WBR0459
| Author | [[PageAuthor::Rim Halaby, M.D. [1]]] |
|---|---|
| Exam Type | ExamType::USMLE Step 1 |
| Main Category | MainCategory::Pharmacology |
| Sub Category | SubCategory::Vascular |
| Prompt | [[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 | AnswerA::Acute pancreatitis |
| Answer A Explanation | AnswerAExp::Acute pancreatitis may be caused by hypertriglyceridemia, not with fenofibrate therapy per se. |
| Answer B | AnswerB::Acute cholecystitis |
| Answer B Explanation | AnswerBExp::Gall bladder stone formation and subsequent acute cholecystitis have been associated with fibrate therapy, especially clofibrate. |
| Answer C | AnswerC::Pulmonary embolism |
| Answer C Explanation | AnswerCExp::Clofibrate therapy is not commonly associated with increasing risk of pulmonary embolism. |
| Answer D | AnswerD::Pneumonia |
| Answer D Explanation | AnswerDExp::Clofibrate therapy is not commonly associated with increasing risk of pneumonia. |
| Answer E | AnswerE::Myocardial infarction |
| Answer E Explanation | [[AnswerEExp::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 | RightAnswer::B |
| Explanation | [[Explanation::There is a strong association between clofibrate therapy and gallstones. 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. A relatively common adverse reaction of clofibrate is gall stone formation that might lead to acute cholecystitis. Reference:
Michielsen PP, Fierens H, Van Maercke YM. Drug-induced gallbladder disease. Incidence, aetiology, and management. Drug Saf. 1992;7(1):32-45. |
| Approved | Approved::No |
| Keyword | WBRKeyword::acute, WBRKeyword::cholecystitis, WBRKeyword::gallbladder, WBRKeyword::gall, WBRKeyword::bladder, WBRKeyword::stone, WBRKeyword::clofibrate, WBRKeyword::fibrate, WBRKeyword::triglyceride, WBRKeyword::hypertriglyceridemia |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |