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Instructors can request access to the Casebook Instructor's Guide on AccessPharmacy. Email User Services (userservices@mheducation.com) for more information.
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After completing this case study, the reader should be able to:
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Identify patients who require treatment for dyslipidemia.
Stratify individual patients for risk of coronary heart disease (CHD) and stroke.
Determine appropriate LDL and non-HDL goals and thresholds based on individual risk factors.
Recommend a cholesterol management strategy that includes therapeutic lifestyle changes (TLC), drug therapy, patient education, and monitoring parameters.
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“I am here to see if I need additional meds.”
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Thomas Smith is a 52-year-old man who presents to pharmacotherapy for optimization of risk reduction therapy clinic by referral from his primary care provider following an ST-elevation myocardial infarction (STEMI) 6 months ago. He reports good adherence to his medications since having his heart attack.
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Chronic kidney disease (stage 3) × 5 years
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CAD, s/p STEMI 6 months ago (drug-eluting stents placed in right circumflex and left anterior descending arteries)
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Father: age 72 with MIs at age 50 and again at age 60
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Mother: age 70 with no major medical conditions noted
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Patient has one older brother age 55 with HTN and a history of one MI at the age of 48.
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Patient is married and lives with his wife.
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College graduate, works as an accountant.
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Admits to drinking one to two beers most days of the week and has never used tobacco.
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Exercise regimen has increased since his MI; currently rides the bike at the gym for 30 minutes 2–3 days a week.
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Meds (Per medication fill history)
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Atorvastatin 80 mg PO once daily
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Aspirin 81 mg PO once daily
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Clopidogrel 75 mg PO once daily
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Pantoprazole 40 mg PO once daily
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Lisinopril 40 mg PO daily
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Chlorthalidone 25 mg PO daily
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Acetaminophen 500 mg, one to two tablets PO PRN every 6 hours for pain
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Patient states that he had a heart attack about 6 months ago and was put on a number ...