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DR. MADRAS CARDIO PART 1 EXAM 2

Total questions: 67

Worksheet time: 2hrs 18mins

Name
Class
Date
1.

Which of the following are the causes of reduced HDL? Select all that apply

a)

Smoking

b)

Obesity

c)

Sedentary lifestyle

d)

Beta-blockers

2.

Which of the following makes HDL increase? Select all that apply

a)

Smoking cessation

b)

Moderate alcohol ingestion (< 2 drinks/day)

c)

Physical exercise

d)

Weight loss

e)

Oral contraceptives and Phenytoin

3.

Which of the following lipoproteins is secreted by the liver?

a)

VLDL

b)

HDL

c)

IDL

d)

LDL

4.

Which of the following drugs can cause Hypercholesterolemia e Hypertriglyceridemia? Select all that apply

a)

Thiazides

b)

Cyclosporine

c)

Glucocorticoids,

d)

Sirolimus

e)

Beta Bllockers

5.

Which of the following can cause Hypocholesterolemia? Select all that apply

a)

Malabsorption

b)

AIDS

c)

Malnutrition

d)

Chronic liver disease

e)

Rosiglitazone

6.

Which of the following can cause Hypercholesterolemia and Low HDL? Select all that apply

a)

Isotretinoin

b)

Rosiglitazone

7.

Which of the following inhibit intestinal absorption of dietary & biliary CHO?

a)

Benecol (plant stanol-saturated form of plant sterols) and Take Charge (plant sterols)

b)

Lipochol

8.

Which of the following decrease beta-carotene absorption?

a)

Stanol

b)

Sterol

c)

Benecol

9.

Which of the following decrease absorption of alpha and beta carotene, vitamin E?

a)

Stanol

b)

Sterol

c)

Benecol

10.

Which of the following should the patient avoid if has sitosterolemia? Select all that apply

a)

Benecol

b)

Stanol

c)

Sterol

d)

Plant Sterols/Stanols

11.

Which of the following drug class inhibits exogenous pathway and bind bile acids in intestine?

a)

HMG-CoA reductase inhibitors

b)

Bile acid sequestrants

c)

Fibrates

d)

Ezetimibe (Zetia®)

12.

Which of the following drugs reduce LDL and improve glycemic control in type 2 DM adult pts?

a)

Colestipol

b)

Cholestyramine

c)

Colesevelam

d)

Bile Acid Sequestrans

13.

Bile acid sequestrants can cause which of the following?

a)

headache

b)

constipation

c)

migraine

d)

fever

14.

Bile acid sequestrants must be mixed with water, non-carbonated beverage (ex: apple juice, grape juice, pulpy juice-orange juice)

a)

True

b)

False

15.

Which of the following drugs is powder from packet with water or non-carbonated liquid): do not sip or keep in mouth for long time® may cause tooth discoloration and enamel decay

a)

Cholestyramine suspension

b)

Periogard

16.

In Colesevelam adverse effects occur less often but large tablets.

a)

True

b)

False

17.

Bile sequestrants decrease the absorption of which of the following medications? Select all that apply

a)

Warfarin

b)

Niacin

c)

Digoxin

d)

Acetaminophen

18.

Which of the following statements are TRUE about Bile acid sequestrants? Select all that apply

a)

Administer medications at least 1-4 hours before or 4-6 hours after

  bile acid sequestrant (medication specific)

b)

can cause Constipation

c)

decrease absorption of medications (ex: warfarin, niacin, digoxin, etc)

d)

Mix with water, non-carbonated beverage (ex: apple juice, grape juice, pulpy

       juice-orange juice)

e)

decrease LDL

19.

Other medications must be administered 4 hours prior to Colesevelam.

a)

True

b)

False

20.

Which of the following drugs class Inhibit HMG CoA reductase (endogenous pathway)?

a)

Bile acid sequestrants

b)

Statins

21.

Which of the following statins is reduced VLDL secretion from liver? Select all that apply

a)

Atorvastatin

b)

Fluvastatin

c)

Pravastatin

d)

Rosuvastatin

22.

