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

Fibrates activate PPARα, a nuclear receptor that increases lipoprotein lipase expression, reduces apoC-III production, and increases apoA-I synthesis, resulting in reduced triglycerides and increased HDL-C.

Question 2

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

Accepted Answer

Gemfibrozil + any statin

Answer

Gemfibrozil inhibits the glucuronidation pathway responsible for statin metabolism, raising statin plasma concentrations significantly and increasing the risk of myopathy and rhabdomyolysis; fenofibrate does not share this interaction.

Question 3

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

Accepted Answer

Severe hypertriglyceridemia (≥500 mg/dL)

Answer

Fibrates reduce triglycerides by 20–50% and are indicated as first-line pharmacotherapy for severe hypertriglyceridemia (≥500 mg/dL) to reduce pancreatitis risk.

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

Niacin raises HDL-C by 15–35%, which is the largest HDL-C increase achievable with any single pharmacologic agent currently available.

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

Both AIM-HIGH and HPS2-THRIVE found no cardiovascular benefit from adding niacin to statin therapy and documented increased adverse events including hepatotoxicity and serious infections, substantially reducing niacin's clinical use.

(CLS) Clinical Lipid Specialist Certification Practice Test

(CLS) Clinical Lipid Specialist Certification Practice Test

CLS Non-Statin Lipid-Lowering Pharmacotherapy 2