What are Statins?

Indications

Statins are among the most widely prescribed medicines. More than 35 million people in the United States have been prescribed statins – and given the rate of growth of cardiovascular disease and obesity, these figures are likely to rise.

But what are statins – how do they work, and what side effects do they carry?

Due to the widespread use of statins in society, candidates should expect MCQs on these drugs during the exam. Below, we review the kind of PTCB practice test MCQs to expect. First, let’s quickly review what you need to know about this important drug class.

Statins are easily identified as having the convenient suffix –statin, and include:

Statin	Brand Names
Atorvastatin	Lipitor
Lovastatin	Altoprev, Mevacor, Altocor
Pravastatin	Pravachol
Simvastatin	Zocor
Rosuvastatin	Crestor

In medicine, the therapeutic function of a drug is referred to as its indication. There are three main indications of statins, including:

• Primary prevention of cardiovascular illness
• Secondary prevention of cardiovascular illness
• Primary hyperlipidemia

A primary disease is the root cause of an illness, whereas a secondary disease develops from the effects of a primary disease.

Statins are used in the primary prevention of cardiovascular disease, to prevent CV events – such as heart attacks and strokes – in patients susceptible to these conditions.

They are also used to prevent further cardiovascular events in patients who have already suffered one, a secondary form of prevention.

Finally, statins are used to treat hyperlipidemia, to reduce the levels of harmful fats – such as LDL cholesterol – in the blood. HDL levels rise during statin treatment, but HDL is established as “good cholesterol” so this is a desirable clinical outcome.

Mechanism of Action

Statin pharmacology is very well understood.

Statins work by inhibiting an enzyme called HMG-CoA reductase. This enzyme is intimately involved in one of the steps in the pathway of cholesterol production – namely, the mevalonate pathway. HMG-CoA reductase is the rate-limiting enzyme in this pathway, meaning that it plays a vital role in the rate at which mass cholesterol production takes place.

More broadly, statins reduce hepatic (liver) cholesterol production and increase the elimination of harmful LDL cholesterol from the blood. In addition to this, statins also reduce triglyceride levels. Triglycerides are a type of fat found in blood which have been linked to an increased risk of serious cardiovascular disease.

Side Effects of Statins

Statins are generally well tolerated drugs.

However, long-term use is associated with a range of serious effects and, if taken at high doses for prolonged periods, statins can cause myopathies – or muscle damage. In its most serious form, some patients develop rhabdomyolysis, a condition characterised by muscle breakdown, the toxic metabolites of which pass on to cause often fatal kidney damage.

Aside from the effects of statins on muscle, other side effects include:

• Headache
• Gastrointestinal effects
• Elevation of liver enzymes – such as alanine transaminase (ALT)
• Increased risk of diabetes – in patients already at risk of this disease

Though as we stated, they are generally well tolerated medicines.

Practical Prescribing

By interfering in the enzymes that metabolise statins, grapefruit juice is avoided in patients taking these drugs. Grapefruit juice slows the metabolism of statins, meaning that toxic doses become more likely – and therefore increase the risk of serious side effects. However, grapefruit juice has no impact on pravastatin or rosuvastatin.

Statins are typically advised to be taken at night when cholesterol production is at its highest.

Because statins are eliminated by the kidneys, doses are typically reduced in patients with established renal disease. Similarly, caution is warranted in patients with existing liver disease.

Statins are avoided in pregnancy because cholesterol is necessary for normal fetal development.

PTCB Practice Test Questions

As part of PTCB test prep training, candidates should practice as many PTCB questions as possible. The more questions you practice, the more it identifies your strengths and weaknesses – and how to turn those weaknesses into strengths.

Here are the kind of questions you can expect on statins.

Q. What is the active ingredient of the medicine Zocor?

a. Ezetimibe

b. Simvastatin

c. Lisinopril

d. Bisoprolol

Q. Drugs that inhibit the enzyme, HMG-CoA reductase, are used in the treatment of which condition?

a. Hyperlipidemia

b. Atrial fibrillation

c. Myocardial infarction

d. Diabetes type 2

Q. What effect do statins have on LDL and HDL cholesterol levels?

a. Both are decreased

b. Both are increased

c. LDL is increased, HDL is decreased

d. LDL is decreased, HDL is increased

Q. Which of these side effects is most associated with statins?

a. Hepatotoxicity

b. Hearing damage

c. Diarrhea

d. Muscle pains and aches

Q. Grapefruit juice should be avoided when taking which of these drug classes?

a. Fluoroquinolones

b. Opioids

c. Statins

d. Beta-blockers

Top 10 Takeaway Facts about Statins!

Statins are an important drug class that always get tested on the PTCB exam.

Here are the top 10 takeaway facts you need to know:

• Statins always end in the suffix -statin, such as atorvastatin.
• Statins work by inhibiting the HMG-CoA reductase enzyme.
• Statins are used to prevent cardiovascular disease and hyperlipidemia.
• Statins are associated with muscle aches/pains, and rarely, rhabdomyolysis.
• Statins are typically taken at night when cholesterol production is highest.
• Statins are avoided in pregnancy. Fetus development requires cholesterol.
• Grapefruit juice is avoided with most statins as it can increase toxicity risk.
• Statins lower harmful LDL and triglycerides but increase HDL levels.
• In at-risk patients, statins increase the risk of developing type 2 diabetes.
• Statins increase liver enzymes, so caution is warranted in liver disease.

As a pharmacy technician, you will meet hundreds of patients each month taking statins. You will be handling these medicines in the pharmacy setting and so it is important you have an understanding of this drug class and why these medicines are prescribed to patients.

With the above facts to hand, there is no reason why you cannot ace this topic on the PTCB exam.

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