questions

Original work, No Plagiarism, Cite, Reference, this is NOT a paper

Respond underneath the question #1,#2 and #3

Case Study: Anticoagulation/Lipid

After reviewing the case, please provide answers to the questions that follow. Concise, bulleted answers are highly preferred. Points will be removed for lengthy answers. 

1st Visit

Background:

BT is a 65-year-old African-American male presenting to the primary clinic for regular scheduled follow-up.  He works as a contractor and has an active, busy work schedule at construction sites through the day. He works long hours and endorses that this is stressful, but that he loves his work. He wants to keep feeling well, as he has no plans to retire.

Vitals:

· Blood pressure: 138/82 mmHg

· Pulse: 86 bpm

· Height: 69”

· Weight: 208 pounds

PMH: 

He established regular medical care with his PCP about 5 years ago. Since that time, he has been diagnosed with:

· Hypertension

· Dyslipidemia

· Diabetes (no complications) 

· Obesity 

· Atrial fibrillation

· Osteoarthritis (both knees)

Social History: 

· Pt lives with his wife 

· Has two grown children with their own families 

· No exercise except the active nature of his job during the week 

· Diet is primarily fast food for breakfast and lunch, wife prepares home cooked meals for dinner 

· Drinks one 12 oz. beer per evening 

· Never smoker 

 

Current Medications:

· ASA 81 mg once daily 

· Hydrochlorothiazide 12.5 mg daily

· Losartan 50mg daily

· Naproxen 500 mg twice daily

· Metformin 1000 mg BID

· Warfarin 7.5 mg MWF, 5 mg all other days (5 mg tablets, PEACH)

 

Fasting Labs:

	Today’s Value	Normal Range
Sodium Level (SOD)	139	136-146 mMol/L
Potassium Level (POT)	4.0	3.5-5.0 mMol/L
Chloride (CHLOR)	99	98-108 mMol/L
CO2 (CO2)	26	22-34 mMol/L
Urea Nitrogen (UN)	16	8-20 mg/dL
Creatinine Level (CREAT)	1.0	0.5-1.0 mg/dL
Glucose Level (GLUC)	96	73-110 mg/dL
Calcium Level (CAL)	9.6	8.6-10.3 mg/dL
Cholesterol (CHOL)	181	1-200 mg/dL
Triglycerides (TRIG)	176	1-150 mg/dL
High Density Lipoprotein Chol (HDL)	34	40-60 mg/dL
Low Density Lipoprotein Chol (LDLC)	108	1-129 mg/dL
Hemoglobin (HGB)	12.0	13.5-17.0 g/dL
Hematocrit (HCT)	39	40-50%
Aspartate Transaminase (AST)	19	8-30 IU/L
Alanine Transaminase (ALT)	21	< 35 IU/L
B-Type Natriuretic Peptide (BNP)	110	0-100 pg/mL
Hemoglobin A1c	7.0	%
Most recent INR	2.6	Goal 2.0-3.0

 

Lipid Questions:

1. Would you suggest statin initiation at this time? If so, suggest a regimen.  

2. BT does start his statin regimen. What monitoring for efficacy and safety do you recommend?

3. After 4 weeks of statin therapy BT reports some right shoulder muscle pain with overhead arm movement. His friends told him it was from the statin and that they stopped their statin when this happened. How do you respond?