Which of the following statins have a short half life and must be taken taken in evening (PM) ?

a)

Fluvastatin

b)

Lovastatin

c)

Pravastatin

d)

Simvastatin

23.

Which of the following statins can be taken anytime of day? Select all that apply

a)

Fluvastatin XL

b)

Atorvastatin

c)

Pitavastatin

d)

Rosuvastatin

e)

Pravastatin

24.

Lovastatin IR must be taken

a)

with food (evening meal) to increase bioavailability

b)

taken in evening at bedtime (HS)

25.

Lovastatin ER must be taken

a)

taken in evening at bedtime (HS)

b)

food (evening meal) to increase bioavailability

26.

Statins maximum effect is seen in how many weeks?

a)

2 weeks

b)

6 weeks

c)

8 weeks

d)

3 weeks

27.

Which statins are more hydrophilic?

a)

Pravastatin and Rosuvastatin

b)

Atorvastatin and Rosuvastatin

28.

Which of the following statins should be used in renal impairment, cyclosporine, Asians, etc)?

a)

Rosuvastatin 40mg

b)

Atorvastatin 80 mg

c)

Atorvastatin 20 mg

d)

Rosuvastatin 5mg

29.

Simvastatin 80 mg increases ­muscle injury or myopathy.

a)

True

b)

False

30.

Know this

a)

True

b)

False

31.

Pitavastatin not indicated to reduce CV morbidity & mortality.

a)

True

b)

False

32.

Fluvastatin and Atorvastatin NO adjustment needed in renal impairment? Select all that apply

a)

Fluvastatin

b)

Rosuvastatin

c)

Atorvastatin

d)

Pravastatin

33.

Which of the following are TRUE about Rosuvastatin? Select all that apply

a)

Primary Prevention of CVD

b)

Reduce risk of stroke

c)

Reduce risk of MI

d)

Reduce risk of arterial revascularization procedures

34.

Liver enzyme tests (ALT, AST) before initiating statin and as clinically indicated

         thereafter

a)

True

b)

False

35.

Statins (Select all that apply)

a)

Increase in blood glucose reported

b)

may cause Dyspepsia

c)

Avoid gemfibrozil, Niacin, CYP 3A4 inhibitors

d)

Causes Myalgia

e)

Myopathy/rhabdomyolysis

36.

Gemfibrozil inhibits glucuronidation or preventing renal clearance of statins and

         increases statin levels

a)

True

b)

False

37.

Which of the following causes increase risk of Myotoxicity? Select all that apply

a)

Female

b)

Combination regimens (statin, slow release niacin, fibrates, gemfibrozil

c)

Use with CYP inhibitors or substrates (cyclosporine, azole antifungals,

         erythromycin, amiodarone

d)

Low BMI

e)

Hypothyroidism

38.

Know this

a)

Yes

b)

No

39.

ACC/AHA/ADA 2018 Lipid Guidelines: baseline, 4-12 weeks after starting or

        adjusting statin dose, and then every 3-12 months

a)

True

b)

False

40.

Know this

a)

Yes

b)

No

41.

If I need to take Erythromycin, I need to DISCONTINUE the STATIN during this period and RESTART AFTER completion of the medication.

a)

True

b)

False

42.

If I need to take Cyclosporine on long term basis, I need to use lowest effective statin dose, use statin with least interactions.

a)

True

b)

False

43.

If patient taking Warfarin which of the following STATINS Increase the effect of Warfarin?

a)

Lovastatin

b)

Simvastatin

c)

Rosuvastatin

d)

Gemfibrozil

44.

Take aluminum and magnesium hydroxide combination antacid at least 2 hours after Rosuvastatin.

a)

True

b)

False

45.

Know this

a)

Yes

b)

No

46.

Know this

a)

Yes

b)

No

47.

Know this

a)

Yes

b)

No

48.

Pitavastatin will have drug interactions with which of the following? Select all that apply

a)

Gemfibrozil

b)

Niacin

c)

Colchicine

d)

Fibrates

49.

