Assignment 9.2: Statin Case Study Due: Day 7 Value: 12 points J.J., a 55-year-ol

Question

Assignment 9.2: Statin Case Study Due: Day 7 Value: 12 points J.J., a 55-year-old white male, has come in for his annual physical. He has hypertension and type 2 diabetes mellitus. His blood pressure is controlled with lisinopril 20 mg daily and amlodipine 5 mg daily (BP 132/82 mm Hg). His most recent HbA1c was 7.2% while taking metformin. His father died at age 55 of a myocardial infarction, and his brother, age 57, just underwent angioplasty. J.J. eats fast food at least five times a week because of his work schedule. He weighs 245 lbs. and stands 5-foot-11. His blood pressure is 134/80. His total cholesterol is 237 (LDL, 162; HDL, 35; triglycerides, 200).

Answer the following questions. Include two references, cited in APA style.

Does J.J. fall into any of the statin risk categories? If so, which one?

What drug therapy and dose would you prescribe, and why?

What are the parameters for monitoring the success of the therapy?

List one or two adverse reactions for the drug therapy that you prescribed for J.J. that would cause you to change therapy.

When rechecked, J.J.’s total cholesterol is 174 (LDL, 100; HDL, 38), but he is complaining of muscle pain.

How would you manage J.J.’s treatment?

Explanation / Answer

1Bruckert E,Hayem G,Dejager S,Yau C,Begaud B.Mild to moderate muscular symptoms with high dosage statin therapy in hyperlipidemic patients-the PRIMO study.Cardiovasc Drugs Ther 2005;19:403-414

2. Statins are primarily used for reducing the cardiovascular mortality and morbidity in high-risk patients.Statin risk categories are age,alcoholism,increased physical activity,small body frames ,multisystem disorders And major surgery Short stature is one of the risk factor as he is only 5 foot inch.

3 Statins are usually given to reduce the high cholesterol level in the blood and prevent the occurence of CHD.Since the patient has multitude of problems he should be given statin therapy For Eg Atorvastatin which lowers the cholesterol level in the blood.

4 Atorvastatin reduces the elevated triglyceride levels ,total cholesterol and LDL and elevate HDL level .This drug is dose related.Additionaly it prevents heart attack in patients with diabetes with multitude of other risk factors of coronary disease.

5 The adverse reaction of this therapy would it may cause liver as well as muscle damage.Therefore liver tests should be performed before giving this drug..Statins also increase the HBA1c level and FBS in diabetic patients.

6.Some patients are intolerant to statin .the main reason behind is because of its muscle-related symptoms.Sometimes this symptoms may be unaccompanied by an increase in Creatinine kinase.It is shown that statins may sometimes result in myopathy resulting in calcium signal impairing.Simvastatin triggers mitochondrial depolarization and calcium efflux.The risk factors for developing statin-induced myopathy is old age,small body frame,multisystem diseases,alcoholism,major surgery and excessive physical activity.Simvastatin will be effective.It is not advisable to stop the prescribed medication without talking to the doctor.The doctor may probably adjust the dosage or recommend a different statin.

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