190) A 45 year old man presents to your office for follow up of his dyslipidemia that was diagnosed 6 month. His lipid panel at that time was consistent with high Total cholesterol , Low HDL and high triglyceride levels. He was instructed on dietary modification. He presents for a follow up visit today and reports that he had been strictly compliant with reduced fat diet. His social history is significant for smoking 1 pack per day for the past 25 years . He reports drinking about 1 pint vodka per day for past 10 years. He read on an online magazine that drinking alcohol would boost his “Good” cholesterol. At this time, a repeat fasting lipid profile reveals:
Total Cholesterol : 250mg%
HDL cholesterol : 35mg%
Triglycerides: 500mg%
The most important step at this time to address his lipid abnormalities:
A) Niacin
B) Gemfibrozil
C) Fenofibrate
D) Alcohol cessation
E) Smoking cessation
fenofibrate
d?
alcohol cessation
b
A)Niacin
Niacin Increases HDL level while
able to lowering LDL level stimulant
niacin
e smoking cessation
c fenofibrate ….since when Triglyceride is 500 or more you have to treat the hypertrigylceridemia first to prevent pancreatitis
guille, niacin,but pls we need the corret answer
C -> Triglycerides Pancreatitis -> mitigated by Fenofibrate
You cannot have 2 drugs that lower triglicerides in the answer.
Both can be used
Fenofibrate and gemfibrozil
This patient is a chronic alcoholic and has alcohol induced Hypertriglyceridemia. The first step is to counsel against Alcohol consumption. Remember simple and most effective measures first! Alcohol cessation will address the etiology and will eventually, reduce his TG level. If patient continues to have increased TG , drug therapy can be considered at a later date.
Elimination strategy to answer this question: Niacin, fenofibrate and gemfibrozil – all of these can reduce triglyceride levels. However, when the question gives three drugs in the choices that can reduce triglycerides, you can use elimination strategy to arrive at the correct answer. Often, it indicates the drug is probably, not even the answer.