Cardiovascular Drugs and Medications Q 49
As a competent nurse, you know that the most significant contraindication for therapy with lipid-lowering agent is:
A. Renal disease.
B. Diabetes.
C. Liver disease.
D. Cardiac disease.
Correct Answer: C. Liver disease.
All lipid-lowering agents except the bile acid sequestrants are potentially hepatotoxic, so the most significant contraindication is liver disease. Contraindications to statins include use by patients with active hepatic disease or unexplained persistent elevations in aminotransferase levels. Ezetimibe is contraindicated in patients who are using an HMG-CoA reductase inhibitor (statin) in patients with active liver disease or otherwise unexplained elevated serum transaminase values. Ezetimibe alone is not contraindicated in patients with mild to moderate hepatic impairment.
Option A: Fibrate use requires monitoring with liver function tests, renal function tests, and also CBC due to risk for pancytopenia. Ezetimibe, when used with a statin, can increase the risk of muscle toxicity, especially in advanced age over 65 years old, renal impairment, or hypothyroidism. Patients taking ezetimibe with cyclosporine are at an increased risk of ezetimibe toxicity as it can result in a 2.3- to 12-fold increase in ezetimibe concentration.
Option B: Statins have an increased risk of developing diabetes mellitus; thus, caution is necessary for patients with already increased blood glucose levels or increased Hba1c levels.
Option D: Statin-induced muscle injury can vary from myalgias to rarely myonecrosis or rhabdomyolysis. A meta-analysis of 42 randomized trials of statins found little or no excess risk of myalgias, CK elevations, rhabdomyolysis, or discontinuation of therapy versus placebo; however, in clinical practice muscle side effects are relatively common and the explanation for this difference is uncertain.