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Myocardial infarction also known as Heart attack is a medical condition that occurs when blood stops flowing properly to a part of the heart
Usually this is because one of the coronary arteries that supplies blood to the heart develops a blockage due to an unstable buildup of white blood cells, cholesterol and fat.
OVERVIEW OF MYOCARDIAL INFARCTI ON
Chest painDypsnoea Diaphoresis, weakness, light-
headedness, nausea, vomiting, and palpitations
Loss of consciousnessSudden death
SIGNS AND SYMPTOMS
The most common triggering event is the disruption of an atherosclerotic plaque in an epicardial coronary artery, which leads to a clotting cascade, sometimes resulting in total occlusion of the artery
Atherosclerosis is the gradual buildup of cholesterol and fibrous tissue in plaques
PATHOPHYSIOLOGY
Lovastatin Simvastatin Pravastatin Atorvastatin Fluvastatin Rosuvastatin Mevastatin Cerivastatin
STATINS EXAMPLES OF DRUGS UNDER THIS CLASS
BreastfeedingHigh alcohol intakeMyopathy Increase in liver enzymesActive liver disease or persistent
abnormal liver function testPregnancy
PRECAUTIONS AND CONTRAINDICATION
RhabdomyolysisKidney injuryLiver damageNeuropathyMemory defectsAcceleration of ageing Infection and CancerDiabetes Increase in liver enzymes
ADVERSE DRUG REACTION
Taking a statin drug with amiodarone, clarithromycin, cyclosporine, erythromycin, fluconazole, gemfibrozil, itraconazole, ketoconazole, or niacin increases the risk of myopathy or rhabdomyolysis
Lovastatin, rosuvastatin and simvastatin may increase the risk of bleeding when administered with warfarin
INTERRACTIONS
Most of the statins (lovastatin, simvastatin, and atorvastatin, ) are metabolized by the cytochromal P450 3A4. Drugs that inhibit P450 3A4, such as itraconazole, cyclosporine, and erythromycin, increases plasma statin level
Grapefruit juice can inhibit intestinal metabolism of the statins and can result in an increase in artovastatin, lovastatin, and simvastatin serum levels.
INTERRACTIONS cont.
Co-administration of fluvastatin with warfarin increases warfarin toxicity, because they are both metabolised by cytochrome P450 2C9
food increases the bioavailability of lovastatin Conversely bioavailability of pravastatin,
atorvastatin, and fluvastatin is decreased by food
INTERRACTIONS cont.
Statin equivalent dosages
% LDL reduction (approx.)
Atorvastatin Fluvastatin Lovastatin Pravastatin Rosuvastatin Simvastatin
10–20% – 20 mg 10 mg 10 mg – 5 mg
20–30% – 40 mg 20 mg 20 mg – 10 mg
30–40% 10 mg 80 mg 40 mg 40 mg 5 mg 20 mg
40–45% 20 mg – 80 mg 80 mg 5–10 mg 40 mg
46–50% 40 mg – – – 10–20 mg 80 mg*
50–55% 80 mg – – – 20 mg –
56–60% – – – – 40 mg –
* 80-mg dose no longer recommended due to increased risk of rhabdomyolysis
Starting dose
Starting dose 10–20 mg 20 mg 10–20 mg 40 mg 5–10 mg 20 mg
If higher LDL reduction goal
40 mg if >45%
40 mg if >25%
20 mg if >20%
-- 20 mg if LDL >190 mg/dL (4.87 mmol/L)
40 mg if >45%
Optimal timing
Anytime Evening With evening meals
Evening Anytime Evening
DOSES
Primary prevention: prevention of heart disease in those with high cholesterol
Secondary prevention: decreasing mortality in people with pre-existing CVD
Familial hypercholesterolemia In children: statins are effective at reducing their cholesterol level when lifestyle changes are not enough
Meanwhile statins in children should be started at age 8
INDICATIONS
Researchers hypothesize that statins prevent cardiovascular disease via four proposed mechanisms
Improve endothelial functionModulate inflammatory responsesMaintain plaque stabilityPrevent thrombus formation
OTHER EFFECTS OF STATINS
The statins that produce the greatest percentage change in LDL cholesterol levels are atorvastatin and simvastatin
Atorvastatin and fluvastatin are least affected by alterations in renal function
Fewer pharmacokinetic drug interactions are likely to occur with pravastatin and fluvastatin, because they are not metabolized through the cytochrome P450 (3A4) system
The most cost-effective statins, based on cost per percentage change in LDL cholesterol levels, are fluvastatin and atorvastatin
IMPORTANT THINGS TO NOTE
CIPRIDE: Simvastatin tablet 10mg, marketed by VIXA Pharmaceutical
LIPIVASTIN: Atorvastatin tablet 10mg, marketed by NEROS Pharmaceutical
STATINS STOCKED IN THE HOSPITAL