Module 2: Dyslipidemia

Bad lipoprotein; main transport for triglycerides

A) Chylomicrons

B) LDL

C) HDL

D) VLDL

E) IDL

A

Bad lipoprotein; main transport for cholesterol (carry cholesterol to cells)

A) IDL

B) Chylomicrons

C) VLDL

D) HDL

E) LDL

E

Transports cholesterol away from the blood vessels; carries cholesterol away from cells. Exact protective mechanism unknown

A) VLDL

B) HDL

C) IDL

D) LDL

E) Chylomicrons

B

Undesirable levels of total serum cholesterol (mg/dL)

A) >160

B) <40

C) >240

D) 200-239

E) >200

C

Borderline levels of total serum cholesterol (mg/dL)

A) >160

B) <40

C) >240

D) 200-239

E) >200

D

Borderline levels of LDL

A) >160

B) 130-159

C) 150-199

D) 200-239

E) >200

B

Undesirable levels of LDL

A) >160

B) >240

C) <40

D) 200-239

E) >200

A

Desirable levels of HDL

A) >160

B) >240

C) >40

D) >200

E) <40

C

Undesirable levels of HDL

A) >200

B) <40

C) >160

D) >40

E) >240

B

Borderline level of Triglycerides

A) 150-199

B) 130-159

C) >160

D) 200-239

E) >200

A

Undesirable levels of Triglycerides

A) 150-199

B) 130-159

C) >160

D) 200-239

E) >200

E

A drug class has this mechanism of action and use:

• Inhibits enzyme primarily responsible for hepatic synthesis of cholesterol

• Treat hypercholesterolemia/dyslipidemia ; reduce risk of CV events

• lowers LDL, TG, and increases HDL

What is the name of the drug class?

A) PCSK9 Inhibitors

B) Bile acid sequestrants

C) Fibric acid derivatives

D) HMG-CoA reductase inhibitors (statins)

E) Cholesterol absorption inhibitors

D

Which drugs lower LDL cholesterol, TG, and increases HDL levels?

A) HMG-CoA reductase inhibitors (statins)

B) Cholesterol absorption inhibitors

C) Fibric acid derivatives

D) Bile acid sequestrants

E) PCSK9 Inhibitors

F) Niacin

A

Which drugs are best in their class for lowering LDL cholesterol?

A) Fibric acid derivatives

B) Cholesterol absorption inhibitors

C) PCSK9 Inhibitors

D) Bile acid sequestrants

E) HMG-CoA reductase inhibitors (statins)

E

Which dyslipidemia drugs have a pregnancy category X?

A) HMG-CoA reductase inhibitors (statins)

B) Bile acid sequestrants

C) Niacin

D) PCSK9 Inhibitors

E) Fibric acid derivatives

F) Cholesterol absorption inhibitors

A

Which is the drug prototype for bile acid sequestrants?

A) Atorvastatin

B) Ezetimibe

C) Cholestyramine (Prevalite, Questran)

D) Fenofibrate (Tricor)

E) Alirocumab

F) Niacin (Niacor, Niaspan)

C

Which dyslipidemia drug is contraindicated in pregnancy and lactation and not recommended for patients with severe hepatic impairment?

A) Bile acid sequestrants

B) PCSK9 Inhibitors

C) Niacin

D) HMG-CoA reductase inhibitors (statins)

E) Cholesterol absorption inhibitors

F) Fibric acid derivatives

E

Which drug should be taken at evening/night time

A) Statins

B) Cholestyramine

C) PCKS9 inhibitors

D) Cholesterol absorption inhibitors

E) Fenofibrate

F) Niacin

A

Which type of dyslipidemia drug has this side effect description: “Usually tolerated well, but can cause myopathy, affect patients with hepatic dysfunction, rhabdomyolysis, and increase blood glucose (increase risk of developing diabetes).”

A) HMG-CoA reductase inhibitors (statins)

B) Fibric acid derivatives

C) Bile acid sequestrants

D) PCSK9 Inhibitors

E) Niacin

F) Cholesterol absorption inhibitors

A

Statin side effects

Myopathy, rhabdomyolysis, increase blood glucose

Myopathy

• Muscle pain/weakness associated with statin use

• Can range from mild to severe

Rhabdomyolysis

• Severe, potentially life-threatening side effect

• Muscle is broken down, releasing enzymes which can damage the kidneys

How to alleviate myopathy side effect in statins?

