Statins (HMG-CoA Reductase Inhibitors) and PCSK9 Inhibitors

Every question here, with the answer

1. A client taking atorvastatin reports new muscle weakness and very dark urine. What is the nurse's priority concern?

   1. Rhabdomyolysis
   2. Expected mild myalgia that needs no follow-up
   3. Injection site reaction
   4. New-onset diabetes

   Answer: Rhabdomyolysis

   Muscle weakness with very dark urine can indicate rhabdomyolysis, the most severe muscular side effect of statins, whose byproducts can cause fatal kidney toxicity. Statins are oral, and these symptoms are not a harmless expected effect.

2. A client prescribed simvastatin asks when to take it. What should the nurse teach?

   1. In the evening, because it has a shorter half-life.
   2. Any time of day, because it has a long half-life.
   3. Every other day to reduce side effects.
   4. Only in the morning with breakfast.

   Answer: In the evening, because it has a shorter half-life.

   Simvastatin has a shorter half-life than rosuvastatin or atorvastatin, so clients take it in the evening when cholesterol synthesis is most active. Any-time dosing applies to long half-life statins.

3. A nurse is teaching a client who will self-inject a PCSK9 inhibitor at home. Which instructions are correct? Select all that apply.

   1. Inject into a bruised area to reduce pain.
   2. Let a refrigerated dose warm to room temperature before injecting.
   3. Rotate injection sites for each dose.
   4. Store the drug in the refrigerator in the original carton.
   5. Use the medication even if it looks cloudy.

   Answer: Let a refrigerated dose warm to room temperature before injecting., Rotate injection sites for each dose., Store the drug in the refrigerator in the original carton.

   The drug is refrigerated in its carton, warmed to room temperature for 30–40 minutes before use, and injection sites are rotated. Cloudy medication should not be used, and bruised areas should be avoided.

4. A kidney transplant recipient on immunosuppressants needs statin therapy. Which statin is often considered the drug of choice for this client?

   1. Simvastatin
   2. Pravastatin
   3. Lovastatin
   4. Simvastatin 80 mg

   Answer: Pravastatin

   Pravastatin relies less on cytochrome enzymes, so it has fewer drug interactions and is often chosen for clients taking highly interacting drugs such as immunosuppressants after transplant. Simvastatin and lovastatin interact with many drugs, and simvastatin 80 mg should not be used.

5. A nurse is caring for a client who is starting a statin. Which nursing actions are appropriate? Select all that apply.

   1. Ensure LDL-cholesterol levels are monitored.
   2. Monitor for muscle-related adverse effects.
   3. Teach that diet no longer matters once on a statin.
   4. Obtain a home medication list and check for interactions.
   5. Make sure liver enzymes are tested before therapy starts.

   Answer: Ensure LDL-cholesterol levels are monitored., Monitor for muscle-related adverse effects., Obtain a home medication list and check for interactions., Make sure liver enzymes are tested before therapy starts.

   The nurse checks the medication list for interactions, watches for muscle effects, ensures LDL monitoring, and liver enzymes are tested before starting. Clients should still maintain a heart-healthy diet.

6. A client asks whether they can give themselves inclisiran at home like their neighbour does with a PCSK9 inhibitor. What should the nurse say?

   1. Yes, but only in the thigh.
   2. No, a health care professional should give it, so keep your appointments.
   3. Yes, it is self-injected every 2 weeks.
   4. No, it is taken by mouth daily.

   Answer: No, a health care professional should give it, so keep your appointments.

   Inclisiran is given subcutaneously by a health care professional, twice a year after a loading phase, so the client must make and keep appointments. It is not self-injected every 2 weeks and not taken by mouth.