21.2 Statins (HMG-CoA Reductase Inhibitors) and PCSK9 Inhibitors
2 min read•june 18, 2024
and are powerful tools in the fight against high cholesterol. These medications work in different ways to lower lipid levels in the blood, reducing the risk of heart disease and stroke.
Understanding how these drugs work is crucial for nurses. We'll look at their mechanisms of action, clinical uses, side effects, and important nursing considerations to help patients get the most benefit from lipid-lowering therapy.
Mechanisms of Action and Effects
Statins and PCSK9 inhibitors lower lipid levels
Statins ( inhibitors)
Block HMG-CoA reductase enzyme involved in rate-limiting step of liver cholesterol synthesis
Decreases liver cholesterol production causing upregulation of on liver cells
Increased LDL receptor expression enhances removal of LDL and VLDL from blood (, )
bind to and inhibit PCSK9 protein
PCSK9 normally binds LDL receptors causing their breakdown and reducing LDL removal
Inhibiting PCSK9 increases available LDL receptors on liver cells
Enhanced LDL receptor expression increases removal of LDL and VLDL from blood (, )
Clinical Use and Efficacy
Indications and effectiveness of statins vs PCSK9 inhibitors
Indications
Statins first-line for primary and secondary prevention of (ASCVD)
PCSK9 inhibitors for or ASCVD patients needing more LDL lowering despite maximum statin dose
Effectiveness
Statins reduce LDL 30-50% and significantly reduce cardiovascular event and mortality risk
PCSK9 inhibitors further lower LDL 50-60% when added to statin
Statin plus PCSK9 inhibitor can reduce LDL up to 75-80%
PCSK9 inhibitors show additional cardiovascular risk reduction when combined with statins
Adverse Effects and Interactions
Common side effects and drug interactions with statins and PCSK9 inhibitors
Statins
Common side effects: muscle pain/weakness, fatigue, digestive issues, headache, elevated liver enzymes
Rare serious side effects: , , liver damage
Drug interactions: increased muscle side effect risk when combined with certain antibiotics, antifungals, fibrates
PCSK9 inhibitors
Generally well-tolerated with few side effects
Most common adverse effect is injection site reactions (pain, redness, itching)
No significant drug interactions identified so far
Nursing Considerations
Key nursing considerations and patient education for lipid-lowering medications
Nursing considerations
Monitor lipid levels and liver function tests regularly
Assess for muscle symptoms and check creatine kinase if muscle symptoms occur
Encourage medication and lifestyle changes
Educate patients to report any adverse effects
Patient education
Emphasize how lipid-lowering medications reduce cardiovascular risk
Discuss importance of taking medications as prescribed and not stopping without consulting provider