Can lower dose or try a different statin

A patient is given a statin to treat their cholesterol levels. What is a sign that patient is experiencing rhabdomyolysis?

Watch for dark, cola-colored urine

Drugs that can increase risk of statin toxicity? Choose all that apply:

A) Azole antifungals (fluconazole)

B) Bile acid derivaties

C) Macrolide antibiotics (erythromycin)

D) Fibric acid derivatives (fenofibrate)

E) Grapefruit juice (CYP-450 inhibitor)

F) PCSK9 inhibitors

A, C, D, E

Atorvastatin is the prototype drug to:

A) Fibric acid derivatives

B) Niacin

C) PCSK9 Inhibitors

D) Cholesterol absorption inhibitors

E) HMG-CoA reductase inhibitors (statins)

F) Bile acid sequestrants

E

Cholestyramine (Prevalite, Questran) is a prototype drug to:

A) Colesevalm (Welchol); Colestipol (Colestid)

B) Fenofibrate (Tricor)

C) Gemfibrozil (Lopid)

D) Evolocumab (Repatha)

E) Alirocumab (Praluent)

A

Fenofibrate (Tricor) is a prototype drug to:

A) Colesevalm (Welchol); Colestipol (Colestid)

B) Fenofibrate (Tricor)

C) Gemfibrozil (Lopid)

D) Evolocumab (Repatha)

E) Alirocumab (Praluent)

C

Alirocumab is a prototype drug to:

A) Colesevalm (Welchol); Colestipol (Colestid)

B) Fenofibrate (Tricor)

C) Gemfibrozil (Lopid)

D) Evolocumab (Repatha)

D

A drug class has mechanism of action and use:

• Binds to bile acids, causing them to be excreted in the feces. Results in liver using excess cholesterol to make new bile acids

• Used to decrease LDL; little to no effect on TG or HDL

Which drug class is this?

A) PCSK9 Inhibitors

B) Fibric acid derivatives

C) Cholesterol absorption inhibitors

D) Niacin

E) Bile acid sequestrants

F) HMG-CoA reductase inhibitors (statins)

E

Which drugs decrease efficacy of statins as well as many orally taken drugs?

A) Fibric acid derivatives

B) Cholesterol absorption inhibitors

C) PCSK9 Inhibitors

D) Bile acid sequestrants

E) HMG-CoA reductase inhibitors (statins)

D

Which drug class may require the patient to take fat-soluble vitamin supplements (A, D, E, K)?

A) PCSK9 Inhibitors

B) Fibric acid derivatives

C) Cholesterol absorption inhibitors

D) Bile acid sequestrants

E) HMG-CoA reductase inhibitors (statins)

D

Which type of dyslipidemia drug has this side effect description: “Most side effects are GI-related, such as constipation, N/V/D, etc.”

A) Bile acid sequestrants

B) Misc. dyslipidemia agent (Niacin)

C) HMG-CoA reductase inhibitors (statins)

D) Fibric acid derivatives

E) Cholesterol absorption inhibitors

F) PCSK9 Inhibitors

A

Which is the drug prototype for fibric acid derivatives?

A) Ezetimibe

B) Niacin (Niacor, Niaspan)

C) Atorvastatin

D) Alirocumab

E) Fenofibrate (Tricor)

F) Cholestyramine

E

A drug class has mechanism of action and use:

• Decrease hepatic production of TG, decrease VLDL cholesterol, increase HDL

• Most effective at lowering serum TG

Which drug class is this?

A) Niacin

B) HMG-CoA reductase inhibitors (statins)

C) Bile acid sequestrants

D) PCSK9 Inhibitors

E) Fibric acid derivatives

F) Cholesterol absorption inhibitors

E

Which drug is most effective at lowering serum TG?

A) Cholesterol absorption inhibitors

B) Fibric acid derivatives

C) Bile acid sequestrants

D) Misc. dyslipidemia agent (Niacin)

E) PCSK9 Inhibitors

F) HMG-CoA reductase inhibitors (statins)

B

Which drug is contraindicated in patients with severe renal impairment or liver disease?

A) Fibric acid derivatives

B) PCSK9 Inhibitors

C) Bile acid sequestrants

D) HMG-CoA reductase inhibitors (statins)

E) Cholesterol absorption inhibitors

A

Fibrates can cause or worsen both severe renal impairment or liver disease.

