WBR0352

Author	Neeraja Danda M.B.B.S
Exam Type	USMLE Step 2 CK
Main Category	Internal medicine
Sub Category	Cardiovascular
Prompt	A 55 year old male presented to the Emergency room with the acute onset of chest pain, shortness of breath and excessive sweating. Electrocardiogram was perfomed, and cardiac enzymes were measured, confirming the diagnosis of myocardial infarction. Angiogram showed a 75% stenosis in the left coronary artery and angioplasty was performed. The patient’s post-angioplasty recovery was unremarkable. While discharging the patient, Atorvastatin was advised as the patient’s Low density lipoprotein level was 115mg/dl. While the patient is on statins which of the following should be routinely monitored?
Answer A	Creatinine phosphokinase and Potassium levels
Answer A Explanation	Incorrect While myositis is a common side effect of statin therapy, myositis is rarely responsible for therapy cessation and doses can be adjusted by symptom severity. There is no need to monitor Creatinine phosphokinase on a regular basis
Answer B	Blood statin levels
Answer B Explanation	Incorrect Blood statin levels are not monitored regularly
Answer C	Aspartate Transaminase and Alanine Transaminase levels
Answer C Explanation	In patients on statins liver enzymes Aspartate and Alanine transaminases should be monitored regularly as statins cause elevation in the levels
Answer D	Aspartate Transaminase , Alanine Transaminase and Creatinine phosphokinase levels
Answer D Explanation	Incorrect Aspartate and alanine transaminases are monitored regularly but not creatinine Phosphokinase
Answer E	Urine Myoglobin levels
Answer E Explanation	Incorrect Urine myoglobin levels are raised in rhabdomyolysis . Rhabdomyolysis is a rare complication of statin therapy. Monitoring of urine myoglobin is not standard of care
Right Answer	C
Explanation	Statins are the important medication in Myocardial Ischemia. Statins decrease the mortality risk in post-MI patients unlike other lipid lowering medication. They act by inhibiting HMG- Co A reductase and increasing Low density lipoprotein uptake. Side effects of statins are myositis, and elevation of liver enzymes. Statin induced hepatotoxicity can be a dangerous side effect of these drugs. Therefore, it is important to regularly monitor the liver enzymes aspartate transaminase, and alanine transaminase. While myositis is a very common complication of statin therapy, doses can be adjusted to a patient’s symptomatic tolerance without needing to monitor myoglobin or creatinine phopsphokinase levels. Educational Objective: In patients on statins liver enzymes Aspartate and Alanine transaminases should be monitored regularly as statins cause elevation in the levels. Though statins also cause myositis,regular monitoring of Creatinine Phosphokinase of urine myoglobin is not indicated References: Page 60 Master the boards Step 2 CK second edition Educational Objective: References:
Approved	Yes
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