Drugs for Dyslipidemias Quiz

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Questions and Answers

Which statin is known for its effectiveness in lowering LDL and total cholesterol levels?

  • Pravastatin
  • Rosuvastatin (correct)
  • Fluvastatin
  • Simvastatin

What is the main adverse response associated with statin use that involves muscle conditions?

  • Myalgia
  • Myopathy (correct)
  • Hepatotoxicity
  • Interstitial lung disease

In patients taking statins, which finding is indicative of persistent myopathy?

  • Normal liver function tests
  • Mild muscle pain
  • The absence of any muscle symptoms
  • Elevated creatine phosphokinase above 1950 U/L (correct)

Which of the following factors may increase the risk of statin-related myopathy?

<p>Advanced age (B)</p> Signup and view all the answers

What type of muscle condition is associated with the disintegration of striated muscle fibers due to statin use?

<p>Rhabdomyolysis (D)</p> Signup and view all the answers

What is a major risk associated with the co-administration of statins and Niacin?

<p>Increased hepatotoxicity (A)</p> Signup and view all the answers

Which statement about Fibrates is true?

<p>They activate lipase to help break down cholesterol. (B)</p> Signup and view all the answers

What adverse effect is less common with Fibrates compared to statins?

<p>Myositis (B)</p> Signup and view all the answers

Which of the following is a possible adverse effect of Fibrates?

<p>Gallstones (A)</p> Signup and view all the answers

What is a common use of Niacin in combination with statins?

<p>To manage high triglyceride and cholesterol levels (D)</p> Signup and view all the answers

What effect does Niacin have on HDL levels?

<p>Increases HDL levels (A)</p> Signup and view all the answers

Which drug increases the risk of myopathy when combined with statins?

<p>Gemfibrozil (B)</p> Signup and view all the answers

Which of the following statements about Clofibrate is true?

<p>It has a high risk of GI malignancies in men. (D)</p> Signup and view all the answers

What is a contraindication for lipid-lowering therapy?

<p>Biliary obstruction (A)</p> Signup and view all the answers

When should patients take other medications in relation to meals to avoid absorption interference?

<p>1 hour before or 4 to 6 hours after meals (B)</p> Signup and view all the answers

What dietary advice should be given to patients taking Clofibrate?

<p>Increase fiber and fluid intake (C)</p> Signup and view all the answers

What is a recommended practice to minimize niacin side effects?

<p>Beginning with a low dose and gradually increasing (C)</p> Signup and view all the answers

How should powder forms of medications be taken?

<p>Taken with a liquid, mixed thoroughly but not stirred (B)</p> Signup and view all the answers

What is the primary function of apoproteins in the blood?

<p>To bind with lipids for transport in the bloodstream (A)</p> Signup and view all the answers

Which lipoprotein has the highest protein content?

<p>High-density lipoprotein (HDL) (B)</p> Signup and view all the answers

For individuals at high risk of coronary heart disease, what is the target LDL level?

<p>Less than 70 mg/dL (B)</p> Signup and view all the answers

What is the purpose of combining multiple lipid-lowering drugs in treatment?

<p>To enhance the effectiveness while managing risks (A)</p> Signup and view all the answers

Which of the following is NOT a type of drug used for lowering lipid levels?

<p>Beta-blockers (A)</p> Signup and view all the answers

What potential risk do lipid-lowering drugs pose for certain populations?

<p>Dangers for pregnant women and breast-fed infants (D)</p> Signup and view all the answers

What is the effect of reducing total cholesterol levels by 10% on coronary heart disease mortality?

<p>Drops mortality by approximately 15% (A)</p> Signup and view all the answers

What factor is NOT considered when treating dyslipidemias?

<p>The patient's level of physical activity (C)</p> Signup and view all the answers

What is a recommended strategy to handle cutaneous flushing and pruritis caused by Niacin?

<p>Use sustained release preparation (D)</p> Signup and view all the answers

Which of the following is a relative contraindication for using Niacin?

<p>Peptic ulcer disease (C)</p> Signup and view all the answers

What effect do bile acid sequestrants have on LDL cholesterol?

<p>Lower LDL cholesterol levels (D)</p> Signup and view all the answers

Which of the following side effects is commonly associated with bile acid sequestrants?

<p>Constipation (A)</p> Signup and view all the answers

What interaction does Niacin have with antidiabetic drugs?

<p>It antagonizes their effects (B)</p> Signup and view all the answers

In the study of Evolocumab, what was the best mean percent change in UC LDL-C after 52 weeks with a dosage of 420 mg every two weeks?

