QuestionPrescription
QuestionComment
according to BNF guidelines Simvaststin is indicated for DM, Atrovastatine doe's not mentions anything specific about DM 
"Prevention of cardiovascular events in patients with atherosclerotic cardiovascular disease or diabetes mellitus"
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Amnesia Kinin
QuestionComment
Why not Simvastatin?
8187
QuestionComment
If you type 'cholesterol' then click dyslipidemia, you'll see a table with strengths and see it's low intensity. I've just found it. 
17467
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Axillary Hereditary
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Jargon Recessive
QuestionComment
BNF treatment summary 
NICE (2016) recommend low-dose atorvastatin for patients who have a 10% or greater 10-year risk of developing CVD (using the QRISK2 calculator), and for patients with chronic kidney disease. Low-dose atorvastatin should be considered in all patients with type 1 diabetes mellitus, and be offered to patients with type 1 diabetes who are either aged over 40 years, have had diabetes for more than 10 years, have established nephropathy, or have other CVD risk factors. Patients aged 85 years and over may also benefit from low-dose atorvastatin to reduce their risk of non-fatal myocardial infarction. SIGN (2017) recommend low-dose atorvastatin for patients who are considered to be at high risk of CVD and not on dialysis. 
8370
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Yellow Zebras
QuestionComment
So it seems simvastatin is almost never the correct answer and atorvastatin almost always is 
61262
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Retake Prophylaxis 
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.

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Primary prevention of cardiovascular events
Topic
75
GP
# Drug choice feedback

This gentleman qualifies for lipid-lowering therapy as part of primary prevention of cardiovascular events as he is at high risk of a first cardiovascular event. He has had type 1 diabetes mellitus for more than 10 years and has established nephropathy; either alone qualifies him for lipid-lowering therapy. The recommended pharmacological management is with atorvastatin.

# Dose/Route/Frequency/Duration feedback

The recommended starting dose by NICE is 20mg. Atorvastatin, like most other statins, is taken orally once a day.
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20 mg
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atorvastatin 20 mg tablets
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3 months
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nightly
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oral (PO)
PrescriptionAnswer
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20 mg
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atorvastatin 20 mg tablets
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3 months
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daily (OD)
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oral (PO)
Case Presentation: A 37-year-old gentleman attends an annual review with his GP. He is currently asymptomatic.


## PH

Type 1 Diabetes Mellitus, diagnosed 11 years ago

## DH

Insulin Glargine (Lantus) 15 units, Insulin Aspart (Novorapid) 5 units at mealtimes (NKDA)

## On examination

Alert and oriented. Neurological examination normal. Fundoscopy normal.

Temperature 36.2°C, HR 72, RR 13, BP 130/88, O<sub>2</sub> 98% RA, GCS 15, Weight 60kg

## Investigations

Proteinuria 2+ on dipstick, no blood noted

# Prescribing Request

Write a prescription for one lipid-lowering drug that is most appropriate for prevention of cardiovascular events.