antilipemic agents - Sheet1

Question 1

What is the primary organ targeted by antilipemic agents?

Answer 1

The liver.

Question 2

Where do some lipid-lowering drugs work besides the liver?

Answer 2

The intestines.

Question 3

What is the desired total cholesterol level?

Answer 3

Less than 160 mg/dL.

Question 4

What is the desired HDL cholesterol level?

Answer 4

Greater than 40 mg/dL.

Question 5

Why is HDL cholesterol considered “good”?

Answer 5

It carries LDL cholesterol away from the liver to be excreted.

Question 6

What is the desired LDL cholesterol level?

Answer 6

Less than 100 mg/dL.

Question 7

Why is LDL cholesterol considered “bad”?

Answer 7

It contributes to fatty buildup in arteries.

Question 8

What is the desired triglyceride (TG) level?

Answer 8

Less than 150 mg/dL.

Question 9

What is the most common type of fat stored in the body?

Answer 9

Triglycerides (TGs).

Question 10

What is the most effective drug class for lowering LDL cholesterol?

Answer 10

HMG-CoA reductase inhibitors (statins).

Question 11

Besides lowering LDL, what other benefits do statins provide?

Answer 11

Increase HDL, lower triglycerides in some, stabilize plaques, reduce cardiovascular (CV) events, and increase bone formation.

Question 12

Why is plaque stability important?

Answer 12

If unstable plaque breaks off, it can lead to strokes or myocardial infarctions (MIs).

Question 13

What is the first-line treatment to lower cholesterol?

Answer 13

Statins.

Question 14

How do statins work?

Answer 14

They inhibit cholesterol production in the liver, prompting the liver to produce more LDL receptors to remove cholesterol from the blood.

Question 15

What organ function should be monitored when taking statins?

Answer 15

Liver function.

Question 16

What conditions are statins used for?

Answer 16

Hypercholesterolemia, primary & secondary CV event prevention, post-MI therapy, and diabetes (protection against MI & stroke).

Question 17

What are the common adverse effects (AEs) of statins?

Answer 17

Headache, rash, and GI upset (usually improve over time).

Question 18

What are the rare but serious AEs of statins?

Answer 18

Myopathy/rhabdomyolysis, hepatotoxicity, cataracts.

Question 19

What symptom should prompt lowering the statin dose?

Answer 19

Muscle aches (risk of myopathy/rhabdomyolysis).

Question 20

What drugs interact with statins?

Answer 20

Other lipid-lowering drugs (fibrates, ezetimibe), CYP3A4 inhibitors (e.g., grapefruit juice).

Question 21

Why should grapefruit juice be avoided with statins?

Answer 21

It inhibits CYP3A4, affecting statin metabolism.

Question 22

What is the pregnancy category for statins?

Answer 22

Category X – contraindicated in pregnancy due to fetal harm.

Question 23

What lab values should be monitored with statin use?

Answer 23

Lipid levels, liver function tests (LFTs), creatine kinase (CK).

Question 24

Why is CK monitored in statin users?

Answer 24

To detect muscle breakdown (rhabdomyolysis).

Question 25

What symptoms indicate possible rhabdomyolysis?

Answer 25

Muscle tenderness, pain, numbness, tingling.

Question 26

When should statins be taken?

Answer 26

In the evening, preferably with an evening meal, because cholesterol is produced at night.

Question 27

What are some common statins?

Answer 27

Simvastatin, Simvastatin + Ezetimibe, Lovastatin, Pravastatin, Rosuvastatin, Fluvastatin, Pitavastatin.

Question 28

What is an example of a cholesterol absorption inhibitor?

Answer 28

Ezetimibe.

Question 29

How is ezetimibe typically used?

Answer 29

As an add-on with a statin, unless statins cannot be used.

Question 30

Where does ezetimibe work?

Answer 30

In the intestine.

Question 31

What does ezetimibe do?

Answer 31

Blocks cholesterol absorption, lowering total cholesterol, LDL, and apolipoprotein B.

Question 32

What are the adverse effects (AEs) of ezetimibe?

