Dyslipidemia
IW is an obese 67-year-old woman who was diagnosed with elevated cholesterol levels several years ago. She has been taking cholesterol-lowering medications since then but is not adhering to a cholesterol-lowering diet or lifestyle modifications. Her past medical history also is significant for diabetes mellitus type 2, coronary artery disease, hypertension, and gastroesophageal reflux disease. Her current medications are as follows:
- Rosiglitazone 8 mg daily
- Metformin 500 mg 3 times daily
- Lisinopril 20 mg daily
- Rosuvastatin 20 mg daily
- Ranitidine 150 mg twice daily
She presents to Treat-You-Right Pharmacy to pick up her refill for rosuvastatin, only to find that the new insurance plan she switched to does not cover it. The pharmacist offers to call her doctor to see whether he can switch her prescription to a different statin medication that is covered by the insurance plan. On the phone, the physician tells the pharmacist to go ahead and change rosuvastatin to simvastatin. He tells the pharmacist that he would like to maintain IW on a dose equivalent to what she was taking previously.
After receiving her filled prescription for simvastatin, IW complains to the pharmacist that she does not even know why she still has to take cholesterol medication. She tells the pharmacist that it has been several years since her doctor first diagnosed her with an elevated low-density lipoprotein (LDL) level. IW insists that her LDL level has gone down since she started taking the cholesterol-lowering medications. The pharmacist asks IW if she knows what her LDL level is now and if the doctor has discussed with her what her goal level should be. She replies, “My LDL was 160 the last time I went to the doctor, and I have no clue what my goal is.”
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