A) True

B) False

A

Which type of dyslipidemia drug has these nursing considerations: “Increased risk of bleeding from anticoagulants; contraindicated for patients with severe renal impairment or liver disease.”

A) PCSK9 Inhibitors

B) Fibric acid derivatives

C) Bile acid sequestrants

D) HMC-CoA reductase inhibitors (statins)

E) Cholesterol absorption inhibitors

F) Misc. dyslipidemia agent

B

What are fibric acid derivative drugs indicated for?

TG > 500 mg/dL

A dyslipidemia drug is indicated for a patient who has a TG 521 mg/dL. What type of drug is it?

A) PCSK9 Inhibitors

B) Bile acid sequestrants

C) Fibric acid derivatives

D) Cholesterol absorption inhibitors

E) HMG-CoA reductase inhibitors (statins)

C

Which dyslipidemia drugs reduce LDL? Choose all that apply.

A) PCSK9 Inhibitors

B) Bile acid sequestrants

C) Cholesterol absorption inhibitors

D) Fibric acid derivatives

E) HMG-CoA reductase inhibitors (statins)

A, B, F

A drug class has mechanism of action and use

• Blocks biliary and dietary cholesterol absorption

• Used to treat dyslipidemia (monotherapy or combo with statin); has same, but smaller effect as statins

Which drug class is this?

A) Fibric acid derivatives

B) PCSK9 Inhibitors

C) Cholesterol absorption inhibitors

D) HMG-CoA reductase inhibitors (statins)

E) Bile acid sequestrants

C

Which type of dyslipidemia drug can be used in monotherapy or can be used in combination with statins?

A) HMG-CoA reductase inhibitors (statins)

B) Fibric acid derivatives

C) Cholesterol absorption inhibitors

D) Bile acid sequestrants

E) PCSK9 Inhibitors

C

Which type of dyslipidemia drug is not recommended in patients with severe hepatic impairment?

A) HMG-CoA reductase inhibitors (statins)

B) PCSK9 Inhibitors

C) Cholesterol absorption inhibitors

D) Fibric acid derivatives

E) Bile acid sequestrants

D

Which type of dyslipidemia drug has these nursing considerations: “Contraindicated in pregnancy and lactation, Not recommended in patients with severe hepatic impairment.”

A) Cholesterol absorption inhibitors

B) PCSK9 Inhibitors

C) Fibric acid derivatives

D) HMG-CoA reductase inhibitors (statins)

E) Bile acid sequestrants

F) Misc. dyslipidemia agent (Niacin)

A

This drug class has mechanism of action and use

• Increases activity of the receptor that clear cholesterol

• Used for adults with ASCVD & familial hypercholesterolemia (same/better effect as statins)

Which drug class is this?

A) Cholesterol absorption inhibitors

B) Bile acid sequestrants

C) PCSK9 Inhibitors

D) Fibric acid derivatives

E) HMG-CoA reductase inhibitors (statins)

C

Which type of dyslipidemia drug has these nursing conditions: “Given by Sub-Q injection; seems to be well tolerated; very expensive.”

A) PCSK9 Inhibitors

B) Bile acid sequestrants

C) HMG-CoA reductase inhibitors (statins)

D) Fibric acid derivatives

E) Cholesterol absorption inhibitors

F) Misc. dyslipidemia agent (Niacin)

A

Which dyslipidemia drug is given by Sub-Q injection?

A) Fibric acid derivatives

B) Cholesterol absorption inhibitors

C) Bile acid sequestrants

D) HMG-CoA reductase inhibitors (statins)

E) PCSK9 Inhibitors

E

Which dyslipidemia drug is noted be very expensive?

A) Bile acid sequestrants

B) Fibric acid derivatives

C) Cholesterol absorption inhibitors

D) PCSK9 Inhibitors

E) HMG-CoA reductase inhibitors (statins)

F) Misc. dyslipidemia agent (Niacin)

D

What are PCSK9 drugs used for?

