Question

1-Which of the following would cause a deficiency in vitamin d?

Simvastatin

Niacin

Cloofibrate

Cholestyramine

Ezetimibe

2-Which time of the day should rosuvastatin be taken?

After the largest meal of the day

It does not matter

First thing in the morning, 2 hours before any food

At night or before sleep

Answer 1

1.answer is Cholestyramin. It binds bile acids in the intestinal tract and inhibiting enterohepatic synthesis of cholesterol. It inhibit absorption of vitamin and minerals especially fat soluble vitamins like vitamin D3 , results vitamin D deficiency. Other side effects are nausea and vomiting, loose stool.

Simvatatin inhibit HMG CoA reductase and decreasing hepatic cholesterol synthesis. Usual side effects are muscle pain and rabdomyolysis.

Niacin is also a lipid lowering agents does not cause vitamin D deficiency

Clofibate is a convert VLDL into LDL. Does not affect intestinal absorption.

Zetimibe is also station inhibit entero hepatic cholesterol synthesis. Myalgia and constipation present for the patients. Does not affect intestinal absorption.

2.simvastatin is lipid lowering agents, administered during night time. Either after dinner or just before bed. Reason is high level of bioavailability of drug is needed for inhibiting cholesterol synthesis . During resting period large amount of cholesterol is synthesized and enzymes are more active.