Daily of lipitor vs a more moderate approach using 40 mg of pravachol. A 52-year-old male patient presented to his family practice physician's office with a chief complaint of chest pain at night that had been occurring for one week. He felt this pain was due to indigestion. He wanted to see his physician, whom he had seen several times during the previous seven months, but the receptionist told him that if he wanted to come in that day, he would have to see the nurse practitioner NP ; . The patient had undergone a complete physical examination at a previous office visit. His physician noted that the patient was a smoker, 5'9" and 192 pounds, BP: 140 80 and total cholesterol: 262 LDL 173 ; . His physician talked to him about the need to reduce his cholesterol level and fat intake from his diet, get more aerobic exercise and quit smoking. He diagnosed the patient with mild hyperlipidemia. A repeat lipid panel came back high. Nicoderm nicotine transdermal system ; and Prravachol pravastatin sodium ; were prescribed. On the day the patient presented to the office with the chest pain complaint, the NP noted that he reported some weakness during the day, some shortness of breath with pain, chest pressure, and pain starting at the sternum and radiating across the chest to both upper arms. She also noted that the patient took Tums for relief. The NP ordered an EKG, which was administered by the medical assistant in the office that day. The EKG showed T wave inversion and T wave abnormality, as well as some mild ST depression. The NP interpreted this EKG as normal. She prescribed Zantac, referred the patient to a cardiologist and scheduled a stress EKG for the following week in the family practice physician's office. The NP later reported that the patient did not think he needed to see a specialist and that he just needed something that worked better on his indigestion. ; The NP made the cardiology referral nonetheless and initiated the paperwork. She failed, however, to document the patient's reluctance to pursue the consultation, the discussion she had with the patient regarding the risks of not seeing a specialist and the patient's acknowledgement of those risks. When the patient returned home, he told his family that he was going to be fine and that he would know more after having the stress test the following week. The patient did not return for the recommended stress test. ; Although no consultations or discussions between the NP and supervising physician were charted, the physician later reported that the NP had told him that the patient was not in pain during the final visit. The physician believed that the NP did not tell the patient that he needed a cardiology workup on an urgent basis and that she did not followup with the patient regarding the cardiology consultation or the missed stress test and promethazine.

There are currently six statin drugs on the market: atorvastatin lipitor ; fluvastatin lescol ; lovastatin mevacor ; pravastatin pravachol ; simvastatin zocor ; rosuvastatin crestor ; a seventh statin, cerivastatin baycol ; was removed from the market in 2001 because of adverse reactions and serious side effects, including rhabdomyolysis. Pravachol cheap buy pravachol with no membership pravachol overnight saturday delivery. Spiller 1 division of gastroenterology, university hospital, queen's medical centre, nottingham, uk 2 department of pathology, university hospital, queen's medical centre, nottingham ng7 2uh, uk correspondence to: dr c, for instance, www pravachol.

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