WBR0459

Author	[[PageAuthor::Rim Halaby, M.D. [1] (Reviewed by Will Gibson)]]
Exam Type	USMLE Step 1
Main Category	Pharmacology
Sub Category	Gastrointestinal, Vascular
Prompt	A 56 year old patient presents to his physician’s office for his annual check-up. Appropriate work-up reveals that the patient has elevated levels of triglycerides. The physician decides to initiate therapy with clofibrate. Several weeks later, the patient presents to the emergency department with epigastric pain. The physician in the emergency department suspects the patient’s symptoms are associated with the clofibrate therapy. What is the most likely diagnosis of this patient’s epigastric pain?
Answer A	Acute pancreatitis
Answer A Explanation	Acute pancreatitis may be caused by hypertriglyceridemia, not with fenofibrate therapy per se.
Answer B	Acute cholecystitis
Answer B Explanation	Gallbladder stone formation and subsequent acute cholecystitis have been associated with fibrate therapy, especially clofibrate.
Answer C	Pulmonary embolism
Answer C Explanation	Clofibrate therapy is not commonly associated with an increased risk of pulmonary embolism.
Answer D	Pneumonia
Answer D Explanation	Clofibrate therapy is not commonly associated with an increased risk of pneumonia.
Answer E	Myocardial infarction
Answer E Explanation	Hypercholesterolemia predisposes patients to myocardial infarction through atherosclerotic plaque formation. Fibrate therapy may reduce cholesterol levels, but its most pronounced effect is the reduction of triglycerides. Statins are more beneficial in the treatment of hypercholesterolemia.
Right Answer	B
Explanation	[[Explanation::There is a strong association between clofibrate therapy and gallstone formation. Clofibrate is a fibrate that is used especially for hypertriglyceridemia. Clofibrate causes an increase in cholesterol saturation in bile contributing to increased risk of cholesterol gall stones. Clofibrate is believed to cause symptomatic gall stone disease. The clofibrate tendency to cause gall bladder stones has been validated by several studies that showed consistent outcomes. Educational Objective: Fibrate therapy is used to treat hypertriglyceridemia. One common complication of clofibrate therapy is gallstone formation, which can lead to acute cholecystitis. References: Michielsen PP, Fierens H, Van Maercke YM. Drug-induced gallbladder disease. Incidence, aetiology, and management. Drug Saf. 1992;7(1):32-45. First Aid 2015 page 375 (Fibrates) First Aid 2015 page 375 (Gallstones) ]]
Approved	Yes
Keyword	Acute cholecystitis, Cholecystitis, Gallbladder, Stone, Gallstones, Clofibrate, Fibrate, Triglyceride, Hypertriglyceridemia, Abdominal pain
Linked Question
Order in Linked Questions