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INTRODUCTION

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CASE LEARNING OBJECTIVES

  • Determine a patient's coronary heart disease (CHD) risk and corresponding treatment goal according to the National Cholesterol Education Program Adult Treatment Panel (NCEP ATP) III guidelines

  • Recommend appropriate therapeutic lifestyle changes and pharmacotherapy interventions for patients with dyslipidemia

  • Describe the components of a monitoring plan to assess the effectiveness and adverse effects of pharmacotherapy for patients with dyslipidemia

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PATIENT PRESENTATION

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Chief Complaint

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"My doctor sent me here for you to check my cholesterol."

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History of Present Illness

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Joe Sanchez is a 68-year-old Hispanic male who is referred to the pharmacy clinic for lipid evaluation and management. He is new to this clinic, having recently been seen by one of the clinic's primary care physicians. He is feeling well with no complaints today. His last appointment with his primary care provider was 2 months ago when the dose of his BP medication was increased, so laboratory tests were drawn. That provider felt he would benefit from a pharmacist evaluation of his cholesterol, so he consulted a clinic pharmacist to assess JS's lipid panel and other pertinent laboratory results, initiate treatment for his lipid management, and follow-up to monitor for the efficacy and safety of the therapy. JS has long-standing HTN and was started on prescription medications several years ago, in addition to aspirin. He questions the safety of prescription medications as "they are not natural," and is resistant to taking prescription medications. He drinks four 8 oz (240 mL) glasses of grapefruit juice every day, stating that "it keeps me healthy."

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Past Medical History

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HTN

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Osteoarthritis

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BPH

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Obesity

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Family History

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Father died from complications of CAD at age 52. Mother is alive at 91 with advanced dementia and diabetes.

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Social History

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JS is a devout Catholic born in Tucson, Arizona. He speaks Spanish and English. He is married and lives with his wife of 43 years, and they have four children, aged 41, 38, 36, and 35. He is retired from his job at the U.S. Postal Service, and he now works part-time as a handyman.

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Tobacco/Alcohol/Substance Use

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Current smoker, ½ ppd; drinks six beers each weekend; has never used illicit drugs

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Allergies/Intolerances/Adverse Drug Events

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Penicillin (unknown reaction)

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Medications (Current)

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HCTZ 25 mg daily PO, last refill June 26, 2012 (30-d supply)

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Lisinopril 20 mg daily PO, last refill June 26, 2012 (30-d supply)

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Doxazosin 4 mg at bedtime PO, last refill July 31, 2012 (30-d supply)

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Ibuprofen 200 mg PRN PO for knee and low back pain

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Aspirin ...

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