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Case Study – Dislipidemia Jeremy, age 55 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, NKA, and denied any hx of smoking. His most recent HbA1c was 7.2% while taking metformin 500 mg twice a day. His father died at age 55 of a myocardial infarction, and his brother, age 57, just underwent angioplasty. Jeremy eats fast food at least five times a week because of his work schedule. He weighs 245 lb and stands 5-foot-11. His fasting blood sugar is 213. His blood pressure is 134/80. His total cholesterol is 237 (LDL, 162; HDL, 35; triglycerides, 200). 1. Does Jeremy fall into any of the statin risk categories? If so, which one? 2. What drug therapy and dose would you prescribe, and why? 3. What are the parameters for monitoring the success of the therapy? 4. List one or two adverse reactions for the drug therapy that you prescribed for Jeremy that would cause you to change therapy. Provide rationale for your answer. 5. When rechecked, Jeremy’s total cholesterol is 174 (LDL, 100; HDL, 38), but he is complaining of muscle pain. How would you manage Jeremy’s treatment? Provide rationale for your answer. 6. When would you have patient follow up? 7. What labs would you order and why?
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