Test Bank for Patient Centered Pharmacology by Tindall

Test Bank for Patient Centered Pharmacology by

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Chapter 8. Drugs Used in the Treatment of Hyperlipidemias

Multiple Choice
Identify the choice that best completes the statement or answers the question.

____ 1. Which condition is a contraindication to prescribing a statin?

A. Testosterone deficiency
B. Elevated liver function test results
C. Anemia
D. Elevated hemoglobin level and hematocrit
____ 2. While on statin therapy, a patient should limit which common beverage?
A. Milk
B. Apple juice
C. Grapefruit juice
D. Soda
____ 3. When should liver function tests be performed for a patient on statin therapy?
A. Baseline, 6 months, 12 months, and then annually
B. Baseline, 6 months, and then annually
C. 1 month, 2 months, then at 6-month intervals
D. 1 month, 6 months, 12 months, and then annually
____ 4. Which option describes the mechanism of action of statins?
A. Enhances conversion of 3-hydroxy-3 methylglutaryl coenzyme A (HMG-CoA),
the transmembrane protein that catalyzes a key step in the mevalonate pathway
B. Inhibits conversion of HMG-CoA
C. Increases fatty acid release from adipose tissue and inhibits fatty acid and
triglyceride synthesis in the liver
D. Increases fatty acid release from adipose tissue and increases fatty acid and
triglyceride synthesis in the liver
____ 5. The half-life of rosuvastatin (Crestor) is:
A. 1.2 hours.
B. 2 hours.
C. 14 hours.
D. 19 hours.
____ 6. Statins are metabolized via the:
A. Kidneys.
B. Liver.
C. Large bowel.
D. Small bowel.
____ 7. Any statin can be used to treat which condition?
A. Heterozygous familial hypercholesterolemia in adolescents
B. Homozygous familial hyperlipidemia
C. Hypertriglyceridemia
 D. Mixed dyslipidemia
____ 8. Which effect is considered a serious adverse reaction to statin therapy?
A. Rhinitis
B. Altered taste
C. Rhabdomyolysis
D. Headache
____ 9. Which natural product may reduce the effectiveness of statins?
A. Yohimbe
B. St. John’s wort
C. Vitamin C
D. Chromium
____ 10. Bile acid sequestrants are excreted via:
A. Urine.
B. Feces.
C. Skin.
D. Large bowel.
____ 11. Bile acid sequestrants cause which effects?
A. Reduce LDL and HDL cholesterol
B. Reduce LDL cholesterol and increase HDL cholesterol
C. Reduce LDL and total cholesterol
D. Reduce LDL cholesterol and increase triglycerides
____ 12. Bile acid sequestrants are not recommended for monotherapy if triglyceride levels are more than:
A. 100 mg/dl.
B. 200 mg/dl.
C. 300 mg/dl.
D. 400 mg/dl.
____ 13. The bile acid sequestrant cholestyramine (Questran, Prevalite) is used to treat hyperlipidemia and
what other condition?
A. Adult onset acne
B. Pruritus associated with partial biliary obstruction
C. Exercise-induced pruritus
D. Urticaria of unknown etiology
____ 14. Bile acid sequestrants may cause a deficiency of which vitamin?
A. Vitamin A
B. Vitamin B1
C. Vitamin B6
D. Vitamin C
____ 15. Bile acid sequestrants are taken via which route?
A. Injection
B. Oral
C. Transdermal
 D. Rectal
____ 16. The typical starting dose of any statin is:
A. 10 mg.
B. 20 mg.
C. 30 mg.
D. 40 mg.
____ 17. Which findings are indications to begin niacin drug therapy?
A. Low triglycerides, low HDL cholesterol, and elevated LDL cholesterol
B. Elevated triglycerides, elevated HDL cholesterol, and elevated LDL cholesterol
C. Elevated triglycerides, low HDL cholesterol, and elevated LDL cholesterol
D. Elevated triglycerides, low HDL cholesterol, and low LDL cholesterol
____ 18. Which substance can be taken 30 minutes prior to taking niacin to reduce flushing and pruritus?
A. Aspirin
B. Caffeine
C. Coffee
D. Tylenol
____ 19. What is the mechanism of action of niacin?
A. Inhibits fatty acid release from adipose tissue and inhibits fatty acid and
triglyceride synthesis in the liver
