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turlough's version from 2017-10-30 23:57

Section 1

Question Answer
2 indications for atorvastatin Hypercholesterolaemia and prevention of cardiovascular disease
How is atorvastatin typically dosed for hypercholesterolaemia? Patients typically start on 10 mg once daily and can be titrated up at intervals of at least 4 weeks to a max dose of 80 mg once daily.
How does atorvastatin work? Atorvastatin is a selective inhibitor of the HMG-CoA reductase enzyme. It inhibits the synthesis of mevalonate which is a cholesterol precursor. As a result, atorvastatin lowers plasma cholsterol levels. It also increases the number of LDL receptors on hepatic cells. This is beneficial because these receptors bind and remove LDL from the circulation.
Atorvastatin is more effective than other lipid-lowering drugs at treating what condition?Homozygous familial hypercholesterolaemia.
5 contraindications to the use of atorvastatin. Hypersensitivity, pregnancy, breast-feeding, active liver disease and unexplained persistent elevated LFTs.
Does food affect atorvastatin absorption? Food delays atorvastatin absorption but does not reduce it.
Atorvastatin is a major substrate of which hepatic enzyme and which transport protein?CYP3A4/5 and P-glycoprotein.
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Section 2

Question Answer
6 interactions with atorvastatin. CYP3A4/5 inducers, CYP3A4/5 inhibitors, transport protein inhibitors, fibrates, ezetimibe and digoxin.
Explain the interaction between atorvastatin and fibratesConcurrent use increases the risk of myopathy
Explain the interaction between atorvastatin and ezetimibeConcurrent use increases the risk of myopathy.
Explain the interaction between atorvastatin and digoxinAtorvastatin may increase digoxin levels and thus increases the risk of side effects.
List 6 P-GP inhibitors Amiodarone, macrolides (clarithromycin and erythromycin), non-DHP CCBs (verapamil and diltiazem), PPIs, paroxetine and sertraline.
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Section 3

Question Answer
How should atorvastatin be taken? Swallow the tablets whole with a glass of water. Atorvastatin can be taken at any time of the day. It can be taken with or without food because while food delays its effects, the full amount is still absorbed and atorvastatin is not a drug that we need to act quickly.
When should liver function tests be performed in a patient using atorvastatin? Check LFTs at baseline, 12 weeks after initiation and every 6 months thereafter.
What would you test to measure the efficacy of atorvatatin? Total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides.
3 counselling points for patients on atorvastatin1) Avoid alcohol, grapefruit and grapefruit juice. 2) This drug doesn't take the place of exercise and dietary changes.
What symptoms should patients be told to watch out for while on atorvastatin? Muscle pain, cramps or weakness, particularly if present in conjunction with malaise or fever. This is due to the risk of rhabdomyolysis (rapid destruction of skeletal muscle).
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Section 4

Question Answer
5 common side effects of atorvastatinHeadache, arthralgia, muscle pain, constipation and diarrhoea.
3 rare but serious side effects of atorvastatinRhabdomyolysis, myopathy and tendon rupture.
Discuss the relationship between statins and diabetesStatins can cause hyperglycaemia so patients at risk of diabetes warrant additional monitoring.
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