This is a case study.

The patient is a 62 y/o man complaining of decreased exercise tolerance. He suffered an MI 2 years ago for which he received PCI and a bare metal stent.. He has DM type II, COPD, and hyperlipidemia. Pertinent meds are verapamil ER 240mg daily, ISDN 30mg daily. He also takes NPH insulin for DM and albuterol and ipratropium for COPD. Also he is on aspirin 81mg daily.

His current ejection fraction is 30% and BP is 118/86. HR is 74 bpm, Scr is 1.4. BUN is 24 and Na and K are in normal limits.

I think the verapamil should be discontinued and replaced with carvedilol since it has been studied more in heart failure, but I’m worried about it affecting his COPD status. Can you tell me what suggestions you have? Please include references (or links) if you are using web resources.

Serious answers only please. Thank You!

The problem referred to is familial hypertriglyceridemia and mixed hyperlipidemia.

I’m a pharmacy student, and I have a patient who is on zinc sulfate 220 mg daily. There is no history of a deficiency, and I was wondering if anyone knew of any other indications for this.
Patient has PMH significant for DM, stroke, hyperlipidemia, CAD, Obestiy, sleep apnea, NASH.
Thanks!