A 46-year-old woman is admitted to the hospital because of tarry-black stools and epigastric pain for 2 weeks. The epigastric pain is relieved after meals, but worsens after 1-2 hours. She has a history of hypertension and hyperlipidemia, for which he takes amlodipine and simvastatin. Physical examination shows no abnormalities. Helicobacter pylori infection is diagnosed and she is started on treatment and has had partial symptom improvement. After two weeks she presents with progressive myopathy and fatigue. Physical examination shows diffuse muscle tenderness. Laboratory evaluation reveals elevated blood urea nitrogen and serum creatinine levels. Urine microscopy shows no red or white blood cells. Which of the following medications most likely precipitated this patient's current condition?

Question

A 46-year-old woman is admitted to the hospital because of tarry-black stools and epigastric pain for 2 weeks. The epigastric pain is relieved after meals, but worsens after 1-2 hours. She has a history of hypertension and hyperlipidemia, for which he takes amlodipine and simvastatin. Physical examination shows no abnormalities. Helicobacter pylori infection is diagnosed and she is started on treatment and has had partial symptom improvement. After two weeks she presents with progressive myopathy and fatigue. Physical examination shows diffuse muscle tenderness.  Laboratory evaluation reveals elevated blood urea nitrogen and serum creatinine levels.  Urine microscopy shows no red or white blood cells.  Which of the following medications most likely precipitated this patient's current condition?

Quizplus · Accepted Answer

Eductional Objective: Statins, primarily simvastatin, lovastatin, and atorvastatin, are metabolized by CYP3A4.  Drugs that inhibit this enzyme (eg, macrolide antibiotics, ketoconazole, non-dihydropyridine calcium channel blockers, amiodarone) can cause increased statin drug levels and lead to statin myopathy

A 46-Year-Old Woman Is Admitted to the Hospital Because of Tarry-Black