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Case 3. Ephraim R. Caangay Pharmacology A. Patient History. Mr. Reyes 42 yoa 75 kg Moderately sedentary Moderate drinker (few times per week) No serious health problems noted, aside from occasional headaches. Chief Complaint: routine physical examination. Family History.

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case 3

Case 3

Ephraim R. Caangay

Pharmacology A

patient history
Patient History
  • Mr. Reyes
  • 42 yoa
  • 75 kg
  • Moderately sedentary
  • Moderate drinker (few times per week)
  • No serious health problems noted, aside from occasional headaches.
  • Chief Complaint: routine physical examination
family history
Family History
  • Father – deceased at 55 following MI.
  • Mother – 65
    • mild Type II DM
    • Occasional angina from physical exertion
lab work up
Lab Work Up

(Following 12 - 14 hour fasting)

  • Dipstick urinalysis – normal
  • Blood tests – plasma cholesterol
    • Total plasma cholesterol: 290 mg/dl
    • Plasma 140 mg/dl
    • HDL 40 mg/dl

AST (SGOT) = 22/UL (normal = 10-59 U/L)

ALT (SGPT) = 18 U/L (normal = 13-40 U/L)

questions
Questions
  • Why was Mr. Reyes told to fast before the test?
  • What conclusions can you draw from the clear plasma sample?
  • What are the options for treating Mr. Reyes, and which one might you try first?
  • If you decided to start Mr. Reyes on Lovastatin, what pre-drug lab data would you be particularly interested in?
synthesis of cholesterol

Mevalonate

Squalene

Lanosterol

14-Desmethyllanosterol

SqualeneEpoxide

Acetotacetyl-CoA

Zymosterol

7,24-Cholestadienol

3-Hydroxy-3-methlglutaryl-CoA

Desmosterol

Cholesterol

Mevalonate

Synthesis of Cholesterol

SqualineEpoxidase

Acetyl-CoA

Thiolase

OSLC

HMG-CoASynthase

Isomerace

HMG-CoA

HMG-CoAReductase

24-Reductase

MevanolateKinase

synthesis of cholesterol1

Mevalonate

Squalene

Lanosterol

14-Desmethyllanosterol

SqualeneEpoxide

Acetotacetyl-CoA

Zymosterol

7,24-Cholestadienol

3-Hydroxy-3-methlglutaryl-CoA

Desmosterol

Cholesterol

Mevalonate

Synthesis of Cholesterol

SqualineEpoxidase

Acetyl-CoA

Thiolase

OSLC

HMG-CoASynthase

Isomerace

HMG-CoA

HMG-CoAReductase

24-Reductase

MevanolateKinase

why was mr reyes told to fast before the test
Why was Mr. Reyes told to fast before the test?
  • In order to get the most accurate reading of his lipid levels.
  • Dietary fats are absorbed from the small intestines and transported into the liver by lipoproteins called chylomicrons.
  • After a 12- to 14-hour fast, chylomicrons are absent from the bloodstream.
what conclusions can you draw from the clear plasma sample
What conclusions can you draw from the clear plasma sample?
  • He did, in fact, fast prior to the examination.
  • If he had eaten, chylomicrons from lipid digestion and absorption would cause turbidity.
what are the options for treating mr reyes and which one might you try first
What are the options for treating Mr. Reyes, and which one might you try first?

Treatment, in order of preference:

  • Lifestyle change: diet and exercise
  • Lovastatin with lifestyle changes
slide12
If you decided to start Mr. Reyes on Lovastatin, what pre-drug lab data would you be particularly interested in?
  • Liver function - serum transaminases
    • AST (SGOT) = 22/UL (normal = 10-59 U/L)
    • ALT (SGPT) = 18 U/L (normal = 13-40 U/L)
  • Adrenal/gonadal steroid production
    • Cortisol
    • Testosterone