S.P., a 49-year-old mayor, lives a busy life but manages to exercise regularly and tries to follow a healthy lifestyle, including watching her diet. She is a nonsmoker and is not overweight. Recently...

S.P., a 49-year-old mayor, lives a busy life but manages to exercise regularly and tries to follow a healthy lifestyle, including watching her diet. She is a nonsmoker and is not overweight. Recently S.P. had a medical checkup and, to her surprise, was told that her lipid levels are elevated. She has no history of diabetes mellitus, and her blood pressure is within normal limits. Her nurse practitioner has recommended that she start the HMG–CoA reductase inhibitor (statin) drug atorvastatin (Lipitor) at a dosage of 20 mg every evening. 1. S.P. says, “Isn’t there something else I can do instead of taking this medicine? I really don’t like taking pills.” What alternatives may be available to her? 2. After 4 months, S.P.’s lipid levels are not improved. The nurse practitioner discusses S.P.’s risk factors, including the fact that her father died at 54 years of age of a myocardial infarction. What other risk factors need to be considered? 3. S.P. agrees to take the medication and schedules a follow-up appointment for 3 months. Two months later, she wakes up with some pain in her legs and feels extremely tired. She thinks she is suffering the effects of a new workout program that she started the previous day. But when she goes to work, the pain gets worse, and she calls the office nurse to describe her symptoms. What could be happening? 4. S.P. asks whether she will just be switched to another “statin” drug. How will the nurse respond?