Welcome to
U.S. Pharmacist's
new monthly communication that presents interesting case studies and asks pharmacists for their input. In about 2 weeks, you will receive a follow-up email with selected responses, as well as the author's own answer.

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Dosing Simvastatin:
New 2011 FDA Recommendation

Chief Complaint: "I need refills."

History of Present Illness
FR is a 67-year-old Hispanic male who presents to see the cardiologist, Dr. B, for a follow-up visit. FR was last seen in clinic on 1/20/12, at which time the simvastatin dose was increased to 80 mg daily to better control his dyslipidemia. The patient has no new complaints today and states that he is feeling "great." FR requests refills on his medications. You are the newly hired PharmD in this clinic, and the cardiologist asks your opinion regarding this patient's case.

Past Medical History
Type 2 diabetes mellitus × 4 years
Hypertension × 6 years
Dyslipidemia × 2 years
Constipation

Medication List
Lantus 10 units QHS (started 3/18/11)
Glipizide XL 7.5 mg (started 9/24/10)
ASA 81 mg (started 9/24/10)
Lisinopril 10 mg (started 7/22/09)
Hydrochlorothiazide 12.5 mg
    (started 7/12/11)
Simvastatin 80 mg (started 1/20/12)
Docusate 100 mg PRN
    (started 2/15/08)

Allergies
No known drug allergies
Family and Social History
Father died at age 82 from
    myocardial infarction
Mother died at age 61;
    medical history unknown
Patient is married with two children
Denies current alcohol and tobacco use

Fasting lipid profile rechecked
today at 8 AM

Total cholesterol: 248 mg/dL
Triglycerides: 320 mg/dL
HDL: 66 mg/dL
LDL: 143 mg/dL

Liver function tests from 8/11/11
    are within normal limits.

Vital Signs
BP: 124/76, P: 89, RR: 18, T: 37.2°C,
Wt: 94 kg, Ht: 5'8"

What is your recommendation for Dr. B regarding this patient's dyslipidemia management?

Anna Markel Vaysman, PharmD, BCPS
Clinical Pharmacist, Clinical Assistant Professor
College of Pharmacy
University of Illinois at Chicago
Chicago, Illinois


Click here... Send your input to casestudychallenge@uspharmacist.com by April 16, 2012, and include the words "Case Study" and the date of this email in the subject line. Also, please include your last name and first initial along with your pharmacy degrees and city and state. (Or, let us know if you would like to remain anonymous in the event we choose your answer for the follow-up email.)