B. Increases fatty acid release from adipose tissue and inhibits fatty acid and
triglyceride synthesis in the liver
C. Increases fatty acid release from adipose tissue and increases fatty acid and
triglyceride synthesis in the liver
D. Inhibits fatty acid release from adipose tissue and increases fatty acid and
triglyceride synthesis in the liver
____ 20. The most common adverse effect of niacin and the number one reason it is discontinued is:
A. Headache.
B. Muscle pain.
C. Facial flushing.
D. Elevations of liver enzymes.
____ 21. Niacin is excreted via:
A. Feces.
B. Large bowel.
C. Skin.
D. Urine.
____ 22. When niacin is given concomitantly with some antihypertensive medications, which reaction can
occur?
A. Headache
B. Postural hypotension
C. Postural hypertension
D. Vomiting
____ 23. What is the half-life of ezetimibe (Zetia)?
A. 12 hours
B. 22 hours
C. 28 hours
D. 32 hours
____ 24. What is the typical dose of ezetimibe (Zetia)?
A. 5 mg
B. 10 mg
C. 15 mg
D. 20 mg
____ 25. Ezetimibe (Zetia) is secreted primarily via:
A. Skin.
B. Stomach.
C. Feces.
D. Urine.
____ 26. When concomitantly taking a statin, ezetimibe (Zetia) can be taken:
A. At the same time as the statin.
B. 1 hour before taking the statin.
C. 2 hours before taking the statin.
D. 4 hours after taking the statin.
____ 27. When concomitantly taking a bile acid sequestrant, ezetimibe (Zetia) can be taken:
A. At the same time as the bile acid sequestrant.
B. 30 minutes before taking the bile acid sequestrant.
C. 60 minutes before taking the bile acid sequestrant.
D. 120 minutes before taking the bile acid sequestrant.
____ 28. Which patient has contraindications to the prescription of ezetimibe (Zetia)?
A. An individual on a statin with hepatitis
B. An individual on a statin with diabetes
C. An individual on a statin with gout
D. An individual on a statin with hypertension
____ 29. Fibric acid derivatives are primarily prescribed to:
A. Lower LDLs and HDLs.
B. Lower triglycerides and HDLs.
C. Lower triglycerides and increase HDLs.
D. Increase LDLs and HDLs.
____ 30. After oral administration, what percentage of fibric acid derivatives is absorbed?
A. 10%
B. 20%
C. 40%
D. 60%
____ 31. What is the half-life of the fibric acid derivative gemfibrozil (Lopid)?
 A. 1.5 hours
B. 5 hours
C. 12 hours
D. 20 hours
____ 32. What is the trade name for clofibrate?
A. TriCor
B. Triglide
C. Antara
D. Atromid-S
____ 33. Which of the following is a cardiovascular adverse reaction that can occur in patients taking
gemfibrozil (Lopid)?
A. Myocardial infarction
B. Arrhythmias
C. Hypertension
D. Hypotension
____ 34. Absorption of fibric acid derivatives is reduced by the presence of which of the following?
A. Niacin
B. Statins
C. Bile acid sequestrants
D. Red wheat rice
____ 35. Concurrent use of a fibric acid derivative with which substance increases the risk of
rhabdomyolysis?
A. Niacin
B. HMG-CoA reductase inhibitor
C. Ezetimibe
D. Red wheat rice
____ 36. What is the staring dose of ezetimibe/simvastatin (Vytorin)?
A. 5 mg/10 mg
B. 10 mg/10 mg
C. 10 mg/20 mg
D. 20 mg/20 mg
____ 37. How should niacin/simvastatin (Symcor) be taken?
A. 500 mg/20 mg daily at bedtime with a snack
B. 20 mg/500 mg daily at bedtime on an empty stomach
C. 500 mg/20 mg twice a day
D. 20 mg/500 mg twice a day
____ 38. What is the trade name of amlodipine besylate/atorvastatin calcium?
A. Caduet
B. Advicor
C. Vytorin
D. Symcor
____ 39. Vytorin is a common combined drug used to treat elevated cholesterol that is composed of which
two drugs?
A. amlodipine besylate and atorvastatin calcium
B. niacin and lovastatin
C. ezetimibe and simvastatin
D. niacin and simvastatin
____ 40. Statins are in which U.S. Food and Drug Administration (FDA) pregnancy safety category?
A. Category A
B. Category B
C. Category C
D. Category X
Chapter 8. Drugs Used in the Treatment of Hyperlipidemias
Answer Section

