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From Pharmacy Times(www.pharmacytimes.com)
Thanks to the author Craig I. Coleman, PharmD(Dr. Coleman is an assistant professor of pharmacy practice and director of the pharmacoeconomics and outcomes studies group at the University of Connecticut School of Pharmacy.)
以下为正文(需要翻译的部分),欢迎会员跟帖认领并尽可能在48小时内翻译完毕并提交,将奖励50威望和50金钱.
Statin Conversion
MD, a 73-year-old woman with a history of hypertension, high cholesterol, and diabetes, goes to her local pharmacy with a letter from her prescription insurance provider. The letter states that one of MD’s current medications, Caduet (amlodipine/atorvastatin) 10 mg/40 mg, will no longer be on the plan’s formulary this coming year and that she has the option of paying for it out-of-pocket or switching to the preferred agent(s), in this case, amlodipine 10 mg and simvastatin 80 mg each once daily. MD’s blood pressure and low-density lipoprotein (LDL) cholesterol have been at target goals for the past 1½ years. She is concerned that her care is going to be adversely affected by the medication switch. MD also tells the pharmacist that her cousin is taking pravastatin, and she is doing well. She asks if it would be possible to start pravastatin instead of simvastatin?
How should the pharmacist respond?
ANSWER
Six statins are currently approved for marketing in the United States by the FDA. Although they all share the same mechanism of action for lowering cholesterol, they are not all equally potent reducers of LDL cholesterol levels at FDA-approved doses. According to the insurance provider’s letter, the 40 mg of atorvastatin MD receives in her Caduet will be replaced with an adequate LDL cholesterol–lowering equivalent dose of simvastatin (80 mg). Thus, the pharmacist can tell MD that her LDL cholesterol levels should not be affected by the statin switch. The pharmacist also should explain to MD that although pravastatin’s LDL-lowering efficacy may be sufficient for her cousin, it does not lower LDL cholesterol enough to enable MD to reach her own LDL goal and therefore is not an option. Finally, MD should be reminded that she will still receive her amlodipine, however, not as part of a combination tablet.
以下为翻译后的内容感谢“姚施”提供,欢迎大家对翻译结果进一步完善。
调换其他的他汀药物
MD 是一位73岁既往有高血压、高胆固醇和糖尿病的妇女,来到她当地的药房同时带来一封医保部门的信函。信中提到MD正在使用的药物中,其中有一个药物 Caduet(氨氯地平/阿托伐他汀)10 mg/40 mg,在新的一年里将不再予以报销,MD或是自费购药或是选用其他(可报销同类)药物,如,氨氯地平10 mg 和辛伐他汀80 mg,每天一次。MD的血压和低密度脂蛋白(LDL)胆固醇在过去1、2年(此处原文不清)中得到很好的控制(达标)。她担心一旦换药会影响治疗。
MD还告诉药师她的堂妹正在服用的是普伐他汀(pravastatin),而且效果很好。因此她要求调换成普伐他汀而不是辛伐他汀。
问;药师应如何回答?
答案
目前有6个他汀药物获得FDA批准在美国销售。虽然他们都有着同样的降胆固醇的作用机制,但是这些药物在FDA批准的剂量条件下降低LDL-C的强度则是不同的。按照医保局的来信所说,MD所服用的药物Caduet中阿托伐他汀的剂量是40 mg,它降低LDL-C水平的作用与辛伐他汀(80 mg)的作用相当。因此,她不必担心换成其他他汀药会影响其降LDL-C的水平。药师还应告诉MD,虽然普伐他汀也可以降低LDL-C水平,并且适用其堂妹,效果很好,但是并不一定能够达到她自己所要求的降低LDL-C的目标值,因此不宜选用。最后,还有提醒MD要继续服用氨氯地平,它也是原先复方制剂中的一种成分。 |
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