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

• Father – deceased at 55 following MI.

• Mother – 65– mild Type II DM– Occasional angina from physical exertion

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

• 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?

HMG-CoASynthase

MevanolateKinase

SqualineEpoxidase

OSLC

Isomerace

24-Reductase

Synthesis of CholesterolAcetyl-CoA

Acetotacetyl-CoA

3-Hydroxy-3-methlglutaryl-

CoA

Mevalonate

Mevalonate Squalene

SqualeneEpoxide

14-Desmethyllanosterol

Lanosterol

Zymosterol 7,24-Cholestadienol

Desmosterol

Cholesterol

HMG-CoA

Thiolase

HMG-CoAReductase

HMG-CoASynthase

MevanolateKinase

SqualineEpoxidase

OSLC

Isomerace

24-Reductase

Synthesis of CholesterolAcetyl-CoA

Acetotacetyl-CoA

3-Hydroxy-3-methlglutaryl-

CoA

Mevalonate

Mevalonate Squalene

SqualeneEpoxide

14-Desmethyllanosterol

Lanosterol

Zymosterol 7,24-Cholestadienol

Desmosterol

Cholesterol

HMG-CoA

Thiolase

HMG-CoAReductase

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?

• 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?

Treatment, in order of preference:

1. Lifestyle change: diet and exercise

2. Lovastatin with lifestyle changes

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