatin (Mevacor)
Pitavastatin (Livalo)
Pravastatin (Pravachol)
Rosuvastatin (Crestor)
Simvastatin (Zocor)
HMG-CoA Reductase Inhibitors

5.  HMG-CoA reductase is an
enzyme responsible for
cholesterol synthesis.
Inhibiting this enzyme will
lower the levels of serum
cholesterol and LDL levels, an
important element of
developing atherosclerosis,
and slightly increase HDL
levels, the “good cholesterol,”
due to the fat metabolism shift
(Karch, 2013, p. 788).
 This drug class is typically
used for treatment of
hyperlipidemia/hypercholester
olemia and to slow
progression of CAD (Karch,
2013, p. 789)

6. According to the literature search of Thomas et
al. (2010) in the PubMed database from January
1984-April 2009, they found that “from large,
randomized, controlled trials show that statin
therapy lowers both all-cause and coronary heart
disease mortality and reduces myocardial infarction,
stroke and the need for revascularization in
individuals aged ≥65 years who have a history of
coronary heart disease… there is substantial
potential for statin treatment to provide benefits in
this population.”

7. Statin, the drug of choice for lowering
cholesterol levels…
New guidelines on November 2013, jointly issued by the American
College of Cardiology (ACC) and the American Heart Association
(AHA) will greatly impact the treatment of hyperlipidemia…
 25% increase of overall population that is treated with statins
over the next 3 years, increasing from 3,909,407 (27.7%) patients
to 4,892,668 (34.7%) patients (Tran et al., 2013).
 Statins will be utilized as a primary prevention medication for
patients aged 40 to 75 years who were not on any anti-cholesterol
medications at baseline (Tran et al., 2013).
 “…increase the overall number of statin prescriptions by 25%
and will decrease the number of non-statin cholesterol-lowering
medication prescriptions by 68% during the next 3 years” (Tran
et al., 2013).

8. Pathophysiology
Hyperlipidemia
 lipids are cholesterol and triglycerides
 elevated levels of serum cholesterol and triglycerides
 increased level of the lipoprotein LDL (“bad cholesterol”) and
low level of HDL (“good cholesterol”)
 high lipids will increase risk of atherosclerosis and CAD
Atherosclerosis
 type of arteriosclerosis (hardening of arteries).
 fatty, fibrous plaque formed in the lining of the arteries (aorta
and its branches, coronary and cerebral) (Porth, 2011, p. 411)
 leading cause of coronary artery disease, stroke and peripheral
artery disease (Porth, 2011, p. 411)

10. Therapeutic Goals
 Treatment for
hyperlipidemia/hypercholesterolem
ia/dyslipidemia
 Increase HDL levels “the good
cholesterol”
 Help to slow progression of CAD
 Prevent MI (in patients with CAD
or high risk from developing CAD)
 Reduction of the risk of undergoing
revascularization procedures
 Statins adjunct with proper diet
(low-fat, low-cholesterol) and
exercise
(Karch, 2013, p. 786-789)

11. Adverse Effects
Most common (GI):
flatulence, abdominal pain,
cramps, N/V, constipation
(CNS):
headache, dizziness, blurred
vision, insomnia, fatigue,
cataract development
More serious:
Rhabdomyolysis (rovustatin),
increased liver enzymes and
acute liver failure
(atorvastatin and fluvastatin)
Rhabdomyolysis

12. Nursing Management and
Interventions
 Monitor lipid blood level
 Administer medication at bedtime (atorvastatin may be
given anytime of the day)
 Monitor LFTs (liver damage)
 Lifestyle changes to decrease risk for CAD
 Cholesterol lowering diet
 Contraceptives for women of childbearing age
(Pregnancy category X)
 Monitor for side effects
 Assess for compliance with treatment regimen
(Karch, 2013, p. 791-792)

13. Lipid Blood Level
Total cholesterol = Normal <200, Borderline High 200-
239, High ≥240
Low-density lipoprotein cholesterol (LDL) = Optimal
<100, Normal 100-129, Borderline High 130-159, High
160-189, Very High ≥190
High-density lipoprotein cholesterol (HDL) “the good
cholesterol” = Low <40, high ≥60
high level is good, low level is bad.
Triglycerides = Normal <150, Borderline High 150-
199, High 200-499, Very High ≥500
(Karch, 2013, p. 782)

14. Drug-herbal interaction:
St. John’s Wort may decrease levels and
effectiveness of lovastatin and simvastatin
(Deglin & Vallerand, 2009).
Drug-food interaction:
Large quantities of grapefruit juice increase
blood levels and increase risk of
rhabdomyolysis (Deglin & Vallerand, 2009).
Hyperlipidemia: herbal therapy
Garlic – decrease total cholesterol and
triglyceride levels and to
Increase HDL levels.
Olive (oil and leaf) – when part of a diet
high in monounsaturated fats, may
lower cholesterol levels.
Onion – used as raw herb for
hypercholesterolemia
(Springhouse, 2009)

15. Reference
Deglin, J. H., & Vallerand, A. H. (2009). Davis's drug guide for nurses. Philadelphia,
PA: F.A. Davis.
Karch, A.M. (2013). Focus on nursing pharmacology. (6th ed.). Philadelphia:
Lippincott, Williams & Wilkins. ISBN: 978-1-4511-2834-5
Porth, C.M. (2011). Essentials of Physiology (3rd ed.). Philadelphia: Lippincott,
Williams & Wilkins. ISBN: 9781582557243
Springhouse (2009) Nursing Herbal Medicine Handbook (3rd ed.). Lippincott,
Williams and Wilkins ISBN-13 9781582554174
Thomas, J. E., Tershakovec, A. M., Jones-Burton, C., Sayeed, R. A., & Foody, J. M.
(2010). Lipid Lowering for Secondary Prevention of Cardiovascular Disease in Older
Adults. Drugs & Aging, 27(12), 959-972. doi:10.2165/11539550-000000000-00000
Tran, J. N., Caglar, T., Stockl, K. M., Lew, H. C., Solow, B. K., & Chan, P. S. (2014).
Impact of the New ACC/AHA Guidelines on the Treatment of High Blood Cholesterol
in a Managed Care Setting. American Health & Drug Benefits, 7(8), 430-441.

16. Patient Handout
https://magic.piktochart.com/output/7015033-
untitled-infographic-conflict-copy-conflict-copy