What evidence is behind your assumption that simvastatin is more potent than atorvastatin?

Assignment Question

Scenario Lila is 50 years old. She is morbidly obese, has HTN, diabetes, CHF, hyperlipidemia, and depression. She is transferring her care to you as her insurance recently changed. Her current medications include: Lisinopril 20mg daily Atenolol 50mg daily Lasix 20 mg daily Simvastatin 20 mg daily Glyburide 10mg BID Actos 15mg daily Fluoxetine 20mg daily She complains today of fatigue and pain in her knees. She has shortness of breath with activity so she does not exercise. She does not work any longer and stays home most days contributing to her loneliness. Lab data obtained for today’s visit include: HgA1c 8.2% BUN and creatinine within range LFTs within range Lipids: TC 260, HDL 35, LDL 170, Trigs 290 Vitals: BP 156/98; P 60; R 22; O2 sat 95% Height 5’1” 340 pounds Questions Provide as much information about this client and her medications as you can.

Look for interactions, contraindications, adjustments, need for additions or deletions…Make sure you also include anticipatory guidance and patient education. This is a complex patient; it is your opportunity to put all the knowledge you have learned throughout the course together. Be specific about exactly what you want to do. At the end of your essay, write her prescriiptions out exactly as you will send them to the pharmacy.

My question is-what evidence is behind your assumption that simvastatin is more potent than atorvastatin? What reference do you have for the muscle aches being a possible deterrent for using a statin? What do you mean by therapeutic antidepressant approach? What specific interventions would you employ and what is the EBP/rationale for it? I do not see the ADA standards of care mentioned –

-what about use of metformin? Would you consider metformin and if not why? When you deter for standards of care you should provide a rationale. She has heart failure and actos is considered a contraindication. Why did you maintain it on her active prescriiption list and not change it? Would hydrochlorothiazide be better with DM and HTN? What do the standards say? Where is the revised plan for the addition of the calcium channel blocker you suggested? Did you want to address her knee pain so she could exercise-a standard of care for diabetes? What specific education in diet and physical activity would you provide per ADA standards of care?

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