Chapter 10: Drug Therapy for Dyslipidemia

Question 1

Accumulation of abdominal body fat, resulting in an increased waist circumference.

Answer 1

Central adiposity.

Question 2

Component of the cell membrane that is produced and processed in the liver, a fat essential for the formation of steroid hormones that are produced in cells and taken in by dietary sources.

Answer 2

Cholesterol

Question 3

Abnormal lipid levels in the blood; associated with atherosclerosis and its many pathophysiologic effects. (Myocardial ischemia and infarction, stroke, peripheral arterial occlusive disease.)

Answer 3

Dyslipidemia.

Question 4

Specific proteins in plasma that transport blood lipids; contain cholesterol, phospholipid, and triglyceride bound to protein. They vary in density and amounts of lipids and proteins.

Answer 4

Lipoproteins

Question 5

A cluster of several cardiovascular risk factors linked with obesity; increased waist circumference, elevated triglycerides, reduced high-density lipoprotein cholesterol. elevated blood pressure, and elevated fasting glucose.

Answer 5

Metabolic syndrome.

Question 6

Total serum cholesterol (mg/dL) in Adults:

Answer 6

Desirable = <200 Borderline = 200–239 Undesirable = 240 or above

Question 7

LDL cholesterol (mg/dL) in Adults:

Answer 7

Desirable = <130 Borderline = 130–159 Undesirable = 160 or above

Question 8

HDL cholesterol (mg/dL) in adults:

Answer 8

Desirable = 40 or above* Undesirable = <40

Question 9

Triglycerides (mg/dL) in Adults:

Answer 9

Triglycerides (mg/dL) Desirable = <150 Borderline = 150–199 Undesirable = 200 or above

Question 10

Total serum cholesterol (mg/dL) in children:

Answer 10

Desirable = <170 Borderline = 170–199 Undesirable = 200 or above

Question 11

LDL cholesterol (mg/dL) in children:

Answer 11

Desirable = 110–129 Undesirable = >130 or above

Question 12

HDL cholesterol (mg/dL) in children

Answer 12

Desirable level = >45 Borderline = 35–45 Undesirable = <35

Question 13

Triglycerides (mg/dL) in children:

Answer 13

Desirable = <125 Undesirable = >125 or above

Question 14

What is Cholestyramine?

Answer 14

Cholestyramine (Prevalite, Questran), the prototype bile acid sequestrant, has the ability to reduce LDL cholesterol. It has little or no effect on HDL cholesterol and either no effect or an increased effect on triglyceride levels.

Question 15

Route and dosage ranges of Cholestyramine: Prevalite, Questran

Answer 15

PO tablets, 4 g once or twice daily initially, gradually increased at monthly intervals to 8–16 g daily in 2 divided doses. Maximum daily dose, 24 g PO powder, 4 g 1–6 times daily

Question 16

Route and dosage range of Fenofibrate (Antara, TriCor, Lofibra, Trilipix)

Answer 16

Fenofibrate (micronized) PO 67 mg three times daily with meals increased if necessary to a maximum dose of 268 mg (4 capsules) daily

Question 17

Ezetimibe (Zetia) Route and dosage range:

Answer 17

PO 10 mg once daily.

Question 18

Drugs that increase the effects of Atorvastatin:

Answer 18

Magnesium and aluminum containing antacids: Interfere with absorption.
Amiodarone and colchine: Decrease metabolism.
Azole Antifungals: Increase the risk of myopathy recommended that statin therapy be interrupted.
Cyclosporine, CYPA34 inhibitors, diltiazem, fibric acid derivatives, niacin, verapamil: Increase the risk of severe myopathy or rhabdomyolysis.
Erythromycin, macrolide antibiotics, nefazodone, and protease inhibitors Decrease elimination

Question 19

Drugs That Decrease the Effects of Atorvastatin

Answer 19

Cholestyramine Decreases rate of bioavailability; administer atorvastatin at least 4 hours after this bile acid sequestrant. Colestipol Decreases plasma levels

Question 20

Drugs That Increase the Effects of Fenofibrate

Answer 20

Statins Increase the risk of severe myopathy or rhabdomyolysis Cyclosporine Mechanism for increase is unknown.

Question 21

Drugs That Decrease the Effects of Fenofibrate

Answer 21

Bile acid sequestrant drugs Decrease absorption; to avoid, take fenofibrate about 1 hour before or 4 to 6 hours after the bile acid sequestrant.

Question 22

Drugs That Increase the Effects of Ezetimibe

Answer 22

Cyclosporine Increases blood levels

Question 23

Drugs That Decrease the Effects of Ezetimibe

Answer 23

Bile acid sequestrant drugs Mechanism for decrease is unknown.

Question 24

What drugs can Cholestyramine decrease the absorption of?

Answer 24

Cholestyramine may decrease absorption of many oral medications (e.g., digoxin, folic acid, glipizide, propranolol, tetracyclines, thiazide diuretics, thyroid hormones, fat-soluble vitamins, and warfarin).

Question 25

Route and dosage range of holestyramine (Prevalite, Questran;

Answer 25

PO tablets, 4 g once or twice daily initially, gradually increased at monthly intervals to 8–16 g daily in 2 divided doses. Maximum daily dose, 24 g PO powder, 4 g 1–6 times daily

Question 26

Route and dosage ranges of Alirocumab (Praluent)

Answer 26

Sub-Q: 75–150 mg every 2 wk

Question 27

Route and dosage ranges of Niacin (immediate release) (Niacor, Niaspan

Answer 27

PO 1–6 g daily, in 3 or 4 divided doses, with or just after meals