Transcript Case 4 - Caangay

Case 4
Chang Chia-Chieh(Tony)
Mr. Reyes was prescribed
Lovastatin 20mg. b.i.d. and told to
return in 6 weeks.
Is there any value to having Mr. Reyes adjust his
diet while on Lovastatin, or is it necessary?

Patients taking Lovastatin should avoid alcohol and no
more then one quart grapefruit juice per day. While
Lovastatin does decrease the level of LDL, but it does
not increase the level of HDL. Patients on Lavastatin are
still advise to change their daily diet to low cholesterol,
low-fat diet such as cottage cheese, fat-free milk, fish
(not canned in oil), vegetables, poultry, egg whites, and
polyunsaturated oils and margarines (corn, safflower,
canola, and soybean oils) to improve the level of HDL.
What is the mechanism of action of Lovastatin?

Lovastatin is in a class of medications called HMG-CoA
reductase inhibitors, the major regulatory enzyme of the
mevalonate pathway, and induces a significant apoptotic
response in human acute myeloid leukemia (AML) cells.
It works by slowing the production of cholesterol in the
body. Buildup of cholesterol and fats along the walls of
the blood vessels (atherosclerosis) decreases blood flow
and, therefore, the oxygen supply to the heart, brain, and
other parts of the body. Lowering blood levels of
cholesterol and fats may help to prevent heart disease,
angina (chest pain), strokes, and heart attacks.
Laboratory tests at 6 weeks
showed an AST of 62 U/L and ALT
of 31 U/L and Mr. Reyes’ physician
informed him he was to be
switched to another drug, and
prescribed Cholestyramine.
Was the switch necessary? Why or why not?

Yes, the switch was necessary. The elevated AST/ALT
level indicate that Lovastatin was causing problems to Mr.
Reyes’ liver. This is a known side effect of Lovastatin, to
cause acute renel failure.
What might Mr. Reyes have complained of that
would lead to discontinue the Lovastatin?

Mr. Reyes might have complained about constipation,
muscle pain, tenderness or weakness , especially on the
back, lack of energy or fever, yellowing of the skin or
eyes.
Many drugs have wide inter-patient variation in
their pharmacokinetics. Do you think this is likely
for cholestyramine?

It is less likely that cholestyramine would have wide
inter-patient variation in their pharmacokinetics, because
cholestyramine does not need to be absorb by the body
to insert its actions.
What is the action of Cholestyramine?

Binds to bile acids in the intestine. This inhibits their
reabsorption and increases their excretion by up to
tenfold. Since cholestyramine is not absorbed into the
body, these substances also pass out of the body
without being absorbed.
 Increases apoB,E receptor activity.
 Increases LDL clearance from the plasma.
 Reduces plasma level of LDL.
 Weakly stimulate VLDL synthesis resulting in small
increases in VLDL, HDL, and triglyceride.
In a patient who tolerates Lovastatin but who is
achieving insufficient lowering of LDL, can
cholestyramine be added to the regimen, or must
the Lovastatin be stopped?

Cholestyramine can be used together with Lovastatin.
If a patient’s hyperlipedemia is not predominantly
due to increase LDL cholesterol but instead but
instead to elevated triglyceride levels, what
pharmacological treatments might be effective?


Prescription drug therapy includes niacin and gemfibrozil.
People with high triglycerides are typically advised to
reduce their weight and limit the consumption of
processed foods, simple sugar, alcohol, and saturated
fats.