Medicine & USMLE


Cardio Drugs - Lipid Lowering
  1. Fibrates
  2. Statins
  3. Ezetimibe
  4. Nicotinic Acid (Niacin)
  5. Bile Acid Sequestrants


Statins, also called HMG-CoA reductase inhibitors, are easy to recognize by their “-statin” ending. Some examples of statins include lovastatin, simvastatin, and atorvastatin.

These drugs decrease cholesterol synthesis in the liver, causing HDL levels to rise, and LDL levels to fall. In addition, statins lower triglyceride levels 

Statins are lipid-lowering drugs and can be helpful in the prevention of heart attack and stroke.

As a side effect, statins may cause myopathy which, if left untreated, can progress into rhabdomyolysis, a life-threatening medical emergency. Other side effects include liver damage, rash, nausea and vomiting, and headache. Statins are teratogenic, meaning they can cause birth defects and should generally not be used during pregnancy.

As the nurse, teach your patients to avoid grapefruit juice while taking statins. You should also teach them that statins are most effective when taken at night.

Key Points

  • Statins / HMG Co-A Reductase Inhibitors
    • Drug Names
      • “-statin”
        • Lovastatin
        • Simvastatin
        • Rosuvastatin
        • Atorvastatin
        • Pravastatin
        • **Note that nystatin is not a statin medication, it is an antifungal agent
    • Clinical Use
      • Lipid Lowering Drug
        • Lowers cholesterol levels
      • Prevents heart attack and stroke
        • Along with other cardiovascular diseases like coronary artery disease (CAD), blood clots, etc.
    • Mechanism
      • Decreases cholesterol production
        • Blocks the enzyme responsible for making cholesterol (HMG Co-A Reductase)
      • Decreases LDL
        • LDL stands for low density lipoprotein
        • Often referred to as “bad” cholesterol
      • Increases HDL
        • HDL stands for high density lipoprotein
        • Often referred to as “good” cholesterol
        • Memory trick - think of H for Healthy!
      • Decreases triglycerides
        • A type of fat that circulates in the bloodstream
    • Side Effects
      • Liver damage (hepatotoxicity)
      • Myopathy
        • Generalized muscle pain/weakness
        • Can lead to rhabdomyolysis
          • A life-threatening condition where the muscle breaks down, releasing a protein called myoglobin into the bloodstream which is really damaging to the kidneys
        • Monitor CK levels while on treatment
        • Patient should report muscle pain/aches to provider immediately
      • Nausea/Vomiting
        • May be accompanied by other GI adverse effects like diarrhea, constipation, or abdominal cramping
      • Headache
      • Rash
      • Teratogenic
        • Contraindicated during pregnancy
        • Pregnancy Risk Category X
    • Nursing Considerations
      • Avoid grapefruit juice
        • Grapefruit juice interferes with how statins are metabolized in the body
        • A buildup of statins in the blood can lead to increased side effects
      • Best taken at night
        • Most of the cholesterol in the body is synthesized during the fasting state at night.