Day 3 Coverage: Sunday, August 13

Last Updated: Tuesday, 15-Aug-2017 15:45:00 EDT
Coffee and Cases – moderated by Pamela B. Morris, MD, FNLA
 
To kick off the final day, Peter W.F. Wilson, MD, FNLA, Susan Halli Demeter, RN, DNP, CFNP, CLS and Mary-Katherine Cheeley, PharmD, BCPS, CLS each presented their clinical case studies.
 
Chronic Kidney Disease in Stage 4 & 5 and the Use of Statin Therapy

Peter W.F. Wilson, MD, FNLA

Professor of Medicine
Division of Cardiology
Emory University School of Medicine
Professor of Public Health
Rollins School of Public Health
Director, Epidemiology and Genomic Medicine
Atlanta VA Medical Center
Atlanta, GA

 

 

 

 

 

 

 

Dr. Wilson presented a case study on the use of statins in patients with chronic kidney disease. The case study patient presented was a 60-year-old white man with a history of an elevated creatinine. He has a long term history of hypertension and takes an angiotensin receptor blocker and a calcium channel blocker. There is no history of clinical cardiovascular disease or diabetes mellitus. He has never smoked.

Given the patient’s characteristics, the presentation looked at lipid prescriptions for patients with chronic kidney disease, including the results of the SHARP study.

The key takeaways from the case study concluded with:

  • There is no increase in the risk of myopathy, liver and biliary disorders, cancer or nonvascular mortality with statin therapy.
     
  • There is no substantial effect on CKD progression.
     
  • The SHARP trial results showed a 17% CVD risk reduction, which is consistent with meta-analysis results.
     
  • In SHARP, there are favorable CVD effects in non-dialysis CKD, and CVD effects are null in dialysis CKD.
     

“My legs hurt!” A Case of Statin-Related Myalgia in the Setting of Peripheral Vascular Disease


Susan Halli Demeter, RN, DNP, CFNP, CLS

Instructor of Medicine Mayo Clinic
Scottsdale, AZ  
Faculty Associate
Arizona State University
Phoenix, AZ

 

 

Susan Halli Demeter, RN, DNP, CFNP, CLS presented a case study on statin-related myalgias. The patient was a 70-year-old female with a strong family medical history for premature CAD/hypercholesterolemia. She had a past medical history of s/p left CEA age 59, s/p DES to mid RCA and mid LAD age 60, aortoiliac & femoral disease.

Based on the patient’s baseline labs, she tried 80mg of Atorvastatin 80mg, then 40mg after complaining of myalgias in both legs. The patient was also treated with 40 mg of Pravastatin daily with 10mg of Ezetimibe daily after stents.

The patient was then prescribed 20mg of Rosuvastatin daily along with 400mg of CoQ10. She came back to the clinic three months later complaining of calf pain. Based on the patient’s history, a vascular evaluation was ordered and Rosuvastatin was decreased to 10 mg every other day to assess her response. The Exercise ABI revealed 0.52 on the right that decreased to 0.1 and 0.58 on the left that decreased to 0.2.

Her angiogram revealed severe PAD to the right SFA and popliteal in addition to the left SFA and popliteal with moderate disease. The patient went for a PTA and stenting to the right SFA and popliteal artery and tolerated the procedure well.

Achy-Breaky: Patient with Gout and CHD, treated with Colchicine


Mary Katherine Cheeley, PharmD, BCPS, CLS

Clinical Pharmacist
Grady Health System
Atlanta, GA

 


Mary Katherine Cheeley, PharmD, BCPS, CLS, presented a case study on a 59-year-old African-American male patient with a past medical history of CAD (s/p PCI five years ago), T2DM, gout, COPD, HTN, CKD stage 2 (CrCl ~97 ml/min) and previous cigarette smoking (quit five years ago).

After being diagnosed with an acute gout flair, he was treated with colchicine 1.2 mg orally, then 0.6 mg one hour later.  The patient continued with 0.6 mg daily until the flare resolved. Following his treatment, the patient complained of a new onset of bilateral calf pain when resting.

The patient’s concomitant medications included Atorvastatin 80 mg orally daily, Metoprolol succinate 100 mg orally daily, Lisinopril 20 mg orally daily, Metformin 1000 mg orally BID with food, Empagliflozin 10 mg orally daily, Tiotropium 18 mcg inhalation once daily, Albuterol prn and Allopurinol 300 mg orally daily.

The presentation showed that some statins and colchicine are 3A4 metabolites and interference can increase statin drug concentrations.

The key takeaways from the case study concluded with:

  • Use the lowest dose of colchicine necessary (especially in renal diseases).
  • Use colchicine for the shortest amount of time necessary.
  • Monitor for muscle-related AE while on combo therapy.
  • Reduce the dose of 3A4/p-gp statins: Atorva, simva, lova.
  • Limit additional 3A4 inhibitors.