A 72-Year-Old Man Comes to the Physician Complaining of 2

question 204

Multiple Choice

A 72-year-old man comes to the physician complaining of 2 weeks of muscle cramps and stiffness in his legs.  He also feels fatigued and has to rest after walking several blocks.  His past medical history is significant for coronary artery disease, type 2 diabetes mellitus, paroxysmal atrial fibrillation, and hyperlipidemia.
The patient underwent coronary revascularization with placement of 2 drug-eluting stents in his left anterior descending artery 6 months ago.  His medications include metformin, low-dose-aspirin, clopidogrel, metoprolol, valsartan, and atorvastatin.  He was recently started on amiodarone due to recurrent episodes of highly symptomatic atrial fibrillation.
The patient's blood pressure is 129/72 mm Hg and pulse is 65/min.  His body mass index is 30 kg/m².  There is no muscle tenderness on physical examination.  His muscle strength is 5/5 bilaterally and deep-tendon reflexes are 2+ and symmetrical bilaterally.
Laboratory results are as follows:

His atorvastatin is discontinued and his symptoms resolve completely within 4 weeks.
Which of the following is the best next step in management of this patient?

• A)Avoid lipid-lowering therapy
• B)Resume atorvastatin at a lower dose
• C)Start ezetimibe
• D)Start gemfibrozil
• E)Start rosuvastatin

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Definitions:

Vitamin Therapy

The use of vitamins and minerals to improve health and treat various health conditions.

Electroconvulsive Therapy

A psychiatric treatment involving electric currents passed through the brain to induce seizures, used primarily for severe depression.

Biomedical Therapy

Treatment strategies focusing on the biological aspects of health issues and diseases, often involving medication, surgery, or other medical interventions.

Drug Therapy

The treatment of disease and alleviation of symptoms through the administration of drugs.