What group of drugs has the most significant effect on blood cholesterol level?

А. statins

B. ezetimibe

C. bile acid-binding agent

D. fibrates

E. niacin

10. Adverse drug reaction typical for statins:

А. hepatotoxicity

B. nephrotoxicity

C. rhabdomyolysis

D. thrombocytopenia, anemia

E. skin rash, photosensitivity

11. What drugs have NO direct effect on lipid metabolism:

А. ω 3 polyunsaturated fatty acids

B. losartan

C. cholestyramine

D. fenofibrate

E. rosuvastatin

12. Pleiotropic effects of statins DO NOT include:

А. anti-inflammatory effect

B. elevation of fibrinolytic activity

C. improvement of endothelial vasodilatory function

D. suppression of cholesterol synthesis in the liver

E. suppression of smooth muscle cell proliferation

What statement about statins is WRONG?

А. these drugs should be taken in the evening according to biological rhythm of cholesterol production in liver

B. treatment with statins reduces risk of gallstone formation and could cause dissolution of the stones in gallbladder

C. lovastatin and simvastatin reduce both cholesterol and triglyceride levels in the blood

D. stable decrease in cholesterol levels during treatment with simvastatin is observed in a month after the start of drug administration

E. target level of cholesterol on statin therapy is less than 5 mmol/L

Contraindication for statin therapy is

А. pregnancy

B. treatment with immune suppressants

C. hypersensitivity to statins

D. liver disease with elevation of amine transferase levels

E. severe diabetes mellitus

 

What could happen if patient with chronic kidney disease takes a drug with renal rout of elimination?

А. increase in drug elimination

B. decrease in drug elimination rates and accumulation of a drug

C. reduction of risk of adverse drug reactions development

D. decrease in drug efficacy

 

16. How concomitant intake of cytochrome P₄₅₀ inducer could influence the metabolism of other drugs?

 А. increase in rate of other drug metabolism

 B. decrease in rate of other drug metabolism

 C. increase in rate of other drug efficacy

 D. increase in risk of other drug’s side effects development

 

What laboratory values should be monitored for in-time detection of nephrotoxic effects of drugs?

А. creatinine level in blood

B. creatinine level in urine

C. diurnal diuresis

D. amine transferase levels in blood

E. bilirubin and alkaline phosphatase levels in blood

 

What type of adverse drug reaction does hypersensitivity to amoxicillin belongs?

А. type А

B. type В

C. type С

D. type D

 

What is the name of adverse drug reaction characterized by reduction of effectiveness of a drug?

А. withdrawal syndrome

B. “steal” syndrome

C. abstinence syndrome

D. rebound syndrome

E. tachyphylaxis syndrome

 

What is the name of adverse drug reaction characterized by abrupt worsening of disease symptoms after drug administration cessation?

А. withdrawal syndrome

B. “steal” syndrome

C. abstinence syndrome

D. addictive syndrome

E. tachyphylaxis syndrome

 

What parameter characterizes the rate of drug elimination?

А. affinity

B. bioavailability

C. protein binding

D. “first pass” effect

E. half-life period

 

Case studies.

Case №1

Match pharmacokinetic parameter with its definition:

1. Clearance.

2. Bioavailability.

3. Half-life period.

4. Volume of distribution

 

А. The fraction of unchanged drug reaching the systemic circulation following administration by any route.

B. The volume of the blood plasma cleared of the drug per unit of time.

C. The fluid volume that is required to contain the entire drug in the body at the same concentration measured in the plasma.

D. The time required to reduce the amount of drug in the blood by one-half.

Case №2

A 52-year-old patient, who has been suffering of chronic obstructive pulmonary disease for several years, is diagnosed with essential hypertension moderate degree, II stage, risk II. A physician is planning to administer him a beta-blocker as a part of combination pharmacotherapy.

Questions. What types of pharmacotherapy do you know? What type of pharmacotherapy is represented by the therapy of essential hypertension with beta-blockers. Define the following basic concepts: mechanism of action, types of mechanisms of action, selectivity, delayed results of treatment.

 

Case №3

Female patient N., 65-year-old, is treated in hospital for heart disease with chronic heart failure. She also has an accompanying disease chronic pyelonephritis, phase of remission, CKD II stage. She is taking digoxin as a part of her therapy for 4 days. At the exam patient complains of worsening of her condition due to periodic attacks of nausea, not associated with eating, lack of appetite, poor sleep. Her heart beat rate is 52 bpm.

Questions. How can you explain newly appeared patient’s complains? What parameters characterize rate of drug elimination and dosing regimen for the drug? Define the concept of therapeutic window. Give examples of drugs with a narrow therapeutic window and factors that increase the risk of side effects when prescribing these drugs.

 

Case №4

Twenty clinical studies on the efficacy and safety of the original glucosamine sulfate preparation at a dose of 1500 mg once a day in the treatment of knee osteoarthritis were discovered in the Cochrane systematic review

All studies were conducted in different countries, were randomized, double-blind, with a total number of patients 2570.

       Question. What is the name of this type of studies? What is the level of evidence for such trials?

 

Case №5

A patient K, 54-year-old, visited clinic for the first time with complaints of a periodic increase in blood pressure, headaches. An examination revealed an increase in his body weight and lab tests revealed hypercholesterolemia and an increased content of LDL in his blood.

Задание. Develop a reasonable treatment program for the patient, including drugs and their dosing regimen. Explain the MA of the main drugs and criteria for the effectiveness of therapy.

 

Case №6

A 45-year-old man, who has been suffering of diabetes mellitus, type II, for 2 years, has hyperlipidemia (elevation of low density lipoproteins and triglycerides) that is not corrected with diet. Atorvastatin prescribed to the patient 2 weeks ago caused reaction that includes skin rash, itching and redness of the face.

Задание. What hypolipidemic drugs could be used in this patient instead of atorvastatin? What are their side effects?

 

Case №7

Patient К., 55-year-old, was admitted to the hospital with diagnosis of essential hypertension stage II, grade II, risk II, IHD stable exertional angina FC I, CHF stage 0. Family history of the patient revealed that his mother suffered for ischemic heart disease and his brother suffers for essential hypertension and IHD as well. At examination patient is overweight, smokes. Lab tests revealed cholesterol level of 6.5 mmol/L and triglyceride level of 3.4 mmol/L.

Question. What regimen of pharmacotherapy for hyperlipidemia will you use for this patient? Will it be monotherapy or combination therapy? Make the choice of a drug, dosing regimen and duration of treatment.

 

Case №8

A 62-year-old man complains of feeling of discomfort at large skeletal muscles, their pain at palpation, “tea-like” urine discoloration, and periodic attacks of nausea. Patient indicates that he has recently been treated for myocardial infarction and took a cholesterol-lowering drug orally once daily as a component of his therapy.

Question. Identify the pharmacological group of the drug. Write a prescription for the drug of this group. List contraindications for its use and side effects. What side effect has occurred in the patient, explain the mechanism.