A 12-year-old who weighs 200 pounds has been on a diet and exercise program for the past 6 months. His or her weight has not changed. Other vital signs include blood pressure 130/70 mm Hg, pulse 80, and respiratory rate (RR) 20 at rest. Family history does not include severe issues with cholesterol at young ages. A paternal uncle had a myocardial infarction last year at age 42. Both grandfathers died from strokes prior to age 65. The lipid profile shows low-density lipoprotein 200 and high-density lipoprotein 40. The mother wants \"pills\" to control the lipid levels.

1. Are statins given to children?

2. Would the gender of the patient make a difference?

3. How would you approach obtaining information on the prior lifestyle management plan?

4. How would you classify this patient in terms of cardiac risk?

5. From the following categories of medications used to treat hyperlipidemia select two and give an example of the medication, usual maintenance dosage, and identify what specific condition it treats. HMG-CO-A reductase inhibitors, Fibrates, Bile acid sequestrants, Omega 3 fatty acids, Nicotinic acid, Red yeast rice. Example: HMG-CO-A reductase inhibitors (statin) Simvastatin- 20 -40 mg with evening meal - increases the number of DL receptors in the liver, thus lowering LDL levels

#2. Joe is a 42-year-old woodwind musician with the symphony orchestra, is started on a generic angiotensin-converting enzyme (ACE) inhibitor for his newly diagnosed hypertension. He returns to the clinic in a month and demonstrates that his original blood pressure of 150/90 mm Hg has improved to 130/80 mm Hg. He denies chest pain, orthostasis, or peripheral edema. He believes that the medication is working well. As he is getting ready to leave, he mentions that he appears to be \"catching a cold\". He has a persistent, but nonproductive cough. It is starting to affect his breath control required to play his instruments. He believes it is a cold because his upper lip feels thick, full, and a bit tingly as if he is getting a cold sore.

1. What is occurring?

2. What is the source of his cough?

3. Why are his lips swollen and tingly?

4. What medication management decisions must be made?

5. Complete the following table regarding categories of antihypertensive agents

Classification

Name a Specific Drug

Usual Dosage

Possible side effect

Diuretics

Ca++ Chanel Blockers

ACEs

Peripheral Vasodilators

ARBs