Lipid Deck 2

Question 1

Fibrates MOA

Answer 1

Inhibition of cholesterol synthesis

Decreased triglyceride synthesis

Inhibition of lipolysis in adipose tissue

Decreased production of VLDL/increased clearance

Increased plasma and hepatic lipoprotein lipase (LPL) activity

Question 2

Fibrates effect on lipids

Answer 2

Decreases: total cholesterol (TC), LDL, TGs
Increases: HDL

Question 3

Fibric acid derivatives are effective TG-lowering drugs that may modestly lower LDL and raise HDL for some patients. Because these drugs usually do not produce

Answer 3

substantial reductions in LDL cholesterol, they are not appropriate for first-line lowering of LDL levels unless the patient is statin-intolerant. They also have a role in familial hypercholesterolemia.

Question 4

Fibrate Effective

Answer 4

TG-lowering drugs that modestly lower LDL and raise HDL for only some patients

Question 5

Fibrates work for patients with

Answer 5

very high TG levels, such as patients with type 2 diabetes and patients with familial dysbetalipoproteinemia.

Question 6

Fibrates do not produce substantial reduction in

Answer 6

LDL, so are not appropriate as initial or monotherapy.

Question 7

Fibreates ADR

Answer 7

nausea, diarrhea, cholelithiasis, phototoxicity

Question 8

Fibric acid derivatives do have a significant

Answer 8

gastrointestinal (GI) side effect profile

Question 9

Fibrate dug interactions

Answer 9

Increased risk of hepatotoxicity and/or myalgias with concurrent statins and/or niacin
Protein-binding displacement (e.g., warfarin)

Question 10

Fibrates Monitoring

Answer 10

Lipid levels in 4 to 6 weeks, then every 3 to 4 months until control established
LDL levels will drop when triglycerides drop
LFTs before starting and as needed

Question 11

Fibrate ADR incldues

Answer 11

constipation and flatulence

Question 12

Bile Acid Sequestrants (BAS)

Answer 12

By promoting an increase in bile acid excretion, they enhance conversion of cholesterol to bile acids by the liver and increase uptake of LDL

Question 13

BAS bind with cholesterol in the intestine and are NOT

Answer 13

metabolized by the liver

Question 14

BAS are excreted in

Answer 14

bound form in the feces

Question 15

BAS may use with patients with

Answer 15

active liver disease

Question 16

BAS lower and increase

Answer 16

Lower TC, LDL, and TG, and increase HDL, in theory

Question 17

BAS have a strong record for

Answer 17

efficacy and safety

Question 18

BAS are most useful for patients with

Answer 18

moderately elevated LDL levels and low coronary heart disease (CHD) risk profile

Question 19

BAS patients who are not able to re

Answer 19

to reduce their LDLs with lifestyle modifications

Question 20

BAS can be used together with

Answer 20

fibrates

Question 21

BAS ADR

Answer 21

GI – constipation, bloating, abdominal pain, unpleasant taste and texture; HA

Question 22

BAS reduced ___ with long trerm use

Answer 22

folate levels

Question 23

BAS initial dose

Answer 23

one packet mixed with juice; never swallowed in dry form

Question 24

BAS interactionos

Answer 24

Interfere with absorption of other medications

Question 25

BAS Monitoring

Answer 25

lipid levels

bowel issues

Question 26

BAS patient education

Answer 26

Taken with meals mixed with 4 to 6 ounces of fluid

Other Drug absorption impaired if taken at same time

Question 27

BAS ADRs

Answer 27

constipation, may need stool softeners

Question 28

BAS never

Answer 28

swallow in dry form

Question 29

Niacin no longer

Answer 29

approved by the U.S. Food and Drug Administration (FDA) for use in lipid management

Question 30

Niacin previous touted effects

Answer 30

on lipids

Lower TC, LDL, and TG, and elevate HDL

Question 31

Niacin increased risk of

Answer 31

CV events if taken at doses to change lipids. Adverse events stronger than any benefit!

Question 32

Ezetimibe (Zetia) MOA

Answer 32

Selectively inhibits intestinal absorption of cholesterol and related phytosterols

Question 33

Ezetimibe has been shown to reduce

Answer 33

reduce total cholesterol, LDL, and TG while increasing HDL-C

Question 34

Ezetimibe no good

Answer 34

outcome data yet, but most effective in combination with statin

Question 35

Ezetimibe dosing

Answer 35

10 mg/day

Question 36

Ezetimibe pregnancy category

Answer 36

category C; not for children younger than 10 years of age