Hyperlipidemia Case Study
A 70-year old hypertensive and diabetic male is taking an ACE inhibitor and a thiazide for his hypertension. For his type II diabetes he is taking metformin. Both his hypertension and blood glucose are within normal range. Routine blood work reveals normal renal function and liver enzymes. His total cholesterol and low-density lipoprotein (LDL) is elevated.
To reduce the risk of coronary artery disease he is commenced on hydroxymethylglutaryl-CoA (HMG-CoA) reductase inhibitor.
Mechanism of Action
There are several different types of statins that help lower cholesterol. Statins interfere with the substance the body utilizes to make cholesterol. Statins are frequently prescribed medications for both preventive measures and maintenance (Golan, 2004). The ADA, (2017) recommended individuals diagnosed with diabetes, take statins to lower risk factors which may include: High cholesterol, high blood pressure, obesity, smoking, a high level of sodium in your diet, and inactivity. The less risk, the greater chances an individual will not have a cerebrovascular accident. In addition to cholesterol values, age, other health problems, determine if medication is warranted.
Recent guidelines presented by the ACC-AHA (2016) recommended people who have a diagnosis of cardiovascular disease, an LDL cholesterol level of 190 mg/dL or higher. As a practicing practitioner, I would place this patient on Lipitor 10 mg. The patient would be assessed for tolerance and effectiveness monthly; and quarterly thereafter.
Adverse Effects and Interactions
Some studies have shown that statins elevate blood glucose. This may be a concern for a person with diabetes or someone who’s at increased risk of developing diabetes. Blood glucose will be monitored daily to ensure there is no increase in levels.
Common side effects of atorvastatin is cold symptoms such as runny nose, sneezing, and coughing, diarrhea, gas, heartburn, joint pain forgetfulness and confusion. These side effects are mild and should go away in a couple of weeks. The patient should report muscle problems such as unexplained muscle weakness, tenderness, or pain or tiredness or liver problems (tiredness or weakness, loss of appetite, upper stomach pain, and dark-colored urine, yellowing of the skin or the whites of the eyes). Severe allergic reactions can occur such as swelling of face, lips, tongue or throat, trouble breathing or swallowing. Patient should call 911 or go to the nearest emergency room, it that occurs (Katzung, 2017).
Atorvastatin may interact with other medications, vitamins, herbs, antibiotics (charithromycin, erythromycin), fungal drugs (itraconazole, ketoconazole), cholesterol-lowering drugs (gemfibrozil, medications that contain fibrate, niacin), Rifampin, HIV and Hepatitis C drugs (boceprevir, daruavir, fosamprenavir, lopinavir, ritonavir, saquinavir, tipranavir, teleprevir), Digoxin, oral birth control pills, and Colchicine. Medications will be managed carefully to avoid this occurrence (Katzung, 2017).
Making lifestyle changes is always challenging, especially when it comes to managing high cholesterol. Lifestyle changes may assist individuals move closer to meeting the desired health goals and sticking with them too. As a practicing practitioner, it’s important to monitor side effects from statin medications periodically. Depending on what the side effect is or its severity, a dosage adjustment may be required or a switch to an entirely different cholesterol-lowering medication. Careful monitoring of glucose and labs will help assure the correct treatment regimen is prescribed and effective.
American College of Cardiology-American Heart Association (ACC/AHA ) (2016). Low statin use in people with diabetes despite cardioprotective effects, guidelines. Retrieved June 3, 2018 from www.acc.org
American Diabetes Association (ADA) (2017). HMG CoA reductase inhibitors. Retrieved June 2, 2018 from www.ada.org
Golan, D. (2004) Principles of Pharmacology: The Pathophysiologic Basis of Drug Therapy, Second Edition.
Katzung, B. (2017). Basic and Clinical Pharmacology. Cholesterol medications. Retrieved February 24th, 2018, from http://www.heart.org/HEARTORG/Conditions/Cholesterol/PreventionTreatmentofHighCholesterol/Cholesterol-Medications_UCM_305632_Article.jsp#.WpHgd5PwZTY