Complete this simple chart to help you answer the case study questions. Highlight the correct answers or delete the incorrect answers in each column.
| Drug Class | Side Effect | Best for: |
| Fibric acid derivatives (fibrates) | Muscle aches
Rhabdomyolysis GI symptoms Gallstones Constipation Increased blood glucose Headache Affects warfarin levels |
LDL
TG Pregnancy Liver disease CV risk reduction |
| Bile acid sequestrants (BAS) | Muscle aches
Rhabdomyolysis GI symptoms Gallstones Constipation Increased blood glucose Headache Affects warfarin levels |
LDL
TG Pregnancy Liver disease CV risk reduction |
| HMG-CoA reductase inhibitors
(Statins) |
Muscle aches
Rhabdomyolysis GI symptoms Gallstones Constipation Increased blood glucose Headache Affects warfarin levels |
LDL
TG Pregnancy Liver disease CV risk reduction |
Case Information
Mr. Jones, a 65-year-old white male with a history of HTN and diabetes mellitus, has the following lab results:
| Lab | Results |
| Total Cholesterol | 210 mg/dL |
| LDL | 130 mg/dL |
| HDL | 28 mg/dL |
| Triglycerides | 323 mg/dL |
Questions to Answer
Note for students: Type your answers in-line with each question.
What drug class is most important to prescribe for Mr. Jones’ abnormal lipids?
Answer:
If Mr. Jones’ triglycerides were 600, would an additional antilipidemic be indicated? If so, from what drug class? Are these 2 classes okay to combine?
Answer:
What other drug classes would you look for on Mr. Jones’ medication list that can cause elevated triglycerides?
Answer:
How do the three antilipidemic classes work differently? Which can NOT be taken together?
Answer:
What would you teach Mr. Jones about statins?
Answer:
Mr. Jones calls and tells you that he heard from a friend that statins cause muscle aches and that he can no longer take statins if he gets muscle aches. He feels like he might have a few more muscle aches than normal.
Can Mr. Jones still take statins, or does he need to switch to another class of antilipidemics?
Answer:
What labs might you check to confirm whether he is having this side effect?
Answer:
What kind of reassurance can you give Mr. Jones?
Answer:
Answer these additional questions:
What is the difference between a low-intensity, moderate-intensity, and high-intensity statin? What level are most statins?
Answer:
What are the two specific HMG-CoA reductase inhibitor drugs that are considered high potency statins?
Answer:
Which two specific HMG-CoA reductase inhibitor drugs have the least side effects?
Answer:
Which of the antilipemic classes is most effective and recommended as first line treatment by AHA/ACC for most people?
Answer:
Which antilipidemic class is NOT appropriate in pregnancy?
Answer:
For what patients would you consider bile acid sequestrants (BAS)?
Answer:
What are the most common side effects with BAS?
Answer:
References
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