Peter, a 54-year-old male, was recently diagnosed

Peter, a 54-year-old male, was recently diagnosed with dyslipidaemia. His HDL-C was <1 mmol/L, total cholesterol was 7.9 mmol/L and his triglycerides were normal. After a period of dietary modification and an attempt at leading a healthier lifestyle, there was no improvement in his lipid profile. His GP commenced Peter on atorvastatin 10 mg once daily and asked him to return in 4 weeks 1. At his 4-week visit his total cholesterol was 5.9 mmol/L and his HDL-C 1.1 mmol/L. Peter indicated that he felt well and didn't have any adverse effects from the drug. The GP increases the dose to 20 mg daily and asks that he return in another 4 weeks Explain why the GP has commenced Sam on atorvastatin instead of another lipid-lowering drug. Discuss the rationale for doubling the dose of atorvastatin 2. Peter returns in 3 weeks complaining of extensive muscle discomfort (e.g. pain and cramps), which he feels is getting worse. While the GP was undertaking a medical examination Peter volunteers that he has been feeling unwell since his wife started him on a 'fancy grapefruit diet'. The GP immediately advises Peter to stop eating grapefruit and he takes a blood sample for measurement of creatine kinase. Explain the relationship between Peter's myalgia and his grapefruit diet. 3. Explain why the GP has taken blood for a creatine kinase measurement.

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