Deck 10: Lipid-Lowering Agents

Question 1

What is the best agent to increase HDL?

A) Niacin
B) Atorvastatin
C) Gemfibrozil
D) Cholestyramine

Answer 1

A

Question 2

What is true regarding Omega-3 fatty acids?

A) OTC products differ in their EPA/DHA content.
B) Higher doses of Omega-3 fatty acids 2-4 g/day are used to lower triglycerides.
C) In patients with very high triglycerides (>500 mg/dL) there is an increase in LDL.
D) All of the above.

Answer 2

D

Question 3

Which lipid parameter do statins have the greatest effect on?

A) HDL
B) Triglycerides
C) LDL
D) VLDL

Answer 3

C

Question 4

What is the effect on the INR when gemfibrozil is given to patients who are stabilized on warfarin?

A) Increase
B) Decrease
C) No change
D) All of the above

Question 5

To avoid a drug interaction with bile acid sequestrants, how should the patient be counseled?

A) Take the interacting drug concomitantly with the bile acid sequestrants
B) Give other medications 1 hour before or 4-6 hours after giving bile acid sequestrant
C) Discontinue bile acid sequestrants temporarily since there is not a way to avoid the interaction
D) Take it with grapefruit juice

Question 6

What is the maximum dose of Crestor?

A) 40 mg q daily
B) 80 mg q daily
C) 100 mg q daily
D) 120 mg q daily

Question 7

Contraindications to fibrate therapy include which of the following?

A) TG > 500 mg/dL
B) Severe renal disease
C) Anemia
D) Myocardial infarction

Question 8

Vytorin is a combination of which of the following drugs?

A) Simvastatin and ezetimibe
B) Simvastatin and niacin
C) Lovastatin and niacin
D) Lovastatin and ezetimibe

Question 9

Zetia should be dosed as:

A) 5 mg BID
B) 10 mg daily
C) 10 mg BID
D) 20 mg QHS

Question 10

One of the major side effects of bile acid sequestrants is:

A) Constipation
B) Increased glucose levels
C) Myopathy
D) Elevated liver function enzymes

Question 11

Which of the following conditions is NOT considered a reason to discontinue atorvastatin therapy?

A) Becoming pregnant during therapy
B) Development of severe myopathy
C) Normal LFT values
D) Developing active liver disease

Question 12

All of the following statins are metabolized through the CYP3A4 system, EXCEPT:

A) Atorvastatin
B) Simvastatin
C) Lovastatin
D) Fluvastatin

Question 13

Side effects of fish oils include:

A) Fishy odor
B) Increase in bleeding risk at high doses, especially in combination with warfarin
C) GI upset/nausea
D) All of the above

Question 14

Which of the following statements regarding niacin is FALSE?

A) Niacin is absolutely contraindicated in patients with hyperglycemia.
B) Niacin is available as OTC and prescription.
C) Hepatotoxicity from niacin is dose related.
D) Niacin should not be used in patients with active liver disease.

Question 15

Proper counseling of niacin to avoid cutaneous flushing includes:

A) Taking the medication with a hot beverage
B) Taking an aspirin 30 minutes prior to taking niacin
C) Taking niacin on an empty stomach
D) Taking a hot bath or shower prior to taking niacin

Question 16

Which of the following statins should be avoided in HIV patients on protease inhibitors?

A) Simvastatin
B) Lovastatin
C) Pravastatin
D) A and B

Question 17

Which statin can be used safely at a max dose in patients with GFR < 30 mL/minute?

A) Lovastatin
B) Simvastatin
C) Pravastatin
D) Atorvastatin

Question 18

In combination with statin, ezetimibe can:

A) Lower LDL by an additional 25%
B) Lower TC by an additional 50%
C) Lower TG by an additional 35%
D) Increase HDL by an additional 30%

Question 19

Which of the following statements is true regarding niacin products that are available over the counter as "flush free"?

A) They are safe and should be recommended to patients instead of prescription products.
B) They are combined with ibuprofen to prevent flushing.
C) These products fail to release free niacin, making them an ineffective antilipemic agent.
D) None of the above.

Question 20

Increase hypoglycemic effects have been reported when repaglinide is used in combination with:

A) Fluvastatin
B) Gemfibrozil
C) Fish Oils
D) Niacin

Question 21

To prevent cardiovascular disease, what is the best drug to initiate for lipid-lowering therapy?

A) Atorvastatin 10 mg po daily
B) Niacin ER 500 mg po daily
C) Ezetimibe 10 mg po daily
D) Gemfibrozil 600 mg po BID

Question 22

All of the following are contraindications to fibrates, EXCEPT:

A) Patients with severe renal or hepatic disease
B) Unexplained persistent elevated liver function abnormality
C) Patients with history of gout
D) Preexisting gallbladder disease

Question 23

All of the following are brand names for fenofibrate, EXCEPT:

A) Antara
B) Lopid
C) TriCor
D) Triglide

Question 24

To increase tolerance and prevent side effects such as flushing, Niaspan ER should be titrated by:

A) 500 mg every 2 weeks
B) 500 mg every 4 weeks
C) 1000 mg every 2 weeks
D) 1000 mg every 4 weeks

Question 25

The maximum dose of Niaspan ER is:

A) 1000 mg po at bedtime
B) 2000 mg po at bedtime
C) 3000 mg po at bedtime
D) 4000 mg po at bedtime

Question 26

The following drug(s) is/are available over the counter and as a prescription.
Fish oils
Niacin
Lovastatin

A) I only
B) I and II
C) I and III
D) I, II, and III

Question 27

How should you counsel a patient to take over-the-counter fish oil prescription for 1g/day?

A) Patient should be counseled to intake total amount of fish oil concentrate equal to 1
B) Patient should be counseled to intake total omega-6 fatty acids content equal to 1g.
C) Patient should be counseled to intake total amount EPA/DHA content equal to 1g.
D) Patient should be counseled to intake total amount carbohydrates content equal to 1g.
G)

Question 28

In the setting of acute coronary syndrome, atorvastatin may be started on a maximum dose of

A) 80 mg/d without titration.
B) 70 mg/d without titration.
C) 79 mg/d without titration.
D) 120 mg/d without titration.

Question 29

The generic name for Mevacor is:

A) Simvastatin
B) Fluvastatin
C) Atorvastatin
D) Lovastatin

Question 30

Which of the following is a disadvantage of PCSK9 inhibitor?

A) Annual cost of $15,000 a year
B) Reduction in the number of apheresis treatment
C) Significant reduction in LDL (50-75%) on top of statin therapy
D) Biweekly or monthly administration

Question 31

Fluvastatin is metabolized by the _________ system.

A) CYP2C19
B) CYP2C9
C) CYP3A4
D) CYP2D6

Question 32

What is the mechanism of action of fibrates?

A) Stimulate peroxisome proliferator activated receptors (PPARα)
B) Stimulate peroxisome proliferator activated receptors (PPARγ)
C) Stimulate peroxisome proliferator activated receptors (PPARβ)
D) Stimulate peroxisome proliferator activated receptors (PPARμ)

Question 33

Which of the following is true regarding PCSK9 inhibitors?

A) Enhance recycling of LDL receptors
B) No study has shown a reduction in cardiovascular morbidity
C) Provide an additional 10% reduction in LDL-C
D) Administered orally

Question 34

Essential monitoring parameters for statins include all of the following, EXCEPT:

A) Myopathy
B) Blood glucose/Ha1c
C) Lipids
D) INR

Question 35

All of the following drugs require renal dose adjustment, EXCEPT:

A) Cholestyramine
B) Pravastatin
C) Fenofibrate
D) Rosuvastatin