MULTIPLE CHOICE

1. ANS: B
Contraindications to prescribing a statin include liver disease and a history of alcoholism.

PTS: 1 TOP: HMG-CoA Reductase Inhibitors

2. ANS: C
Patients taking certain statins should limit their intake of grapefruit juice because it can result in
increased plasma levels of statins, increasing the risk of myopathy. Suggested ingestion of
grapefruit juice is 200 ml/day, or about 6 oz taken at least 2 hours before ingestion of the statin.

PTS: 1 TOP: HMG-CoA Reductase Inhibitors

3. ANS: A
In addition to being performed at baseline, liver function tests should be performed every 6 months
during the first year and then annually for patients taking statins.

PTS: 1 TOP: Statins

4. ANS: B
Statins inhibit conversion of HMG-CoA, the enzyme that catalyses early steps in cholesterol
synthesis. Subsequently, total cholesterol and low-density lipoprotein (LDL) cholesterol as well as
triglycerides decrease, and a slight elevation in high-density lipoproteins (HDL) occurs. Statins’
peak effects take place usually after about 4 weeks of use.

PTS: 1 TOP: HMG-CoA Reductase Inhibitors

5. ANS: D
The half-life of rosuvastatin is 19 hours.

PTS: 1 TOP: HMG-CoA Reductase Inhibitors

6. ANS: B
All statin agents are extensively metabolized in the liver.

PTS: 1 TOP: HMG-CoA Reductase Inhibitors

7. ANS: D
Any statin can be used to treat mixed dyslipidemia.

PTS: 1 TOP: HMG-CoA Reductase Inhibitors

8. ANS: C
Rhabdomyolysis is considered a serious adverse reaction to statin therapy.

PTS: 1 TOP: HMG-CoA Reductase Inhibitors

9. ANS: B
St. John’s wort may reduce the serum levels and effectiveness of statins.
 PTS: 1 TOP: HMG-CoA Reductase Inhibitors
10. ANS: B
Bile acid sequestering resins bind to bile acids in the intestine to form an insoluble complex that is
excreted in the feces.

PTS: 1 TOP: Bile Acid Sequestrants

11. ANS: B
Resins reduce LDL cholesterol from 15% to 30% with a modest increase in HDL cholesterol.

PTS: 1 TOP: Bile Acid Sequestrants

12. ANS: D
Bile acid sequestrants are not recommended as monotherapy in patients with triglyceride levels
higher than 400 mg/dl or in patients with familial dysbetalipoproteinemia. They may be used as
monotherapy in patients with triglyceride levels less than 200 mg/dl.

PTS: 1 TOP: Bile Acid Sequestrants

13. ANS: B
The bile acid sequestrant cholestyramine is used to treat hyperlipidemia and pruritus, which is
associated with excessive levels of bile acids in the bloodstream and the resultant deposit of bile
acids in the skin.

PTS: 1 TOP: Bile Acid Sequestrants

14. ANS: A
Possible adverse reactions to bile acid sequestrants include vitamin A, D, E, and K deficiency.

PTS: 1 TOP: Bile Acid Sequestrants

15. ANS: B
Instruct patients not to take the powder and dried forms alone but instead to mix them with at least
a full 8 oz glass of beverage. Also, instruct patients to swallow, not chew or crush, tablets.

PTS: 1 TOP: Bile Acid Sequestrants

16. ANS: B
The most effective starting recommended dose by manufacturer is 20 mg.

PTS: 1 TOP: Statins

17. ANS: C
Niacin (vitamin B3) has broad use in the treatment of lipid disorders when used at higher doses
than those used for nutritional supplements. It is indicated for patients with elevated triglycerides,
low HDL cholesterol, and elevated LDL cholesterol.

