CLS Non-Statin Lipid-Lowering Pharmacotherapy 2

Question 1

What is the primary mechanism of action of fibrates?

Accepted Answer

Activate peroxisome proliferator-activated receptor alpha (PPARα)

Answer

Inhibit HMG-CoA reductase to reduce hepatic cholesterol synthesis

Answer

Block the NPC1L1 cholesterol transporter in the small intestine

Answer

Inhibit PCSK9 to upregulate LDL receptors

Question 2

Which fibrate–statin combination carries the greatest risk of severe myopathy and rhabdomyolysis?

Accepted Answer

Gemfibrozil + any statin

Answer

Fenofibrate + rosuvastatin

Answer

Fenofibrate + ezetimibe

Answer

Fenofibrate + atorvastatin

Question 3

For which lipid abnormality are fibrates considered first-line pharmacotherapy?

Accepted Answer

Severe hypertriglyceridemia (≥500 mg/dL)

Answer

Elevated LDL-C (>190 mg/dL)

Answer

Elevated Lp(a)

Answer

Low HDL-C as isolated finding

Question 4

What is the most notable lipid effect of niacin (nicotinic acid) compared to other lipid-lowering agents?

Accepted Answer

Greatest HDL-C increase

Answer

Greatest LDL-C reduction

Answer

Greatest triglyceride reduction

Answer

Greatest Lp(a) reduction

Question 5

What did the AIM-HIGH and HPS2-THRIVE trials of extended-release niacin in statin-treated patients demonstrate?

Accepted Answer

No additional cardiovascular benefit and increased adverse events

Answer

Significant reduction in major adverse cardiovascular events

Answer

Significant reduction in all-cause mortality

Answer

Improved outcomes specifically in patients with very low HDL-C

Question 6

What is the most common adverse effect of niacin, and what can reduce its severity?

Accepted Answer

Cutaneous flushing; reduced by taking aspirin 30 minutes before the dose

Answer

Hepatotoxicity; reduced by taking niacin with food

Answer

Hyperuricemia; reduced by adequate hydration

Answer

Myopathy; reduced by dividing the daily dose

Question 7

Fenofibrate requires dose adjustment or avoidance in patients with which condition?

Accepted Answer

Chronic kidney disease or renal impairment

Answer

Hypertension treated with ACE inhibitors

Answer

Type 2 diabetes mellitus on insulin

Answer

Hypothyroidism on levothyroxine