AntiHyperlipidemia 💊

Question 1

HMG CoA) reductase inhibitors (the key enzyme for de novo cholesterol biosynthesis)

Answer 1

Statins

Question 2

standard practice to initiate therapy by what
immediately after acute coronary syndromes, regardless of lipid
levels.

Answer 2

Reductase inhibitor statins

Question 3

cholesterol synthesis occurs predominantly at night à HMG-
CoA reductase inhibitors should be given in the evening if a single
daily dose is used, except

Answer 3

atorvastatin and rosuvastatin because they
have much longer t 1/2.

Question 4

CI in pregnancy and nursing mothers.

Answer 4

Statins cause taratogenic

Question 5

Statins are metabolized by ?

Answer 5

Cytochrome p450

Question 6

Side effect of statins?

Answer 6

Elevated liver enzyme , myopathies neropathies

Question 7

After being counseled about lifestyle and dietary changes, the patient was started on atorvastatin. During his treatment with atorvastatin, it is important to routinely monitor serum concentrations of which of the following?
A. Blood urea nitrogen
B. Alanine and aspartate aminotransferase
C. Red blood cells
D. Uric acid

Answer 7

B. Alanine and aspartate aminotransferase

Question 8

HMG coA reductase mainly work on ?

Answer 8

Lowering LDL levels

Question 9

PPAR-α agonists).

Answer 9

Fibrates

Question 10

Gemfibrozil & Fenofibrate mainly work by ?

Answer 10

lower serum level of triglycerides , and increase
the HDL.

Question 11

mainly used to treat hypertriglyceridemia.

Answer 11

Gemfibrozil & Fenofibrate

Question 12

the most common adverse effect of gimfibrozil and fenofibrate?

Answer 12

Nausea

Question 13

Which group contraindicated in paitent with gallstone history?

Answer 13

Fibrate group gimfibrozil and fenofibrate

Question 14

Which drugs form an insoluble complex with the bile acids and salts, preventing their reabsorption from the intestine.

Answer 14

cholestyramine, colestipol
Bile acid binding resin

Question 15

used in patients with hypercholesterolemia.
Lower levels of LDL by preventing reabsorbtion?

Answer 15

Bile acid binding resin cholestyramine, colestipol,

Question 16

If a patient has a history of gout, which of the following drugs is most likely to exacerbate this condition?
A. Colestipol
B. Ezetimibe
C. Niacin
D. Simvastatin

Answer 16

Niacin

Question 17

Increase HDL cholestero and reduced VLDL synthesis?

Answer 17

Niacin

Question 18

Preventing absorption of dietary
cholesterol and cholesterol that is excreted in
bile.

Answer 18

Ezetimibe

Question 19

used as an adjunct to statin
therapy or in statin-intolerant patients to lower
LDL cholesterol.

Answer 19

Ezitimbe

Question 20

Side effect of which group
Patients uncomfortable_
unpleasant taste and cause GI
discomfort - Vitamins deficiency.

Answer 20

Bile acid resin

Question 21

Which one of the following is the most common side
effect of antihyperlipidemic drug therapy?
A. Elevated blood pressure.
B) Gastrointestinal disturbance.
C. Neurologic problems.
D. Heart palpitations.
E. Migraine headaches.

Answer 21

B. Gastrointestinal disturbances fre-
quently occur as a side effect of antihyperlipidemic drug therapy. The other choices are not seen as commonly.

Question 22

Which one of the following drugs decreases cholesterol synthesis by inhibiting the enzyme 3-hydroxy-3-methylglutaryl coenzyme A reductase?
A. Fenofibrate.
B. Niacin.
C. Cholestyramine.
D Lovastatin.
E. Gemfibrozil.

Answer 22

Correct answer = D. Lovastatin decreases cholesterol syn-
thesis by inhibiting HMG CoA reductase. Fenofibrate and gemfibrozil increase the activity of lipoprotein lipase, thereby increasing the removal of VLDL from plasma. Niacin inhib-its lipolysis in adipose tissue, thus eliminating the building blocks needed by the liver to produce triglycerides and, therefore, VLDL. Cholestyramine lowers the amount of bile acids returning to the liver via the enterohepatic circulation.

Question 23

Which one of the following drugs causes a decrease in liver triglyceride synthesis by limiting available free fatty acids needed as building blocks for this pathway?
A.Niacin.
B. Fenofibrate.
C. Cholestyramine.
D. Gemfibrozil.
E. Lovastatin.

