Drug Topics - November 5, 2007 - (Page 34)

34 DRUG TOPICS NOVEMBER 5, 2007 www.drugtopics.com CONTINUING EDUCATION she was fasting when the reading was taken. Her A1c is not at the recommended goal of <7%, though some consideration may be given to the fact that she has begun taking her medications consistently for the past two months. With regard to treatment recommendations, metformin therapy could be further increased in J.K.; however, when increasing the dose, she should not continue to receive the combination tablet with glipizide. Increasing the dose of glipizide will provide a dose that is too high and can potentially cause hypoglycemia. Thus, she would need to take metformin 1,000 mg p.o. b.i.d. and glipizide XL 10 mg p.o. daily. The addition of a thiazolidinedione may be warranted to help achieve targeted blood glucose and A1c levels. J.K.’s TC, LDL, and TG levels are currently at the accepted goals of <200 mg/dl, <100 mg/dl, and 50 mg/dl. Niacin would be the best agent to achieve this targeted goal; however, if niacin is used in J.K., worsening of her hot flashes may occur. As a result, she may be reluctant to take the medication. Counseling could be provided on methods to minimize hot flashes from niacin therapy. The presence of diabetes in this patient is not a contraindication to therapy. However, during initiation of niacin, more judicious blood glucose monitoring is warranted, and it may be prudent to get her closer to her fasting blood glucose goals first. Soy may be a good option for this patient for its lipid benefits (especially TC and LDL-C levels) and hot flash relief, whether it is through the use of soy supplements or merely increasing soy intake in her diet. However, soy appears to produce minimal effects on raising HDL-C levels. Hormone replacement therapy may help J.K. with her hot flashes but should not be initiated predominantly for an improvement in her lipid panel. Other lifestyle recommendations such as weight loss, increasing aerobic activity, and smoking cessation can all play a tremendous role in raising her HDL-C level and lowering her blood pressure. Even changes as small as reducing the number of times she gets fast food each week by one trip can make a difference. Changing dietary selections such as frequent consumption of red meat to a leaner option such as chicken or fish may assist with weight loss and, ultimately, lower her risk for heart disease. A discussion with J.K. about her attempts to quit smoking is important. Finding out why the attempts have failed may be vital to finding a method that is tailored to meet her needs. If she is not interested in smoking cessation, asking her at every visit is important as well as reminding her that help is available whenever she is ready to stop. Though the current guidelines do not advocate the initiation of drinking in patients who do not currently drink in order to raise HDL-C levels, education about the potential benefits and risks associated with alcohol in the presence of low HDL-C levels, hypertension, and diabetes may be warranted. The role of the pharmacist Regardless of the type of practice setting, there are many ways pharmacists are able to provide assistance, guidance, and support for patients seeking advice about ways to raise low HDLC levels. Questions may arise about the “best” option for raising HDL-C. Thus, a thorough understanding of the products available is vital. Upon recommendation of over-the-counter products such as immediate-release niacin or soy-containing products, pharmacists have the opportunity to provide patient counseling to ensure correct use of the product to obtain the best possible results. Before recommending any of these products, a series of questions to determine the appropriateness of therapy is warranted. Upon recommendation of niacin, pharmacists can counsel about potential methods such as aspirin use prior to administration and/or the avoidance of hot and spicy foods to reduce the incidence of flushing. Refill reminders may be employed to increase patient adherence to medications. Stressing the importance of routine follow-up to assess lipid panels and other labs, such as liver function tests, are other ways pharmacists can help patients with low HDL-C levels achieve targeted goals to reduce the risk for heart disease. References are available upon request. TEST QUESTIONS Write your answers on the answer form appearing on page 36 (photocopies of the answer form are acceptable) or on a separate sheet of paper. Mark the most appropriate answer. 1. Each 1 mg/dl increase in HDL-C levels reduces the c. HDL-C is involved in the CETP-mediated process of exchanging apolipoproteins for cholesteryl esters. d. HDL-C is thought to be involved in the reverse cholesterol transport process. 3. Which of the following lifestyle recommendations risk for cardiovascular disease by: a. 2% b. 4% c. 6% d. 8% 2. Which of the following statements is correct about the pathophysiology of low HDL-C levels? a. ApoA-I exerts proatherogenic effects as it is an activator of LCAT. b. ApoA-II has antiatherogenic effects through its stimulation of hepatic lipases. should not be recommended to raise HDL-C levels? a. Aerobic exercise b. Heavy alcohol consumption c. Smoking cessation d. Weight loss http://www.drugtopics.com

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Drug Topics - November 5, 2007 Contents Latebreakers Latebreakers in Depth Letters Rx Care Community Practice 150 Years of American Pharmacy Hospital Practice Pharmacists at Risk Government and Law High-Density Lipoprotein New Products Advertisers Index Classified Viewpoint

Drug Topics - November 5, 2007

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