Pharma

Question 1

Atorvastatin dose

Answer 1

20mg for primary prevention- 10 yr CVS risk >10% or type 1 DM, or eGFR <60mls/min
80mg for secondary prevention- known ischemic heart disease, PAD, cerebrovascular disease

Increased physical activity
Reduce alcohol
Cardio protective diet

Question 2

When does QRISK2 underestimate CVD risk

Answer 2

People treated for HIV
Serious mental health issues
Taking meds that cause dyslipidemia such as antipsychotics, corticosteroids, immunosuppressents
Autoimmune systemic inflammatory disorders

Question 3

Measuring lipid levels

Answer 3

Total cholesterol and HDL used together
Full lipid profile before starting a statin

Consider familial hypercholesterilaemia if total cholesterol is over 7.5mmol/l and there is a family history of premature coronary heart disease

Also refer if total cholesterol is over 9 or non HDL is over 7.5

Question 4

Special situations for statin use

Answer 4

Type 1 DM
If older than 40
Diabetes for more than 10years, 
Established nephropathy
Other CVD risk factors

CKD
20mg atorvastain if CKD

Question 5

Follow up on statin

Answer 5

See at 3 months and
Repeat full lipid profile
If non HDL has not fallen by 40%- can consider increasing dose 80mg