Answer 32

Myopathy/rhabdomyolysis, hepatitis, pancreatitis, thrombocytopenia.

Question 33

What should be monitored with ezetimibe use?

Answer 33

Lipids, liver function tests (LFTs), creatine kinase (CK).

Question 34

What drugs interact with ezetimibe?

Answer 34

Bile acid sequestrants (BAS), statins, fibrates.

Question 35

What are examples of bile acid sequestrants (BAS)?

Answer 35

Colesevelam, Cholestyramine, Colestipol.

Question 36

How do BAS lower cholesterol?

Answer 36

They are nonabsorbable resins that bind bile acids in the GI tract, causing the liver to pull cholesterol from the blood to make more bile acids.

Question 37

Can BAS be used alone?

Answer 37

Yes, but they are often combined with a statin.

Question 38

What is a common side effect of BAS?

Answer 38

Constipation (due to staying in the GI tract).

Question 39

How can constipation from BAS be managed?

Answer 39

Increase water, fiber, and food intake.

Question 40

What other GI side effects can BAS cause?

Answer 40

Bloating and nausea.

Question 41

Why do BAS have many drug interactions?

Answer 41

They can bind to other drugs in the GI tract and block their absorption.

Question 42

What medications can BAS interfere with?

Answer 42

Thiazide diuretics, digoxin, warfarin, fat-soluble vitamins, levothyroxine, oral contraceptives.

Question 43

What is the best way to take BAS with other medications?

Answer 43

Take other medications 1 hour before or 4 hours after BAS to avoid absorption issues.

Question 44

How should BAS be taken?

Answer 44

As a tablet or powder with at least 4–8 oz of fluid.

Question 45

Are BAS safe during pregnancy?

Answer 45

Yes, because they are not absorbed by the body and do not reach the fetus.

Question 46

What are examples of fibrates (fibric acid derivatives)?

Answer 46

Gemfibrozil, fenofibrate, fenofibric acid.

Question 47

What do fibrates primarily do?

Answer 47

Lower triglyceride (TG) levels (VLDLs), may raise HDL.

Question 48

When are fibrates used?

Answer 48

As 3rd-line drugs, only if LDL reduction is strongly needed.

Question 49

What are the adverse effects (AEs) of fibrates?

Answer 49

GI upset, gallstones, myopathy, hepatotoxicity.

Question 50

What risk increases when fibrates are combined with statins?

Answer 50

Rhabdomyolysis (muscle breakdown).

Question 51

What risk increases when fibrates are combined with warfarin?

Answer 51

Increased risk of bleeding.

Question 52

What lab values should be monitored with fibrate use?

Answer 52

CK, LFTs, PT/INR (if on warfarin).

Question 53

When should fibrates be taken?

Answer 53

30 minutes before breakfast or dinner.

Question 54

What is another name for niacin (nicotinic acid)?

Answer 54

Vitamin B6.

Question 55

What does niacin do to cholesterol levels?

Answer 55

Reduces LDL and TG, raises HDL (best at raising HDL).

Question 56

Does niacin significantly improve cardiovascular (CV) outcomes?

Answer 56

No, it has little impact on CV events.

Question 57

Why is niacin not preferred over statins?

Answer 57

It has more adverse effects than statins.

Question 58

What are the adverse effects (AEs) of niacin?

Answer 58

Intense flushing, GI upset, liver injury, muscle cramps, headache, rash, photosensitivity.

Question 59

How can flushing from niacin be reduced?

Answer 59

Take one adult-strength aspirin (325 mg) 30 minutes before the niacin dose.

Question 60

Should niacin be taken with or without food?

Answer 60

With food.

Question 61

What are examples of monoclonal antibodies for cholesterol?

Answer 61

Alirocumab, evolocumab.

Question 62

What is the primary effect of monoclonal antibodies on cholesterol?

Answer 62

They lower LDL.

Question 63

What are the adverse effects (AEs) of monoclonal antibodies?

Answer 63

Hypersensitivity reactions, injection site reactions.