Case 3 Ephraim R. Caangay Pharmacology A. Patient History Mr. Reyes 42 yoa 75 kg Moderately...
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Transcript of Case 3 Ephraim R. Caangay Pharmacology A. Patient History Mr. Reyes 42 yoa 75 kg Moderately...
![Page 1: Case 3 Ephraim R. Caangay Pharmacology A. Patient History Mr. Reyes 42 yoa 75 kg Moderately sedentary Moderate drinker (few times per week) No serious.](https://reader034.fdocuments.in/reader034/viewer/2022042702/56649d6f5503460f94a50c56/html5/thumbnails/1.jpg)
Case 3
Ephraim R. Caangay
Pharmacology A
![Page 2: Case 3 Ephraim R. Caangay Pharmacology A. Patient History Mr. Reyes 42 yoa 75 kg Moderately sedentary Moderate drinker (few times per week) No serious.](https://reader034.fdocuments.in/reader034/viewer/2022042702/56649d6f5503460f94a50c56/html5/thumbnails/2.jpg)
Patient History
• Mr. Reyes• 42 yoa• 75 kg• Moderately sedentary• Moderate drinker (few times per week)• No serious health problems noted, aside from
occasional headaches.• Chief Complaint: routine physical examination
![Page 3: Case 3 Ephraim R. Caangay Pharmacology A. Patient History Mr. Reyes 42 yoa 75 kg Moderately sedentary Moderate drinker (few times per week) No serious.](https://reader034.fdocuments.in/reader034/viewer/2022042702/56649d6f5503460f94a50c56/html5/thumbnails/3.jpg)
Family History
• Father – deceased at 55 following MI.
• Mother – 65– mild Type II DM– Occasional angina from physical exertion
![Page 4: Case 3 Ephraim R. Caangay Pharmacology A. Patient History Mr. Reyes 42 yoa 75 kg Moderately sedentary Moderate drinker (few times per week) No serious.](https://reader034.fdocuments.in/reader034/viewer/2022042702/56649d6f5503460f94a50c56/html5/thumbnails/4.jpg)
Lab Work Up
(Following 12 - 14 hour fasting)• Dipstick urinalysis – normal• Blood tests –
plasma cholesterol– Total plasma cholesterol: 290 mg/dl– Plasma 140 mg/dl– HDL 40 mg/dl
AST (SGOT) = 22/UL (normal = 10-59 U/L)
ALT (SGPT) = 18 U/L (normal = 13-40 U/L)
![Page 5: Case 3 Ephraim R. Caangay Pharmacology A. Patient History Mr. Reyes 42 yoa 75 kg Moderately sedentary Moderate drinker (few times per week) No serious.](https://reader034.fdocuments.in/reader034/viewer/2022042702/56649d6f5503460f94a50c56/html5/thumbnails/5.jpg)
Questions
• Why was Mr. Reyes told to fast before the test?
• What conclusions can you draw from the clear plasma sample?
• What are the options for treating Mr. Reyes, and which one might you try first?
• If you decided to start Mr. Reyes on Lovastatin, what pre-drug lab data would you be particularly interested in?
![Page 6: Case 3 Ephraim R. Caangay Pharmacology A. Patient History Mr. Reyes 42 yoa 75 kg Moderately sedentary Moderate drinker (few times per week) No serious.](https://reader034.fdocuments.in/reader034/viewer/2022042702/56649d6f5503460f94a50c56/html5/thumbnails/6.jpg)
![Page 7: Case 3 Ephraim R. Caangay Pharmacology A. Patient History Mr. Reyes 42 yoa 75 kg Moderately sedentary Moderate drinker (few times per week) No serious.](https://reader034.fdocuments.in/reader034/viewer/2022042702/56649d6f5503460f94a50c56/html5/thumbnails/7.jpg)
HMG-CoASynthase
MevanolateKinase
SqualineEpoxidase
OSLC
Isomerace
24-Reductase
Synthesis of CholesterolAcetyl-CoA
Acetotacetyl-CoA
3-Hydroxy-3-methlglutaryl-
CoA
Mevalonate
Mevalonate Squalene
SqualeneEpoxide
14-Desmethyllanosterol
Lanosterol
Zymosterol 7,24-Cholestadienol
Desmosterol
Cholesterol
HMG-CoA
Thiolase
HMG-CoAReductase
![Page 8: Case 3 Ephraim R. Caangay Pharmacology A. Patient History Mr. Reyes 42 yoa 75 kg Moderately sedentary Moderate drinker (few times per week) No serious.](https://reader034.fdocuments.in/reader034/viewer/2022042702/56649d6f5503460f94a50c56/html5/thumbnails/8.jpg)
HMG-CoASynthase
MevanolateKinase
SqualineEpoxidase
OSLC
Isomerace
24-Reductase
Synthesis of CholesterolAcetyl-CoA
Acetotacetyl-CoA
3-Hydroxy-3-methlglutaryl-
CoA
Mevalonate
Mevalonate Squalene
SqualeneEpoxide
14-Desmethyllanosterol
Lanosterol
Zymosterol 7,24-Cholestadienol
Desmosterol
Cholesterol
HMG-CoA
Thiolase
HMG-CoAReductase
![Page 9: Case 3 Ephraim R. Caangay Pharmacology A. Patient History Mr. Reyes 42 yoa 75 kg Moderately sedentary Moderate drinker (few times per week) No serious.](https://reader034.fdocuments.in/reader034/viewer/2022042702/56649d6f5503460f94a50c56/html5/thumbnails/9.jpg)
Why was Mr. Reyes told to fast before the test?
• In order to get the most accurate reading of his lipid levels.
• Dietary fats are absorbed from the small intestines and transported into the liver by lipoproteins called chylomicrons.
• After a 12- to 14-hour fast, chylomicrons are absent from the bloodstream.
![Page 10: Case 3 Ephraim R. Caangay Pharmacology A. Patient History Mr. Reyes 42 yoa 75 kg Moderately sedentary Moderate drinker (few times per week) No serious.](https://reader034.fdocuments.in/reader034/viewer/2022042702/56649d6f5503460f94a50c56/html5/thumbnails/10.jpg)
What conclusions can you draw from the clear plasma sample?
• He did, in fact, fast prior to the examination.
• If he had eaten, chylomicrons from lipid digestion and absorption would cause turbidity.
![Page 11: Case 3 Ephraim R. Caangay Pharmacology A. Patient History Mr. Reyes 42 yoa 75 kg Moderately sedentary Moderate drinker (few times per week) No serious.](https://reader034.fdocuments.in/reader034/viewer/2022042702/56649d6f5503460f94a50c56/html5/thumbnails/11.jpg)
What are the options for treating Mr. Reyes, and which one might
you try first?
Treatment, in order of preference:
1. Lifestyle change: diet and exercise
2. Lovastatin with lifestyle changes
![Page 12: Case 3 Ephraim R. Caangay Pharmacology A. Patient History Mr. Reyes 42 yoa 75 kg Moderately sedentary Moderate drinker (few times per week) No serious.](https://reader034.fdocuments.in/reader034/viewer/2022042702/56649d6f5503460f94a50c56/html5/thumbnails/12.jpg)
If you decided to start Mr. Reyes on Lovastatin, what pre-drug lab data
would you be particularly interested in?
• Liver function - serum transaminases – AST (SGOT) = 22/UL (normal = 10-59 U/L)– ALT (SGPT) = 18 U/L (normal = 13-40 U/L)
• Adrenal/gonadal steroid production– Cortisol– Testosterone