Statins are contraindicated for ? Select all that apply

a)

Active liver disease

b)

Unexplained, persistent elevation of LFTs

c)

Lactation

d)

None of them are correct

50.

Which of the following are TRUE about Bempedoic Acid (Nexletol)? Select all that apply

a)

adjunct to diet and maximum tolerated statin in adults with heterozygous familial hypercholesterolemia or ASCVD who need to decrease LDL

b)

Adenosine triphosphate-citrate lyase (ACL) inhibitor

c)

Decrease LDL

d)

Causes hyperuricemia, back pain, abdominal pain/discomfort, bronchitis, extremity pain, anemia, increased LFTs, tendon rupture, BPH

e)

Effect on CV morbidity and mortality not known

51.

While taking Bempedoic Acid (Nexletol), I must monitor the lipid panels within:

a)

8-12 weeks

b)

16-20 weeks

52.

While taking Bempedoic Acid, myopathy risk increases with use of simvastatin or pravastatin.

a)

True

b)

False

53.

Which of the following stimulates PPAR alpha receptors?

a)

Fibrates

b)

Bile acid sequestrants

c)

HMG-COA reductase inhibitors

54.

Gemfibrozil: decreases CV events in secondary prevention, BUT NOT to reduce CV mortality.

a)

True

b)

False

55.

Which of the following are some adverse effects for Fibrates? Select all that apply

a)

gynecomastia

b)

rhabdomyolysis

c)

gallstones

d)

thrombocytopenia (monitor CBC)

e)

Myopathy, myalgia, myositis

56.

Which of the following are the contraindications for Fibrates? Select all that apply

a)

Gallbladder disease

 

b)

Hepatic disease

c)

Primary biliary cirrhosis

d)

Renal disease

e)

Nursing mothers

57.

Which of the following is the MOA for Zetia (Ezetimibe) besides cholesterol absorption inhibitor?

a)

Adenosine triphosphate-citrate lyase (ACL) inhibitor

b)

Inhibits transport of dietary & biliary CHO across intestinal wall

58.

Which of the following are TRUE about Zetia (Ezetimibe)? Select all that apply

a)

Inhibits transport of dietary & biliary CHO across intestinal wall

b)

Cholesterol absorption inhibitor

c)

acts at brush border of small intestine

d)

decreases LDL in combination with statin

e)

Inhibits exogenous pathway

59.

Which of the following are TRUE about Zetia (Ezetimibe)? Select all that apply

a)

Adverse effects like fatigue, angioedema, gallstones, pancreatitis, depression

b)

Not an inhibitor or inducer CYP450

c)

Contraindicated in active liver disease or persistently elevated liver enzymes

d)

Combined with statin: reports of hepatitis

60.

Which of the following is the MOA for Nicotinic Acid?

a)

Inhibits transport of dietary & biliary CHO across intestinal wall

b)

decreases mobilization of FFA from peripheral adipose tissue to liver

61.

On Nicotinic acid Do NOT recommend IR products (dietary supplement and RX): more flushing.

a)

True

b)

False

62.

On Nicotinic acid Do NOT recommend SR products (dietary supplement and RX)

a)

­increases hepatoxicity

b)

more flushing 

63.

Niaspan ER better than Nicotinic Acid as an option because less hepatoxicity and fewer dermatologic reactions.

a)

True

b)

False

64.

On Nicotinic Acid adverse effects Flushing (tolerance could develop): prostaglandin mediated. Which of the following are TRUE about it? Select all that apply

a)

Avoid drinking hot liquids at time of ingestion

b)

Take up to 325mg ASA 30min before

c)

Avoid hot baths/showers

d)

Take at HS

  and Titrate dose slowly

e)

Take with food (do not take on empty stomach)

65.
a)

Yes

b)

No

66.

Nicotinic acid is contraindicated in? Select all that apply

a)

Arterial bleeding

b)

Active liver disease

c)

Active peptic ulcer disease

67.

Niaspan monitoring is serum transaminase levels (including AST and ALT) obtained at baseline, every 6-12 weeks for 1st year

a)

True

b)

False