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nbme1

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sera
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Topics: 14
Posts: 141

05/04/07 - 09:17 AM

29. A 52-year-old woman with alcoholism comes to the physician after a serum cholesterol level of 290 mg/dL was found on a routine screening. She drinks a pint of vodka daily. She takes captopril for hypertension and glyburide for type 2 diabetes mellitus. She also has intermittent episodes of gout. Fasting serum studies show:

Total cholesterol 252 mg/dL
HDL-cholesterol 80 mg/dL
Triglycerides 300 mg/dL
Glucose 118 mg/dL
Thyroid-stimulating hormone 4.5 µU/mL

Which of the following is the most appropriate next step in management?

A
) Alcohol cessation

B
) Better control of diabetes

C
) Switch from captopril to calcium-channel blocking agent therapy

D
) Gemfibrozil therapy

E
) Thyroid replacement therapy

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syra

ManuNastai
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05/04/07 - 09:35 AM

A

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sera
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05/05/07 - 01:06 AM

so 1st alcohol cessation and then start the medical t/m?

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syra

usmle12
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05/07/07 - 05:55 PM

why not gemfibrozil for tgs?

doc_clotaire
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05/07/07 - 06:46 PM

Gemfibrozil is a FIBRATE ,actually his best indication is for low HDL , it 's best drug to increase HDL ( good cholesterol ) , the other one is Niacin but because of SE , Gemfibrozil is given first . Beside ,Hyperlipidemia treatment is not based on cholesterol level only but rather on LDL , so they would have to do a complete lipid profile first before starting therapy .

so correct answer should be A because of it has been shown a direct relation bewteen alcohol and atherosclerosis , besides it can triggered a gout attack in this patient

More input is WELCOME wink

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young_doc
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05/07/07 - 08:21 PM

usmle12 wrote:
why not gemfibrozil for tgs?

1 pint (~2 cups) of Vodka per day is A LOT of alcohol! Giving medications to this patient might not help if the patient is just boozing away..

That's my take on it!

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ManuNastai
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05/07/07 - 10:16 PM

"Always think cheap for the Boards!!!" (Edward Goljan)

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Justice
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05/08/07 - 11:47 AM

(A)

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arlete
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05/08/07 - 03:54 PM

Fibrates are good for hypertryglyceridemia, too. nod

But I think the answer is A.

This patient is aaaaaaasking for a pancreatitis!

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