Q-risk & statin counselling Flashcards
establish reason for consultation
recent CVD symptoms // family member diagnosis
relevant statin-specific questions in general hx
PMH - liver disease // angina/MI, TIA/stroke, PAD, DM, HTN, AF, CKD
FH - above & familial hypercholostrolaemia
DH+allergies - CYP450 inhibitors
SH - smoke, alcohol, occupation, exercise, diet, support at home
Q-risk & its implication
10 year risk suffering severe CVD event
if 10% –> atorvastatin 20mg
three whats before talking about statins
what they tried - discuss lifestyle (low sat fat, regular exercise, stop smoking, moderate alcohol consumption)
what do they know about statins
what are their concerns
what, when, why, how, how long of atorvastatins
what - tablet
when - once a day anytime (other statins at night)
why - significantly lower cholesterol & reduce CVD risk
how - act on liver, interrupt chain of LDL synthesis
how long - for life
three types of statin side effects
common - MUSCLE ACHE, GI upset, nosebleeds, sore throat, runny nose, headache
uncommon - insomnia, memory problems, ++ DM risk
rare + serious - myopathy & rhabdomyolysis (1/20000)
statin monitoring
baseline lipids & LFTs
initial & at 3 & 12 months
achieved 40% reduction
CIs statins
active liver disease
pregnancy
breastfeeding
interactions statins
avoid CYP450 inhibitors
fyi erythromycin/clarithromycin, ciprofloxacin, miconazole/ketoconazole, NaVal, grapefruit juice
structure of consultation
reason for visit
px PMH // relatives PMH
FH etc
lifestyle advice
free test - fasting blood for lipids
private test - genetic test