<p>-51.5% (C)</p> Signup and view all the answers

When using bile acid sequestrants, what absorption issue may result?

<p>Decreased absorption of fat-soluble vitamins (A)</p> Signup and view all the answers

Which statement correctly describes the function of Bile Acid Sequestrants?

<p>They bind bile acids, decreasing cholesterol reabsorption (B)</p> Signup and view all the answers

What should be done before initiating lipid-lowering therapy?

<p>Obtain a health and medication history (B)</p> Signup and view all the answers

What is a possible side effect when patients use Niacin?

<p>Skin flushing (A)</p> Signup and view all the answers

Flashcards

Lipoprotein

A combination of triglycerides or cholesterol bound to a specialized protein called an apoprotein.

High-Density Lipoprotein (HDL)

The most beneficial type of lipoprotein, known for transporting cholesterol back to the liver for processing.

Triglycerides

A primary form of lipid in the blood, responsible for storing energy.

Low-Density Lipoprotein (LDL)

A type of lipoprotein that carries cholesterol to the liver.

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Statin Mechanism

A process that involves inhibiting the production of cholesterol in the liver.

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Statins

A class of drugs that lower cholesterol levels by inhibiting the enzyme HMG-CoA reductase, which is involved in cholesterol production.

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Dyslipidemia

A condition characterized by abnormal levels of lipids in the blood, including high cholesterol and triglycerides.

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Coronary Heart Disease Risk Factors

A measure of the risk of developing heart disease, taking into account factors like family history, smoking, obesity, diabetes, and high blood pressure.

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Ezetimibe (Zetia®)

A drug that lowers cholesterol by inhibiting the absorption of cholesterol from the intestines.

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Gemfibrozil (LOPID®)

A drug that is used to lower triglyceride levels, believed to work by activating lipase, breaking down cholesterol and suppressing free fatty acid release from adipose tissue.

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Cholelithiasis

A potential side effect of fibrate medications, characterized by the formation of gallstones.

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Cholecystectomy

The surgical removal of the gallbladder.

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Myopathy

A potential side effect of fibrates that occurs when combined with statins, characterized by muscle pain and weakness.

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Niacin (Nicotinic Acid; Vitamin B3)

A type of vitamin B3 that is used to lower cholesterol levels, thought to increase lipase activity and reduce cholesterol and triglyceride metabolism.

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Hypercholesterolemia + hypertriglyceridemia

A condition characterized by high levels of cholesterol and triglycerides in the blood, often treated with a combination of statins and niacin.

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Drug Interactions with Lipid Lowering Medications

These medications can interact with other drugs. It's essential to consider all medications a patient is taking to avoid potential issues.

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Monitoring for Side Effects of Lipid Lowering Medications

These medications can cause side effects such as GI issues, constipation, bleeding, and yellow skin. Monitoring the patient's condition is crucial.

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Baseline Liver Function Studies Before Lipid Lowering Therapy

Before starting lipid-lowering medication, a baseline assessment of liver function should be performed to ensure the liver is healthy and able to process the medication.

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Potential Vitamin Deficiencies with Long-term Lipid Lowering Therapy

Patients on long-term therapy may require vitamin supplements, especially fat-soluble vitamins A, D, and K, as these medications can affect their absorption.

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Taking Lipid-lowering Medications with Meals

Patients should be advised to take these medications with meals to minimize gastrointestinal discomfort.

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Flushing with niacin

A common side effect of niacin, characterized by a feeling of flushing or warmth on the skin, often accompanied by itching.

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Managing Niacin Flushing

Strategies to manage niacin-induced flushing include waiting for tolerance to develop, administering smaller doses, using aspirin premedication, or switching to sustained-release preparations.

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Niacin Contraindications

Niacin is contraindicated in patients with peptic ulcer disease, elevated uric acid levels, gout, diabetes, or impaired liver function.

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Niacin and Statin Interaction

Niacin can increase the risk of muscle damage when taken with statins. This effect is known as statin-induced myopathy.

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Niacin and Antidiabetic Medications

Niacin can counteract the effects of antidiabetic medications, including insulin, oral hypoglycemics, and antihyperglycemics.

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Bile Acid Sequestrants Mechanism

Bile acid sequestrants, such as cholestyramine and colestipol, bind to bile acids in the gut, reducing their reabsorption and promoting their excretion in the feces.

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Bile Acid Sequestrants Effects

Bile acid sequestrants lower LDL cholesterol levels by increasing the conversion of cholesterol to bile acids and enhancing the uptake of LDL from the blood.

