Case studies are a useful way for you to apply your knowledge of pharmacokinetics and pharmacodynamic aspects of pharmacology to specific patient cases and health histories.
Eevaluate drug treatment plans for patients with various disorders and justify drug therapy plans based on patient history and diagnosis.
To Prepare:
- Review the case studies and answer ALL questions.
- When recommending medications, write out a complete prescription for each medication. What order would you send to a pharmacy? Include drug, dose, route, frequency, special instructions, # dispensed (days supply), refills, etc. Also state if you would continue, discontinue or taper the patient’s current medications.
- Use clinical practice guidelines in developing your answers. Please review all Required Learning Resources. Use the Medscape app or website and JNC 8 to complete assignment.
- Include at least three references to support each scenario and cite them in APA format. Please include in-text citations. You do not need an introduction or conclusion paragraph.
SCENARIO 3
Alex is a 52-year-old male following up on his labs that were drawn last week. He smokes 1 pack per day. He is currently on lisinopril 20 mg po daily, semaglutide (Ozempic) 0.5 mg SC qWeek, and St. John’s Wort. Fasting lipid profile shows total cholesterol 260, LDL cholesterol 160, HDL cholesterol 35, and Triglycerides 220. What treatment plan would you implement for Alex’s lipid profile? What is the goal Total Cholesterol (TC), HDL-C, LDL-C, and Triglyceride level for Alex? How would you monitor the effectiveness of your treatment plan? How many risk factors for coronary artery disease does this patient have? Identify them specifically.
Evaluation of Drug Treatment Plan for Alex
Current Medications:
- Lisinopril 20 mg PO daily
- Semaglutide (Ozempic) 0.5 mg SC weekly
- St. John’s Wort
Lipid Profile Results:
- Total Cholesterol (TC): 260 mg/dL
- LDL Cholesterol: 160 mg/dL
- HDL Cholesterol: 35 mg/dL
- Triglycerides: 220 mg/dL
Treatment Plan
1. Statin Therapy: Given Alex’s lipid profile, the initiation of a statin is warranted for both LDL-C lowering and cardiovascular risk reduction.
- Medication: Atorvastatin
- Dose: 40 mg
- Route: Oral
- Frequency: Once daily
- Special Instructions: Monitor liver enzymes and lipid levels periodically.
- # Dispensed: 30 days supply
- Refills: 3
2. Discontinue St. John’s Wort: This herbal supplement can interfere with the metabolism of many medications, including statins, due to its effect on CYP450 enzymes. It is advisable to discontinue this medication.
3. Lifestyle Modifications: Recommend smoking cessation, dietary changes (increased fruits, vegetables, and omega-3 fatty acids), and regular physical activity to help improve lipid levels.
Goals for Lipid Profile
- Total Cholesterol (TC): < 200 mg/dL
- LDL Cholesterol: < 100 mg/dL (consider < 70 mg/dL if high-risk)
- HDL Cholesterol: > 40 mg/dL for men (ideally > 60 mg/dL)
- Triglycerides: < 150 mg/dL
Monitoring Effectiveness of Treatment Plan
1. Lipid Profile Monitoring: Repeat fasting lipid panel in 6–8 weeks after initiating statin therapy to evaluate effectiveness and assess for adherence.
2. Liver Function Tests: Monitor liver enzymes (ALT, AST) initially and periodically thereafter to check for hepatotoxicity.
3. Patient Symptoms: Assess for muscle pain or weakness, which could indicate statin-related myopathy.
Risk Factors for Coronary Artery Disease
Alex has several risk factors for coronary artery disease (CAD):
1. Age: Male, age 52 (age ≥ 45 years for men is a risk factor).
2. Smoking: Smokes 1 pack per day (active smoking is a major risk factor).
3. Dyslipidemia: Elevated LDL cholesterol (160 mg/dL) and low HDL cholesterol (35 mg/dL).
Total Risk Factors Identified: 3
References
1. AHA/ACC Task Force on Practice Guidelines. (2018). 2018 AHA/ACC Guideline on the Management of Blood Cholesterol. Journal of the American College of Cardiology, 73(24), e285-e350. https://doi.org/10.1016/j.jacc.2018.11.003
2. Mazzone, T., et al. (2012). American Diabetes Association; American College of Cardiology Foundation; American Heart Association. Diabetes Care, 35(Supplement 1), S25-S30. https://doi.org/10.2337/dc12-S001
3. Grundy, S. M., et al. (2019). 2019 Guidelines on the Management of Blood Cholesterol. Journal of the American College of Cardiology, 73(24), 3168-3209. https://doi.org/10.1016/j.jacc.2019.08.001