Medications to Lower LDL Cholesterol Levels – Statins (Nursing)

00:01 Now, let's look at the medications that we can use; statins.

00:04 They're the most effective and the most common prescription that's given to lower LDL, the bad cholesterol levels.

00:12 Okay, so I love the graphic that we have for you here.

00:15 Atorvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, simvastatin.

00:22 Okay, think you kind of get the idea on why we call them statins because here's the other name.

00:29 Yeah, HMG-CoA reductase inhibitors.

00:33 Nobody says that. We just call them the statins.

00:37 Now the reason they're the most effective drugs for lowering LDL cholesterol levels is because they increase the number of LDL receptors in the liver. Okay, so look at that.

00:46 See those little LDL receptors there? Look, when we give you a statin, your liver has more of these little guys, these little receptors, and they're ready to receive the LDL.

00:56 So when I have more receptors in the liver, I have less LDL serum in the blood, because more of it is taken up into the liver.

01:05 That's how statins reduce your LDL serum levels.

01:09 Okay, so the sad news is you kind of have to take these for life, if you can't manage your cholesterol levels with lifestyle and diet.

01:17 Now, don't forget, lifestyle and diet really is important. You can lower your -- you can lower your cholesterol levels with lifestyle and diet, but oftentimes, you need the support of the statins to go along with it.

01:30 Either the patient has a difficult time making those choices, or they just are really resistant. Their bodies are really good at LDL.

01:39 So the statins will lower LDL levels, it will slow the progression of atherosclerotic heart disease, and minimize the risk of a cardiovascular event like heart attack or stroke.

01:50 Now, some patients will have to take statins for life if they can't manage their cholesterol levels with lifestyle and diet.

01:56 And again, I want to encourage you, don't overlook the positive benefits of helping your patient change their lifestyle and their diet.

02:04 They can make tremendous strides towards lowering their LDL.

02:07 But if that isn't enough, or the patient has a really difficult time making those lifestyle choices, then the statins can help.

02:14 Because they will lower the LDL levels, and when we can lower the LDL levels, this will slow the progression of atherosclerotic heart disease.

02:22 If we can slow the progression of atherosclerotic heart disease, then we're going to lower their risk of cardiovascular events.

02:30 Remember, when we use that big term, cardiovascular events, we mean a heart attack or a stroke.

02:36 So, lower LDL means less chance of having a heart attack or a stroke.

02:42 We can do that with diet and lifestyle, and also, the addition of statins.

02:48 Now, all drugs come with a price, right? So there are some possible serious side effects with statins.

02:55 They don't happen all the time. They're pretty rare, but these are the 2 things you really want to watch for.

02:59 The first one is hepatotoxicity.

03:02 Now just take your pencil and underline the word "toxicity." You know what that means, right? Toxic, no bueno. Hepat stands for liver.

03:11 So anytime you see "hepat" in something, you know that we're referring to the liver, like hepatitis, right? That's inflammation of the liver.

03:20 But hepatotoxicity means statins can be toxic to your liver.

03:25 So you want to monitor liver function and make sure your patient understands the importance of us keeping an eye on that while they're taking statins. The other one is myopathy.

03:34 Now, that has to do with your muscle, "my." So we want the patient to tell us if they have any symptoms of muscle pain or tenderness or weakness, this might be a side effect of their statins that they wouldn't necessarily connect to the use of taking a statin.

03:48 So 2 rare, but serious adverse effects of statins, going after your liver, hepatotoxicity, and myopathy.

03:56 So your job as a nurse is to educate your patient, just to make them aware that this doesn't happen very often, but to let us know if they notice any of these signs.

04:06 So, the therapeutic uses for these, if you have high cholesterol, that's a no brainer why we'd give a statin, right? It increases those LDL receptors on your liver, takes more of the LDL out of the blood into the liver that will lower your LDL level.

04:22 Now, you're shooting for a target of < 100 mg, okay? That's what I'm shooting for, for an LDL level.

04:30 Now, if you're a high-risk patient, that means you have other risk factors, like you've had a stroke, you've had an MI, or you're diabetic, we'd probably like you to keep it even lower than 100, we'd like it to be lower, like < 70.

04:43 Now, with statins will help us reduce the risk of cardiovascular events.

04:47 We give it to people after an MI, post-MI because they've had a cardiovascular event as an MI and we don't want them to have any more, and someone who's diabetic.

04:59 We know that our diabetic clients are at a really increased risk for cardiovascular events across the board.

05:06 That's why patients will already usually likely be put on a statin if they're diabetic Now this one's kind of like a unique factor of statins.

05:14 It's the timing.

05:16 Most of the manufacturers of statins recommend that you give these medications at night.

05:22 Okay, so I don't want to gloss over that.

05:24 This is kind of a weird thing, but statins should be taken at night.

05:28 They've done research studies and they say that most of the cholesterol is made when dietary intake is the lowest.

05:34 That's why you recommend that statins, drugs that reduce cholesterol levels, are taken at night or at bed time.

05:42 Now, particularly, fluvastatin, lovastatin, simavastin.

05:44 I said those kind of fast but you know they're all statins, they have a pretty short half-life. But let's be honest.

05:52 When you're studying for exams, you only have a certain amount of real estate in your brain available.

05:57 So I just remember, across the board, just recommend that statins be taken at night time.

06:03 Now you'll know, if I were in your brain, you would look up each individual drug if you're educating your particular patient, but as a rule, think about statins are given at night time because we make most of our cholesterol when dietary intake is the lowest.

06:16 So you want to educate your patients to take their statin at bedtime.