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dyslipidemia

CC: 56
PMH: 3 simvastatin (20) 1x1 oral hs

PI: 4 months PTA


enzyme 1 simvastatin
Calcium carbonate (1000) 1x1 oral pc Vitamin B1 1x1 oral pc
3 months PTA
2 months PTA fenofibrate (300) 1x1 oral pc LDL
ALL: NKDA
MH: Fenofibrate (300) 1x1 oral hs
Calcium carbonate (1000) 1x1 oral pc
Physical examination:
BP 105/60 mmHg, PR 78/min, RR 20/min
Laboratory tests
Labs/Date
Reference range
Cholesterol
0-200
LDL-direct
0-100
Direct billirubin
0.1-0.5
Total billirubin
0.3-1.2
AST
15-41
ALT
14-63
ALP
32-91

19/08/58
170
0.2
0.6
29
41
79

Impression: Dyslipidemia with hepatic enzyme elevation


Pharmacists SOAP note:

20/10/58
219
169
0.13
0.4
29
46
78

dyslipidemia

Problem: Hepatic enzyme elevation due to simvastatin


S:
O: simvastatin 3
Laboratory:
Cholesterol 219
LDL 169
AST 29
ALT 46
AP 78
A: Etiology:
enzyme simvastatin (20) 1x1 oral hs
Indication for therapy: systematic review Calmeron RM.
ALT (alanine aminotransferase)
3 statin statin 12
statin statin ALT enzyme 3 upper normal
limit (40 U/L) rechallenge statin
statin 1
ALT enzyme 46 U/L
simvastatin (20) 1x1 oral hs statin LDL-C
LDL-C simvastatin fenofibrate LDL-C
statin 2
LDL-C2
Bile acid resin (Cholestyramine) initial dose 4g 1x1 ac with max. dose 8g 1x2 oral ac
Cholesterol absorption inhibitor (ezetimibe) 10mg 1x1 oral hs ()
P: Therapeutic plan: simvastatin (20) 1x1 oral hs
Goals: LDL-C atherosclerosis
Monitoring efficacy: Lipid profile simvastatin 20 mg 4-12 LFT
Monitoring toxicity:
Myalgia (5-10%), Rhabdomyolysis (0.2%), Transaminase increase (0.5-2%)
Patient education:
,
Future plan:
ALT enzyme >3 ULN ezetimibe (10) 1x1 oral hs
4-12 3-12
CK 10 UNL rhabdomyolysis statin

Timeline

dyslipidemia

Reference
1. Calderon MR, Cubeddu LX, Goldberg RB and Schiff ER (2010). Statins in the treatment
of dyslipidemia in the presence of elevated liver aminotransferase level: a
therapeutic dilemma. Mayo Clin Proc. 2010;85(4):349-356
2. Rosenson RS. Lipid lowering drugs other than statins and fibrates. In: UpToDate, Post
TW (Ed), UpToDate, Waltham, MA. (Accessed on 30th January,2015.)
3. Koanantakul B, Jeamanukulkit N, Piamsomboon C, Chawantanpipat C, Khanacharoen
I. Efficacy and safety of 12 week treatment with fenofibrate 300mg in Thai
dyslipidemic patients. J Med Assoc Thai. 2004 Nov;87(11):1281-5.
4. Stone NJ, Robinson J, Lichtenstein AH, et al. 2013 ACC/AHA Guideline on the
Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in
Adults. Circulation. Published online November 12, 2013.
5. DiPiro JT, et al.,2013.Pharmacotherapy handbook , 9th ed., The Mcgraw-Hills
companies Inc., United states