A) Dyslipidemia (either alone or with statins)

B) ACSVD and familial hypercholesterolemia; similar use to statins

C) Lowering TG levels

D) Decrease LDL (but little effect on TG and HDL)

B

Niacin mechanism of action and use

A) No longer recommended

B) inhibits enzyme primarily responsible for hepatic synthesis of cholesterol; reduce risk of CV events and treat hypercholesteremia

C) Binds to bile acids, causing them to be excreted in the feces. Results in liver using excess cholesterol to make new bile acids

D) Decrease hepatic production of TG, decrease VLDL cholesterol, increase HDL

A

Which type of dyslipidemia drug is no longer recommended?

A) Cholesterol absorption inhibitors

B) Niacin

C) Fibric acid derivatives

D) Bile acid sequestrants

E) PCSK9 Inhibitors

F) HMG-CoA reductase inhibitors (statins)

B

Nursing considerations for Niacin

• No longer recommended for patients except in ones with very high TG (>500)

  • Data did not suggest improved patient outcomes

• Raises blood glucose

• Increased risk of hepatotoxicity

• Common incidence of rash-type reaction

Which dyslipidemia drug raises blood glucose and has increased risk of hepatotoxicity?

A) HMG-CoA reductase inhibitors (statins)

B) PCSK9 Inhibitors

C) Bile acid sequestrants

D) Fibric acid derivatives

E) Cholesterol absorption inhibitors

F) Misc. dyslipidemia agent (Niacin)

F

A client is about to be sent home with a prescription for cholestyramine. What drug class does cholestyramine belong to?

A) HMG-CoA Reductase Inhibitors

B) Fibric acid derivatives

C) Bile Acid Sequestrants

D) PCSK9 inhibitors

E) Cholesterol absorption inhibitors

C

A client has had their atorvastatin dose increased from 10mg daily to 20mg daily. Which statement reflects accurate teaching for the client?

A) It is best to take atorvastatin in the morning.

B) If you experience severe muscle pain, contact your physician.

C) It is safe to continue taking this medication if you become pregnant.

D) Dark-colored urine is a harmless side effect.

B

Which dyslipidemia drugs have increased risk of adverse drug interactions due to inhibition CYP-450 enzyme substrates leading to development of rhabdomyolysis?

A) PCSK9 Inhibitors

B) Cholesterol absorption inhibitors

C) Fibric acid derivatives

D) Bile acid sequestrants

E) HMG-CoA reductase inhibitors (statins)

E

Which dyslipidemia drug class is considered the 1st line option in most circumstances?

A) Cholesterol absorption inhibitors

B) Fibric acid derivatives

C) HMC-CoA reductase inhibitors (statins)

D) Bile acid sequestrants

E) PCSK9 Inhibitors

C

Which dyslipidemia drug class have adverse drug interactions with anticoagulants?

A) Fibric acid derivatives

B) PCSK9 Inhibitors

C) Bile acid sequestrants

D) Misc. dyslipidemia agent

E) HMC-CoA reductase inhibitors (statins)

F) Cholesterol absorption inhibitors

A

Which is the drug prototype for HMG-CoA reductase inhibitors?

A) Ezetimibe (Zetia)

B) Cholestyramine (Prevalite, Questran)

C) Fenofibrate (Tricor)

D) Alirocumab (Praluent)

E) Niacin (Niacor, Niaspan)

F) Atorvastatin (Lipitor)

F

Which is the drug prototype for fibrates?

A) Alirocumab (Praluent)

B) Fenofibrate (Tricor)

C) Cholestyramine (Prevalite, Questran)

D) Niacin (Niacor, Niaspan)

E) Ezetimibe (Zetia)

F) Atorvastatin (Lipitor)

B

Which is the drug prototype for PCSK9 inhibitors?

A) Ezetimibe (Zetia)

B) Atorvastatin (Lipitor)

C) Niacin (Niacor, Niaspan)

D) Fenofibrate (Tricor)

E) Cholestyramine (Prevalite, Questran)

F) Alirocumab (Praluent)

F

Which is the drug prototype for cholesterol absorption inhibitors?

A) Fenofibrate (Tricor)

B) Ezetimibe (Zetia)

C) Atorvastatin (Lipitor)

D) Cholestyramine (Prevalite, Questran)

E) Alirocumab (Praluent)

F) Niacin (Niacor, Niaspan)

B

Why should patients with liver disease be contraindicated for statins?

Because statins are heavily metabolized by the liver, so patients with dysfunctional livers can experience toxic effects (rhabdomyolysis) from not being able to metabolize the drug.