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Bile Acid Sequestrants Interactions

Bile acid sequestrants can bind to and reduce the absorption of other oral medications, leading to potentially significant drug interactions.

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Bile Acid Sequestrants Side Effects

Bile acid sequestrants can cause constipation, heartburn, nausea, belching, and bloating, but these side effects often lessen over time.

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PCSK9 Inhibitors

PCSK9 inhibitors, like evolocumab, are a newer class of drugs that lower LDL cholesterol by blocking the PCSK9 protein, which normally degrades LDL receptors.

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What are statins?

A type of drug that lowers cholesterol levels by inhibiting the enzyme HMG-CoA reductase, which is involved in cholesterol production. Statins can also increase HDL-C and decrease TGs.

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What is myopathy?

Statins can cause inflammation and damage to voluntary muscles, ranging from mild pain to severe, potentially life-threatening conditions like rhabdomyolysis.

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What is rhabdomyolysis?

This condition involves the disintegration of striated muscle fibers, leading to the release of myoglobin into the urine. It can be a serious complication associated with statin use.

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What factors increase the risk of statin-associated myopathy?

Statin-induced myopathy and muscle damage are dose-related, meaning that higher doses increase the risk. Interactions with other medications, renal or hepatic disease, and advanced age can also contribute to this risk.

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What is a potential side effect of statins on the liver?

Statins may cause liver damage, which may be asymptomatic. Regular monitoring of liver function is crucial while on statin therapy.

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Study Notes

Drugs for Dyslipidemias

  • Dyslipidemia is a condition involving abnormal levels of lipids (fatty substances) in the blood.
  • Lipids in the blood include triglycerides and cholesterol.
  • Water-insoluble fats require apoproteins (specialized lipid-carrying proteins) for transport in the blood.
  • Lipoproteins are combinations of triglycerides or cholesterol with apoproteins.

Types of Lipoproteins

  • Chylomicron: Lowest protein content
  • Very-low density lipoprotein (VLDL): Low protein content
  • Low Density Lipoprotein (LDL): Less protein than high-density lipoprotein (HDL)
  • Intermediate-density lipoprotein (IDL)
  • High-density lipoprotein (HDL): Highest protein content

Coronary Heart Disease (CHD)

  • Target total cholesterol in adults should be less than 200 mg/dL.
  • LDL levels between 100 and 130 mg/dL may be acceptable for those without risk factors.
  • High-risk individuals should aim for LDL levels below 70 mg/dL.
  • High-risk factors include family history of premature heart disease (father or brother diagnosed before 55, or mother or sister before 65), smoking, obesity, and diabetes.
  • Low levels of HDL (below 40 mg/dL) also present a high risk.
  • Triglyceride target is less than 150 mg/dL.

Drugs for Dyslipidemia

  • HMG-CoA reductase inhibitors (Statins): Lower cholesterol production in the liver
  • Cholesterol Absorption Inhibitors (Ezetimibe)
  • Fibric acid derivatives: Primarily lower triglycerides
  • Niacin (nicotinic acid): Used to lower triglycerides, and cholesterol if used in combination with statins.
  • Bile acid sequestrants (Colestipol, Cholestyramine): Reduce intestinal reabsorption of bile acids, affecting cholesterol levels.

Adverse Reactions

  • Myositis and Myopathy (muscle pain) including localized or diffuse muscle groups, mild to severe/life-threatening conditions (renal failure/rhabdomyolysis). Risks are dose-related and influenced by drug interactions and diseases of the liver or kidneys, and advanced age
  • Hepatotoxicity (liver damage): Possible asymptomatic liver effects
  • Drug interactions: Statins, Niacin, Fibrates

Important Considerations

  • Drugs for dyslipidemia are adjunctive to non-drug measures; their effects are predictable
  • Combined treatments may be beneficial with additional risks
  • Lipid-lowering drugs are not permanent cures
  • Potential dangers during pregnancy and breastfeeding exist with these medications
  • Patient treatment must consider actual lipid profiles, age, gender, other coronary risk factors, co-morbidities, and the effectiveness of non-drug measures

Additional Notes

  • PCSK9 inhibitors (e.g., evolocumab) are newer medications that target PCSK9, an enzyme affecting LDL receptor activity in the liver.
  • Lipid lowering implications require a thorough assessment of medical history, dietary habits, and lifestyle before medication initiation.
  • Cautious use, monitoring for side effects, and patient counseling about long-term management are crucial.

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