Lippincott Chapter 23: Drugs For Hyperlipidemia Flashcards
23.1 Which one of the following is the most common side
effect of antihyperlipidemic drug therapy?
A. Elevated blood pressure.
B. Gastrointestinal disturbance.
C. Neurologic problems.
D. Heart palpitations.
E. Migraine headaches.
Correct answer = B. Gastrointestinal disturbances fre-
quently occur as a side effect of antihyperlipidemic drug
therapy. The other choices are not seen as commonly.
23.2 Which one of the following hyperlipidemias is
characterized by elevated plasma levels of chylomicrons
and has no drug therapy available to lower the plasma
lipoprotein levels?
A. Type I.
B. Type II.
C. Type III.
D. Type IV.
E. Type V.
Correct answer = A. Type I hyperlipidemia (hyperchylomi-
cronemia) is treated with a low-fat diet. No drug therapy is
effective for this disorder.
23.3 Which one of the following drugs decreases cholesterol
synthesis by inhibiting the enzyme 3-hydroxy-3-
methylglutaryl coenzyme A reductase?
A. Fenofibrate.
B. Niacin.
C. Cholestyramine.
D. Lovastatin.
E. Gemfibrozil.
Correct answer = D. Lovastatin decreases cholesterol syn-
thesis by inhibiting HMG CoA reductase. Fenofibrate and
gemfibrozil increase the activity of lipoprotein lipase, thereby
increasing the removal of VLDL from plasma. Niacin inhib-
its lipolysis in adipose tissue, thus eliminating the building
blocks needed by the liver to produce triglycerides and,
therefore, VLDL. Cholestyramine lowers the amount of bile
acids returning to the liver via the enterohepatic circulation.
23.4 Which one of the following drugs causes a decrease in
liver triglyceride synthesis by limiting available free fatty
acids needed as building blocks for this pathway?
A. Niacin.
B. Fenofibrate.
C. Cholestyramine.
D. Gemfibrozil.
E. Lovastatin
Correct answer = A. At gram doses, niacin strongly inhib-
its lipolysis in adipose tissue—the primary producer of cir-
culating free fatty acids. The liver normally utilizes these
circulating fatty acids as a major precursor for triglyceride
synthesis. Thus, niacin causes a decrease in liver triglyc-
eride synthesis, which is required for VLDL production. The
other choices do not inhibit lipolysis in adipose tissue.
23.5 Which one of the following drugs binds bile acids in the
intestine, thus preventing their return to the liver via the
enterohepatic circulation?
A. Niacin.
B. Fenofibrate.
C. Cholestyramine.
D. Fluvastatin.
E. Lovastatin.
Correct answer = C. Cholestyramine is an anion-exchange
resin that binds negatively charged bile acids and bile
salts in the small intestine. The resin/bile acid complex is
excreted in the feces, thus preventing the bile acids from
returning to the liver by the enterohepatic circulation. The
other choices do not bind intestinal bile acids.
23.6 JS is a 65-year-old man who presents to his physician
for management of hyperlipidemia. His most recent
lipid panel reveals an LDL cholesterol level of 165 mg/
dL. His physician wishes to begin treatment to lower his
LDL cholesterol levels. Which of the following therapies
is the best option to lower JS’s LDL cholesterol levels?
A. Fenofibrate.
B. Colesevelam.
C. Niacin.
D. Simvastatin.
E. Ezetimibe.
Correct answer = D. Simvastatin, an HMG CoA reductase
inhibitor (statin), is the most effective option for lowering
LDL cholesterol, achieving reductions of 30% to 41% from
baseline levels. Fenofibrate and niacin are more effective
at lowering triglyceride levels or raising HDL levels (niacin).
Colesevelam can reduce LDL levels but not as effectively as
statins. Ezetimibe lowers LDL levels modestly compared to
the LDL reduction achieved by statins.
23.7 WW is a 62-year-old female with hyperlipidemia and
hypothyroidism. Her current medications include
cholestyramine and levothyroxine (thyroid hormone).
