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Unchanging Lipid Levels

AB, a 40-year-old woman, comes to your pharmacy and requests a refill on her cholesterol medication. While at the counter, she expresses frustration with her current lipid therapy. You learn that she gained 15 pounds over the past 3 months despite following a strict diet for the past 2 months with hopes of improving her cholesterol.

She goes on to share, “My bad cholesterol was 185 mg/dL before I started this medication and yesterday, after taking the medication for 2 months, it was 171 mg/dL. My doctor said my cholesterol levels hardly improved.”

Before making a recommendation, you ask AB several questions. She shares, “I have been experiencing a tired, run-down feeling for the last several weeks. I tried drinking more coffee to see if that would help, but didn’t have much luck. Do you have an OTC medication to help increase my energy?” She also complains that she is “freezing,” and you notice she is wearing a wool sweater, which is unusual since temperatures are forecasted to reach 90 degrees today. She denies hair loss, symptoms of a cold, and use of alcohol and tobacco, and has no recent additional stressors in her life.

You review her current medication profile, which reveals the following: cholestyramine 4 g po bid with breakfast and dinner; zolpidem 10 mg po qhs prn; and levothyroxine 50 mcg po daily at breakfast. She reports infrequently taking zolpidem, but “I never miss the others. I take ‘the mix’ two times a day with breakfast and dinner and the thyroid pill every morning.” She also reports purchasing and taking docusate sodium 100 mg 1 tablet daily as needed for constipation around five times a week for the past several weeks.

Based on the above information, what recommendation(s) would you have for AB?

Marissa C. Salvo, PharmD
Assistant Clinical Professor
University of Connecticut School of Pharmacy
Storrs, Connecticut

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