Drugs for lipid disorders

Question 1

the 2 fibrates dicussed are

Answer 1

gemfibrozil and fenofibrate

Question 2

most potent statins

Answer 2

Atorvastatin and rosuvastatin are equal then simvastatin

Question 3

what class of drugs predominately decreases VLDL

Answer 3

Fibrates

Question 4

Adverse effects on muscle of statins?

Answer 4

• CK increase (high level of physical activity)
• Rhabdo –>renal injury and myoglobinuria
• myopathy

Question 5

antisense oligonucleotide that targets apolipoprotein B-100 and used to treat homozygous familial hypercholesterolemia

Answer 5

Mipomersen

Question 6

Due to the risk of developing gallstones, Fibrates should be used with caution in what individuals?

Answer 6

those with biliary tract disease or in those at high risk (women, obese pts, native americans)

Question 7

Which statin is NOT metabolized by CYP450s

Answer 7

pravastatin and pitavastatin

Question 8

drug interatction for fibrates?

Answer 8

coumadin and indanedione anticoagulants

Question 9

What patients should you use bile acid resins cautiously

Answer 9

diverticulitis, preexisting bowel disease, or cholestatis

Question 10

What agents that inhibit CYP450 should be avoided with statins unless its pravastatin and pitavastatin

Answer 10

• phenytoin

- griseofulvin

Question 11

Ligand for PPAR-alpha

Answer 11

Fibrates

Question 12

Expression of what is increased when fibrates bind to PPARalpha

Answer 12

lipoprotein lipase which then causes decreased concentration of triglycerides

Question 13

Treatment of homozygous familial hypercholesterolemia that binds to MTP

Answer 13

lomitapide (SUPER EXPENSIVE)

Question 14

What class of drugs are useful in treating hypertriglyceridemia that results from treatment with viral protease inhibitors?

Answer 14

fibrates

Question 15

Ezetimibe inhibits cholesterol absorption through what?

Answer 15

NPC1L1

Question 16

intense cutaneous flush accompanied by an uncomfortable feeling of warmth

Answer 16

Niacin

Question 17

Statins that are inactive prodrugs that must be hyrolyzed in GI to activate

Answer 17

Lovastatin and simvastatin

Question 18

Acts by inhibiting lipolysis of triglycerides in adipose tissue which reduces free fatty acids –>liver makes less VLDL–>lower LDL

Answer 18

Niacin

Question 19

contraindications and cautious use for niacin

Answer 19

• Contraindication in hepatic disease or active peptic ulcer

- caution with DM –>causes insulin resistance and hyperglycemia

Question 20

When are statins not recommended but not absolute contraindication

Answer 20

liver disease or skeletal muscle myopathy

Question 21

What is the least potent statin?

Answer 21

fluvastatin

Question 22

Adverse effects on liver of statins?

Answer 22

increase in aminotransferase (liver disease or alcohol use)

Question 23

Which statins have an extraordinarily long half life of 14 and 19 hours as opposed to others of around 1-3

Answer 23

• Atorvastatin (14)

- Rosuvastatin (19)

Question 24

What time of day should statins be given?

Answer 24

in evening because cholesterol is synthesized at night unless you use longer acting one like Atorvastatin or Rosuvastatin

Question 25

Agents that are totally excreted in feces?

Answer 25

bile acid sequestrants (resins)

Question 26

When should fibrates be taken?

Answer 26

With a meal. well absorbed

Question 27

Contraindication of statins

Answer 27

pregnancy or breast feeding

Question 28

What can be used to relieve pruritus in patients who have bile salt accumulation

Answer 28

Bile acid resins

Question 29

which fibrate has short (1.5 hr) half life? Long (20)?

Answer 29

Gemifibrozil Fenofibrate

Question 30

most effective agent for increasing HDL

Answer 30

niacin (vitamin B3)

Question 31

Fibrate that should not be used because it is associated with cholangiocarcinoma and other GI cancers

Answer 31

clofibrate

Question 32

what is the only lipid-lowering agent that reduces lipoprotein a

Answer 32

Niacin

Question 33

What can mitigate the flushing associted with Niacin use (prostaglandin mediated)

Answer 33

Aspirin

Question 34

What drug reduces fibrinogen levels and increases tissue plasminogen activator levels which reduces endothelial dysfunction

Answer 34

Niacin

Question 35

other adverse effects of niacin other than flushing

Answer 35

- pruritus rashes, dry skin or mucous membranes, and acanthosis nigricans - hepatotoxicity (used extended release)

Question 36

Fibrates should be avoided in patients with what?

Answer 36

hepatic or renal dysfunction

Question 37

Which statin is almost completely absorbed?

Answer 37

fluvastatin

Question 38

When would you use bile acid resins in monotherapy or with niacin?

Answer 38

type IIa or type IIb hyperlipidemia

Question 39

what are the 3 Bile acid sequestrants (resins?

Answer 39

- colestipol - cholestyramine - colesevelam

Question 40

what toxicity can bile acid resins be used to treat

Answer 40

digitalis toxicity

Question 41

When a patient with insulin resistance is given niacin, what can be seen due to elevated insulin levels

Answer 41

acanthosis nigricans

Question 42

What should be the recommendation on when to take other drugs that a patient is taking along with Bile acid resins?

Answer 42

1 hours before or 2 hours after