What advice would you give to WW to avoid a
drug interaction between her cholestyramine and
levothyroxine?
A. Stop taking the levothyroxine as it can interact
with cholestyramine.
B. Take levothyroxine 1 hour before cholestyramine
on an empty stomach.
C. Switch cholestyramine to colesevelam as this will
eliminate the interaction.
D. Switch cholestyramine to colestipol as this will
eliminate the interaction.
E. Take levothyroxine and cholestyramine at the
same time to minimize the interaction.
Correct answer = B. Cholestyramine and the bile acid resins
can bind several medications causing decreased absorp-
tion. Cholestyramine can decrease absorption of medica-
tions such as levothyroxine. Taking levothyroxine 1 hour
before or 4 to 6 hours after cholestyramine can help to avoid
this interaction. Choices C and D are incorrect, as all bile
acid resins cause this interaction. Choice A is incorrect, as
this patient should not stop her thyroid medication. Choice
E will worsen this drug interaction
23.8 AJ is a 42-year-old man who was started on niacin
sustained-release tablets 2 weeks ago for elevated
triglycerides and low HDL levels. He is complaining
of an uncomfortable flushing and itchy feeling that he
thinks is related to the niacin. Which of the following
options can help AJ manage this adverse effect of
niacin therapy?
A. Administer aspirin 30 minutes prior to taking
niacin.
B. Administer aspirin 30 minutes after taking niacin.
C. Increase the dose of niacin SR to 1000 mg.
D. Continue the current dose of niacin.
E. Change the sustained-release niacin to
immediate-release niacin.
Correct answer = A. Flushing associated with niacin is
prostaglandin mediated; therefore, use of aspirin (a prosta-
glandin inhibitor) can help to minimize this adverse effect.
It must be administered 30 minutes prior to the dose of
the niacin; therefore, choice B is incorrect. Increasing the
dose of niacin is likely to increase these complaints; there-
fore, choice C is incorrect. Continuing the current dose is
unlikely to relieve these complaints, which are bothersome
to AJ. The sustained-release formulation of niacin has less
incidence of flushing versus that of the immediate release;
therefore, choice E is incorrect.
23.9 CN is a 72-year-old male who is treated for hyperlipidemia
with high-dose atorvastatin for the past 6 months. He
also has a history of renal insufficiency. His most
recent lipid panel shows an LDL cholesterol level
of 131 mg/dL, triglycerides of 510 mg/dL, and HDL
cholesterol of 32 mg/dL. His physician wishes to add
an additional agent for his hyperlipidemia. Which of
the following choices is the best option to address
CN’s dyslipidemia?
A. Fenofibrate.
B. Niacin.
C. Colesevelam.
D. Gemfibrozil.
E. Ezetimibe.
Correct answer = B. This patient has significantly elevated
triglycerides and low HDL. Niacin can lower triglycerides by
35% to 50% and also raise HDL levels. The fibrates (feno-
fibrate and gemfibrozil) should not be used due to CN’s
history of renal insufficiency. Use of colesevelam is contra-
indicated because triglycerides are greater than 400 mg/dL.
Ezetimibe can further lower LDL cholesterol but has modest
effects on triglycerides versus niacin.
23.10 Which of the following patient populations is more
likely to experience myalgia (muscle pain) or myopathy
with use of HMG CoA reductase inhibitors?
A. Patients with diabetes mellitus.
B. Patients with renal insufficiency.
C. Patients with gout.
D. Patients with hypertriglyceridemia.
E. Patients taking warfarin (blood thinner).
Correct answer = B. Patients with a history of renal insuf-
ficiency have a higher incidence of developing myalgias,
myopathy, and rhabdomyolysis with use of HMG CoA
reductase inhibitors (statins), especially with those that are
renally eliminated as drug accumulation can occur. The
other populations have not been reported to have a higher
incidence of this adverse effect with HMG CoA reductase
inhibitors.