PTS: 1 TOP: Niacin

18. ANS: A
The use of 300 mg of aspirin, or another NSAID, 30 minutes prior to taking niacin can help control
the cutaneous reactions of flushing and pruritus of the face and body.
 PTS: 1 TOP: Niacin
19. ANS: A
In large doses, niacin inhibits fatty acid release from adipose tissue and inhibits fatty acid and
triglyceride synthesis in the liver. The result is increased intracellular degradation of
apolipoprotein B and, in turn, a reduction in the number of LDL particles secreted. Thus, niacin
reduces triglyceride synthesis which, in turn, leads to lower levels of VLDL and thus lower levels
of LDLs and higher levels of HDL.

PTS: 1 TOP: Niacin

20. ANS: C
Facial flushing is the most common adverse effect of niacin and the number one reason it is
discontinued.

PTS: 1 TOP: Niacin

21. ANS: D
Niacin and its metabolites are rapidly eliminated in the urine.

PTS: 1 TOP: Niacin

22. ANS: B
Antihypertensive therapy potentiates the effects of ganglionic blocking agents and vasoactive
drugs, resulting in postural hypotension.

PTS: 1 TOP: Niacin

23. ANS: B
The half-life of ezetimibe is 22 hours.

PTS: 1 TOP: Cholesterol Absorption Inhibitors

24. ANS: B
The typical dosage of ezetimibe is 10 mg once a day with or without food.

PTS: 1 TOP: Cholesterol Absorption Inhibitors

25. ANS: C
Ezetimibe is secreted mostly by biliary/feces elimination and has minimal renal excretion.

PTS: 1 TOP: Cholesterol Absorption Inhibitors

26. ANS: A
The daily dose of ezetimibe may be taken at the same time as statins or fenofibrate.

PTS: 1 TOP: Cholesterol Absorption Inhibitors

27. ANS: D
Dosing of ezetimibe should occur at least 2 hours before or at least 4 hours after administration of
a bile acid sequestrant.

PTS: 1 TOP: Cholesterol Absorption Inhibitors

28. ANS: A
 The combination of ezetimibe with a statin is contraindicated in patients with active liver disease
or unexplained persistent elevations in serum transaminase.

PTS: 1 TOP: Cholesterol Absorption Inhibitors

29. ANS: C
The predominant effects of the fibric acid derivatives gemfibrozil (Lopid), fenofibrate (TriCor),
and clofibrate (Atromid-S), which are synthetic drugs, are decreased triglyceride levels (by 20% to
50%) and increased HDLs (by 9% to 30%).

PTS: 1 TOP: Fibric Acid Derivatives

30. ANS: D
Fibric acids derivatives are well absorbed (60%) after oral administration.

PTS: 1 TOP: Fibric Acid Derivatives

31. ANS: A
The half-life of gemfibrozil is 1.5 hours.

PTS: 1 TOP: Fibric Acid Derivatives

32. ANS: D
The trade name for clofibrate is Atromid-S.

PTS: 1 TOP: Fibric Acid Derivatives

33. ANS: B
Arrhythmias are a cardiovascular adverse reaction to gemfibrozil.

PTS: 1 TOP: Fibric Acid Derivatives

34. ANS: C
Bile acid sequestrants reduce the absorption of fibrates.

PTS: 1 TOP: Fibric Acid Derivatives

35. ANS: B
Concurrent use of fibric acid and an HMG-CoA reductase inhibitor increases the risk of
rhabdomyolysis.

PTS: 1 TOP: Fibric Acid Derivatives

36. ANS: C
This drug is used as adjunctive therapy to diet for the reduction of elevated total cholesterol, LDL
cholesterol, apolipoprotein B, triglycerides, and non-HDL cholesterol and increased HDL
cholesterol. The usual starting dose is 10 mg/20 mg, and the maximum dose is 10 mg/80 mg.

PTS: 1 TOP: Combination Therapy for Hyperlipidemias

37. ANS: A
Niacin/simvastatin should be taken 500 mg ER/20 mg to 1,000 mg ER/40 mg at night.

PTS: 1 TOP: Combination Therapy for Hyperlipidemias

38. ANS: A
Test Bank for Patient Centered Pharmacology by Tindall

The trade name of amlodipine besylate/atorvastatin calcium is Caduet.

PTS: 1 TOP: Combination Therapy for Hyperlipidemias

39. ANS: C
Vytorin is composed of ezetimibe and simvastatin.

PTS: 1 TOP: Combination Therapy for Hyperlipidemias

40. ANS: D
Statins are in FDA pregnancy safety category X.

PTS: 1 TOP: Statins

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