USMLE Forum Archives - USMLE Step 3 - Cardio 2
Cardio 2
meduploader - 01-01-09 12:00
A 55-year-old Caucasian female presents to your office for a routine check-up. She has no present complaints. She experienced an acute myocardial infarction two years ago. Her current medications are metoprolol and aspirin. She does not smoke or consume alcohol. Her blood pressure is 125/80 mmHg and heart rate is 65/min. The physical examination is insignificant. Her fasting blood glucose level is 100 mg/dL. Her lipid profile is:
Total cholesterol: 240 mmHg
HDL cholesterol: 40 mg/dL
LDL cholesterol: 140mg/dL
Triglycerides: 400 mg/dL
Which of the following medications should be considered first in the treatment of this patient’s dyslipidemia?
A) Atorvastatin
B) Gemfibrozil
C) Niacin
D) Cholestyramine
E) Estrogen replacement therapy
meduploader - 01-01-09 12:00
A 55-year-old Caucasian female presents to your office for a routine check-up. She has no present complaints. She experienced an acute myocardial infarction two years ago. Her current medications are metoprolol and aspirin. She does not smoke or consume alcohol. Her blood pressure is 125/80 mmHg and heart rate is 65/min. The physical examination is insignificant. Her fasting blood glucose level is 100 mg/dL. Her lipid profile is:
Total cholesterol: 240 mmHg
HDL cholesterol: 40 mg/dL
LDL cholesterol: 140mg/dL
Triglycerides: 400 mg/dL
Which of the following medications should be considered first in the treatment of this patient’s dyslipidemia?
A) Atorvastatin
B) Gemfibrozil
C) Niacin
D) Cholestyramine
E) Estrogen replacement therapy
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#2
Re: Cardio 2
meduploader - 01-09-09 13:17 This patient"s lipid profile indicates hypercholesterolemia and hypertriglyceridemia (>200 mg/dL). Her history of a previous myocardial infarction places her in a high-risk group; therefore, aggressive measures to control her lipid profile should be undertaken. The elevated LDL cholesterol in this patient is the first target of therapy. The non-HDL cholesterol (total cholesterol – HDL cholesterol) is the second target of therapy after controlling the LDL cholesterol levels in patients with hypertriglyceridemia . According to the current recommendations, non-HDL cholesterol should be kept below 130 mg/dL in patients with established coronary heart disease (CHD). Atorvastatin is effective in lowering non-HDL cholesterol and triglycerides; therefore, it is the best initial choice for this patient.
(Choices B and C) Gemfibrozil or niacin should be added if atorvastatin fails to control the hypertriglyceridemia.
(Choice D) Cholestyramine increases the triglyceride concentration in the blood; therefore, it is contraindicated in this patient.
(Choice E) Estrogen replacement therapy is not a good choice due to the potential adverse cardiovascular outcomes.
#3
Re: Cardio 2 bingousmle - 07-28-10 14:05 yes also in addition a though the patient has trigliceridemia statins like atorvastatin in this case will help to lower LDL as well as the TG. so statins are prudent
#4
Re: Cardio 2 babbu5508 - 07-28-10 15:18 statins sre the first line drugs for hypercholesterolemia and as the patient is haveing hypercholesterolemia with hypertriglyceridemia,statins to be given
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