CLS Statin Therapy & Pharmacology 3

Question 1

Statin-associated muscle symptoms (SAMS) are most accurately defined as which of the following?

Accepted Answer

A spectrum from myalgia without CK elevation to rhabdomyolysis with CK >10× ULN

Answer

SAMS encompasses the full spectrum from mild myalgia (normal CK) through myositis (CK elevation) to life-threatening rhabdomyolysis (CK >10× ULN with renal injury).

Question 2

The PREDICTION score or similar tools for statin myopathy risk account for which of the following as the strongest pharmacogenomic predictor of statin-induced myopathy?

Accepted Answer

SLCO1B1 521T>C variant (rs4149056)

Answer

The SLCO1B1 521T>C variant reduces OATP1B1 transporter activity, impairing hepatic statin uptake and raising plasma concentrations, which significantly increases myopathy risk especially with simvastatin.

Question 3

A patient on atorvastatin 40 mg develops CK of 6× ULN without renal impairment or weakness. What is the recommended management?

Accepted Answer

Hold atorvastatin, recheck CK weekly, and rechallenge with a lower dose once CK normalizes

Answer

For asymptomatic CK elevation between 3–10× ULN without weakness, guidelines recommend withholding the statin, monitoring CK until normalization, and rechallenging at a lower dose or different statin.

Question 4

Which concomitant condition most dramatically increases the risk of statin-induced rhabdomyolysis independent of drug interactions?

Accepted Answer

Hypothyroidism

Answer

Untreated or undertreated hypothyroidism predisposes patients to myopathy and rhabdomyolysis, and statin therapy in this setting substantially amplifies that risk.

Question 5

Statin-associated autoimmune myopathy (SAAM) differs from typical SAMS because it is characterized by which finding?

Accepted Answer

Persistent myopathy with anti-HMGCR antibodies after statin cessation

Answer

SAAM is an immune-mediated necrotizing myopathy driven by anti-HMGCR autoantibodies that persists and may worsen even after statin discontinuation, requiring immunosuppressive treatment.

(CLS) Clinical Lipid Specialist Certification Practice Test

(CLS) Clinical Lipid Specialist Certification Practice Test

CLS Statin Therapy & Pharmacology 3