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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}
|QuestionAuthor={{Rim}} (Reviewed by Will Gibson)
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|SubCategory=Vascular
|SubCategory=Gastrointestinal, Vascular
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|SubCategory=Vascular
|SubCategory=Gastrointestinal, Vascular
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|SubCategory=Vascular
|SubCategory=Gastrointestinal, Vascular
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|SubCategory=Vascular
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|SubCategory=Vascular
|SubCategory=Gastrointestinal, Vascular
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|SubCategory=Vascular
|SubCategory=Gastrointestinal, Vascular
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|SubCategory=Vascular
|SubCategory=Gastrointestinal, Vascular
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|SubCategory=Gastrointestinal, Vascular
|MainCategory=Pharmacology
|MainCategory=Pharmacology
|SubCategory=Vascular
|MainCategory=Pharmacology
|SubCategory=Gastrointestinal, Vascular
|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?
|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?
|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.
|Explanation=There is a strong association between [[clofibrate]] therapy and [[gallstone]] formation.  [[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.


|AnswerA=Acute pancreatitis
|AnswerA=Acute pancreatitis
|AnswerAExp=Acute pancreatitis may be caused by hypertriglyceridemia, not with fenofibrate therapy per se.
|AnswerAExp=Acute pancreatitis may be caused by hypertriglyceridemia, not with fenofibrate therapy per se.
|AnswerB=Acute cholecystitis
|AnswerB=Acute cholecystitis
|AnswerBExp=Gall bladder stone formation and subsequent acute cholecystitis have been associated with fibrate therapy, especially clofibrate.
|AnswerBExp=Gallbladder stone formation and subsequent acute cholecystitis have been associated with fibrate therapy, especially clofibrate.
|AnswerC=Pulmonary embolism
|AnswerC=Pulmonary embolism
|AnswerCExp=Clofibrate therapy is not commonly associated with increasing risk of pulmonary embolism.  
|AnswerCExp=Clofibrate therapy is not commonly associated with an increased risk of pulmonary embolism.
|AnswerD=Pneumonia
|AnswerD=Pneumonia
|AnswerDExp=Clofibrate therapy is not commonly associated with increasing risk of pneumonia.
|AnswerDExp=Clofibrate therapy is not commonly associated with an increased risk of pneumonia.
|AnswerE=Myocardial infarction
|AnswerE=Myocardial infarction
|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.
|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.
|EducationalObjectives=[[Fibrate]] therapy is used to treat [[hypertriglyceridemia]].  One common complication of clofibrate therapy is gallstone formation, which can lead to acute [[cholecystitis]].
|References=Michielsen PP, Fierens H, Van Maercke YM. Drug-induced gallbladder disease. Incidence, aetiology, and management. Drug Saf. 1992;7(1):32-45.<br>
First Aid 2015 page 375 (Fibrates) <br>
First Aid 2015 page 375 (Gallstones)<br>
|RightAnswer=B
|RightAnswer=B
|WBRKeyword=acute, cholecystitis, gallbladder, gall, bladder, stone, clofibrate, fibrate, triglyceride, hypertriglyceridemia
|WBRKeyword=Acute cholecystitis, Cholecystitis, Gallbladder, Stone, Gallstones, Clofibrate, Fibrate, Triglyceride, Hypertriglyceridemia, Abdominal pain
|Approved=No
|Approved=Yes
}}
}}

Revision as of 00:23, 20 April 2015
Author [[PageAuthor::Rim Halaby, M.D. [1] (Reviewed by Will Gibson)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Pharmacology
Sub Category SubCategory::Gastrointestinal, 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::Gallbladder 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 an increased risk of pulmonary embolism.
Answer D AnswerD::Pneumonia
Answer D Explanation AnswerDExp::Clofibrate therapy is not commonly associated with an increased 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 gallstone formation. 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. One common complication of clofibrate therapy is gallstone formation, which can lead to acute cholecystitis.
References: Michielsen PP, Fierens H, Van Maercke YM. Drug-induced gallbladder disease. Incidence, aetiology, and management. Drug Saf. 1992;7(1):32-45.
First Aid 2015 page 375 (Fibrates)
First Aid 2015 page 375 (Gallstones)
]]

Approved Approved::Yes
Keyword WBRKeyword::Acute cholecystitis, WBRKeyword::Cholecystitis, WBRKeyword::Gallbladder, WBRKeyword::Stone, WBRKeyword::Gallstones, WBRKeyword::Clofibrate, WBRKeyword::Fibrate, WBRKeyword::Triglyceride, WBRKeyword::Hypertriglyceridemia, WBRKeyword::Abdominal pain
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