Answer 23

Correct answer = A. At gram doses, niacin strongly inhibits lipolysis in adipose tissue the primary producer of circulating free fatty acids. The liver normally utilizes these circulating fatty acids as a major precursor for triglyceride synthesis. Thus, niacin causes a decrease in liver triglyceride synthesis, which is required for VLDL production. The other choices do not inhibit lipolysis in adipose tissue.

Question 24

Which one of the following drugs binds bile acids in the intestine, thus preventing their return to the liver via the enterohepatic circulation?
A. Niacin.
B. Fenofibrate.
C) Cholestyramine.
D. Fluvastatin.
E. Lovastatin.

Answer 24

Correct answer = C. Cholestyramine is an anion-exchange
resin that binds negatively charged bile acids and bile salts in the small intestine. The resin/bile acid complex is excreted in the feces, thus preventing the bile acids from returning to the liver by the enterohepatic circulation. The other choices do not bind intestinal bile acids.

Question 25

JS is a 65-year-old man who presents to his physician for management of hyperlipidemia. His most recent lipid panel reveals an LDL cholesterol level of 165 mg/ dL. His physician wishes to begin treatment to lower his LDL cholesterol levels. Which of the following therapies is the best option to lower JS's LDL cholesterol levels? A. Fenofibrate. B. Colesevelam. C. Niacin. D. Simvastatin. E. Ezetimibe.

Answer 25

Correct answer = D. Simvastatin, an HMG CoA reductase inhibitor (statin), is the most effective option for lowering LDL cholesterol, achieving reductions of 30% to 41% from baseline levels. Fenofibrate and niacin are more effective at lowering triglyceride levels or raising HDL levels (niacin). Colesevelam can reduce LDL levels but not as effectively as statins.

Question 26

WW is a 62-year-old female with hyperlipidemia and hypothyroidism. Her current medications include cholestyramine and levothyroxine (thyroid hormone). What advice would you give to WW to avoid a drug interaction between her cholestyramine and levothyroxine? A. Stop taking the levothyroxine as it can interact with cholestyramine. B. Take levothyroxine 1 hour before cholestyramine on an empty stomach. C. Switch cholestyramine to colesevelam as this will eliminate the interaction. D. Switch cholestyramine to colestipol as this will eliminate the interaction.

Answer 26

Correct answer = B. Cholestyramine and the bile acid resins can bind several medications causing decreased absorp-tion.

Question 27

AJ is a 42-year-old man who was started on niacin sustained-release tablets 2 weeks ago for elevated triglycerides and low HDL levels. He is complaining of an uncomfortable flushing and itchy feeling that he thinks is related to the niacin. Which of the following options can help AJ manage this adverse effect of niacin therapy? Administer aspirin 30 minutes prior to taking niacin. B. Administer aspirin 30 minutes after taking niacin. C. Increase the dose of niacin SR to 1000 mg. D. Continue the current dose of niacin. E. Change the sustained-release niacin to immediate-release niacin.

Answer 27

Correct answer = A. Flushing associated with niacin is prostaglandin mediated; therefore, use of aspirin (a prostaglandin inhibitor) can help to minimize this adverse effect. It must be administered 30 minutes prior to the dose of the niacin;

Question 28

CN is a 72-year-old male who is treated for hyperlipidemia with high-dose atorvastatin for the past 6 months. He also has a history of renal insufficiency. His most recent lipid panel shows an LDL cholesterol level of 131 mg/dL, triglycerides of 510 mg/dL, and HDL cholesterol of 32 mg/dL. His physician wishes to add an additional agent for his hyperlipidemia. Which of the following choices is the best option to address CN's dyslipidemia? A. Fenofibrate. B. Niacin. C. Colesevelam. D. Gemfibrozil. E. Ezetimibe.

Answer 28

Correct answer = B. This patient has significantly elevated triglycerides and low HDL. Niacin can lower triglycerides by 35% to 50% and also raise HDL levels. The fibrates (feno-fibrate and gemfibrozil) should not be used due to CN's history of renal insufficiency.

Question 29

Which of the following patient populations is more likely to experience myalgia (muscle pain) or myopathy with use of HMG CoA reductase inhibitors? A. Patients with diabetes mellitus. B) Patients with renal insufficiency. C. Patients with gout. D. Patients with hypertriglyceridemia. E. Patients taking warfarin (blood thinner).

Answer 29

Correct answer = B. Patients with a history of renal insufficiency have a higher incidence of developing myalgias, myopathy, and rhabdomyolysis with use of HMG COA reductase inhibitors (statins), especially with those that are renally eliminated as drug accumulation can occur. The other populations have not been reported to have a higher incidence of this adverse effect with HMG CoA reductase inhibitors.