QuestionSBA
QuestionChoice
There is no clinical indication to change his form of statin or the frequency of his medication
34488
d
Switch to simvastatin 20mg PO 12-hrly
QuestionChoice
In this case, his transaminases are raised, his LFT should be repeated in 1 months time. There is no clinical indication to increase the frequency of his medication
34486
b
Atorvastatin 20mg PO 12-hrly
QuestionChoice
His LFT is not raised by more than 3 times the upper limit, there is no need to discontinue his statin at this point
34489
e
Stop atorvastatin
QuestionChoice
In this case, his transaminases are raised, his LFT should be repeated in 1 months time. There is no clinical indication to increase the dose of his medication
34487
c
Atorvastatin 40mg PO daily
QuestionChoice
LFT should be done 3 months after initiation of statin medication. If the transaminase levels are raised by more than 3 times upper limit of normal, discontinue statin and repeat LFT in a month. If the transaminase are raised but less than 3 times upper limit of normal , continue statin and repeat LFT in a month. In this case, his transaminases are raised but not more than 3 times the upper limit, hence, his medication can be continued and LFT should be repeated in a months time
34485
a
Atorvastatin 20mg PO daily
Concept
Chapter
#### Monitoring

The BNF advises to monitor lung function (in patients with a history of obstructive airway disease).

#### Overdoses

Overdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).
Non-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.

Management
 - Airway protection 
 - Activated charcoal within 1 hour
 - IV Fluids
 
IV glucagon is the first-line management.
 
For symptomatic bradycardia, IV atropine may be used.

2618
2840
Statin side effects
Topic
75
GP
6908
Case Presentation:




A 55-year-old man presents to his GP for review of his blood cholesterol. He was started on atorvastatin 3 months ago for his hypercholesterolemia as his QRISK score was 20%. PMH Type 2 diabetes mellitus, Hypercholesterolemia. DH Atorvastatin 20mg PO daily, Metformin 500mg TDS PO.


 **On Examination**
BP 125/85 mmHg


HR 85/min


RR 14


O2 stats 95% RA


 **Investigations**
 3 months ago, prior to treatment:


||||
|---------------------------|:-------:|--------------------|
|Albumin|40 g/L|35 - 50|
|Alanine Aminotransferase (ALT)|30 IU/L|10 - 50|
|Aspartate Aminotransferase (AST)|15 IU/L|10 - 40|
|Alkaline Phosphatase (ALP)|100 IU/L|25 - 115|
|Gamma Glutamyl Transferase (GGT)|30 U/L|9 - 40|
|Bilirubin|15 µmol/L|< 17|
|Prothrombin Time (PT)|15    seconds|10 - 12|



 3 days ago:


||||
|---------------------------|:-------:|--------------------|
|Albumin|45 g/L|35 - 50|
|Alanine Aminotransferase (ALT)|85 IU/L|10 - 50|
|Aspartate Aminotransferase (AST)|40 IU/L|10 - 40|
|Alkaline Phosphatase (ALP)|120 IU/L|25 - 115|
|Gamma Glutamyl Transferase (GGT)|35 U/L|9 - 40|
|Bilirubin|13 µmol/L|< 17|
|Prothrombin Time (PT)|14    seconds|10 - 12|


Question:
Select the most appropriate decision option with regard to the treatment of his hypercholesterolemia based on these data.
a