394) A 36 year old woman with Type I diabetes mellitus presents to your office because she just learned that she is pregnant. She is excited and seeks your advise. Her home blood sugars are well controlled on a basal-bolus regimen of Glargine and Lispro insulin. Her other medications include Atorvastatin and aspirin. Her most recent HgbA1C was 6.0%. Her records also reveal that her most recent fasting lipid profile met the therapeutic goals at LDL of 80mg% and Non-HDL cholesterol of 100mg%. On examination, she is comfortable. Vitals are stable and reminder of the examination is unremarkable. An office based serum pregnancy test is positive. A repeat fasting lipid profile reveals Total Cholesterol : 250 mg% LDL cholesterol (calculated) 140mg%, HDL – cholesterol 40 mg%, Triglycerides 350mg%. Liver function tests , Serum electrolytes, Creatinine and Complete blood count are within normal limitsWhich of the following is the most appropriate next step?
A) Therapeutic Abortion
B) Add Niacin to her Lipid Regimen
C) Discontinue Statin and Start Niacin
D) Discontinue Statin and advise Diet modification alone
E) Increase Atorvastatin
Filed under: Uncategorized, USMLE Test Prep | Tagged: approach to hyperlipidemia, Archer cardiology, archer ostetrics and gynecology, archer preventive medicine, choosing hyperlipidemia therapy, Goals in treating hyperlipidemia, Hyperlipdemia Drugs and effects, hyperlipidemia in pregnancy, USMLE STEP 3 CARDIOLOGY, usmle step 3 gynecology and obstetrics, usmle step 3 preventive medicine |
c
C
The LDL is hight then C?
D) Discontinue Statin and advise Diet modification alone
EE ..isn’t it?? he is diabetic and the LDL goal should be 130mg/dl… so I would increase the Atorvastatin
~E.
Correction.
Ans D.
Statin is teratogenic (X class) drug. Discontinue statin and advise diet modification.
Answer D: Statin is teratogenic. Lipid-lowering therapies have differing levels of safety and efficacy and are not well studied in pregnant women. Therefore, a diet low in cholesterol and fat is the recommended treatment for hypercholesterolemia during pregnancy.