in this lesson we were talking about the side effects of statin medication use so we're going to
talk about what statins are and some of the mild and severe side effects of use of statins what are
statins statins are medications used to lower or reduce blood cholesterol levels so they all have
the suffix statin in their name one example is atorvastatin another one is simvastatin
and another one is rosuvastatin now the statin medications inhibit synthesis of
cholesterol via inhibition of hmg-coa reductase enzyme so they inhibit the activity of hmg-coa
reductase enzyme which is involved in producing cholesterol so there are many many different
enzymatic steps in between hmg coa reductase and cholesterol but this is the rate limiting step
in cholesterol synthesis so if statins bind to this enzyme they prevent cholesterol production
or synthesis but the problem is statins may cause a variety of mild and or severe side effects we're
going to talk about those side effects in the next upcoming slides there are certain
patient characteristics that increase the risk of having side effects these include being female
older age patients especially greater than 80 years of age are at an increased risk as well
having certain medical conditions increases your risk for having side effects of statin medications
these include kidney disease liver disease and hypothyroidism or a low functioning thyroid being
a heavy alcohol consumer is also another risk factor for having statin side effects
and then using multiple cholesterol lowering medications can also increase your risk for having
side effects from statins as well now let's talk about the side effects of statins one of the main
side effects of statin medications is myalgia or myopathy my algae is muscle pain and myopathy is
muscle disease that's what those words mean so the symptoms that patients experience with myalgia and
myopathy include muscle aches pains and tenderness so they can have places where their muscles feel
very tender or they can have aches and pains and in some cases of ear pain we're going to
talk about that in a moment this is relatively common it can affect upwards of 50 of patients so
the range is quoted as 20 to 50 of patients will experience issues with muscle aches and pains this
is a dose-dependent effect so the higher the dose of statin the more likely and more severe these
myalgia symptoms are going to be most of the time it's mild symptoms but there may be more severe
symptoms with rhabdomyolysis occurring but this is a rare outcome of statin use so rhabdomyolysis is
muscle breakdown we can see this in blood work increased levels of creatine kinase so
rhabdomyolysis is when the muscles actually start to break down and this can have a severe pain in
the affected muscles and if this is not treated properly this can lead to kidney issues as well
and another very important significant side effect of statin use is hepatitis so hepatitis the word
hepatitis means inflammation of the liver hepat means liver itis means inflammation
and we can see this in blood work increased liver transaminases so as the liver becomes damaged
the liver releases enzymes into the blood and we can detect these enzymes
what is noted in patients that are affected with hepatitis from statins is that there's right
upper quadrant pain or tenderness so right upper quadrant is in this area here so if we're looking
straight at the patient this is the patient's right side this is the patient's left side
and this is the right upper quadrant so this is where the liver is located and this is where the
patient's going to experience pain and tenderness and in some cases if the hepatitis is severe there
can be significant liver damage leading to some jaundice so jaundice is yellowing of the skin
and yellowing of the whites of the eyes if there is yellowing of the whites of the eyes that is
known as scleral icterus and there can be some other signs and symptoms of liver disease as well
if you want more information on signs and symptoms of liver disease please check out my lesson on
that topic but this is more of a rare side effect of statin use although it can occur so myalgia and
myopathy very common very important to recognize with statins and then hepatitis may occur as well
some other side effects of statins include headaches this may actually be the most
common side effect of statin use and there may be some migraine headache especially in patients
who are more susceptible to migraine headaches so statins may trigger migraine headaches but
paradoxically there's also some evidence that demonstrates that statins if they're used with
vitamin d supplementation may actually reduce the risk of severe headaches and migraines so
some evidence shows that statins perhaps cause headaches or migraine headaches but in some cases
if they are combined with vitamin d supplementation they may actually reduce some
symptoms of severe headaches and migraines so this is very interesting there may be some differences
in side effect profiles depending on vitamin d levels in certain patients so very interesting but
there is some contradicting evidence here another side effect of statin use is fatigue this is again
one of the most common side effects of statins and this may be related to muscle weakness so
because of the myalgia and myopathy there can be some muscle weakness this may lead to a feeling of
fatigue so this can also be another side effect of statin use another side effect of statin use
is memory issues this is an uncommon side effect and there can be some reduced memory or memory
loss with statin use so there can be some issues with cognition with statins however this appears
to reverse when statins are discontinued so some patients may have issues with retention of certain
memories or loss of certain memories but when they are stopped when they have discontinued statins
these memory issues are resolved so this is another very important side effect that can occur
in some patients another possible side effect of statin use is sleep disturbances statins may
cause issues with insomnia although unlikely so there has been some evidence that may suggest that
statins cause insomnia but this doesn't seem to be very strong evidence if it does occur if statins
do cause issues with insomnia the statins that are more likely to do that are simvastatin and
atorvastatin the reason being is that they are more fat soluble so the theory is that perhaps
they can cross the blood-brain barrier easier and cause issues with sleep so this can be a possible
reason but again sleep disturbances may occur with statin use although again it is unlikely
another side effect of statins is pre-syncope this is a sensation of lightheadedness or dizziness
so this can occur with statin use and there can also be issues with bowel habit changes bowel
habit changes meaning constipation and or diarrhea so there can be a change in normal bowel habits
and patients can alternate between constipation and diarrhea so they can have either one of the
other or they can alternate between the two important to note here is that when looking
at the evidence when statins are compared to placebos in trials the placebos also cause
these side effects as well so it may not be the statins themselves it may simply be taking
the statin that is leading to these types of side effects so some of these side effects
are very common with other medications but i do want to mention them here as they are possibly
related to statin use although again placebos can also cause these types of side effects
but some other side effects that statins can cause that are definitely caused by statins include
increased blood sugars this has been observed in patients with type 2 diabetes and there is
some evidence to suggest that may also increase the risk of developing type 2 diabetes so statins
can lead to increased blood sugars but there's not much research done to look at the outcomes of this
so there is some change in blood sugars there's some increased blood sugar levels with statins
but the outcome as to this effect has not been fully studied it does seem to be due to statin
mediated immune responses that depress insulin functioning so this is the reason why statins can
lead to increased blood sugars very important and then statins can also lead to thrombocytopenia so
thrombocytopenia is low platelet count this seems to be a very rare side effect there have been some
case reports of severe thrombocytopenia occurring with atorvastatin use but again this is likely a
very rare side effect and then another possible side effect of statin use is hair loss this is
a very rare side effect affecting likely only one percent of patients who use statins and it likely
occurs with all statins so this is a possible side effect it can happen with other medications
but this is a possible side effect that can occur with statin use so if you want to learn more about
other medications and their side effects please check out my pharmacology playlist and please
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