Antihyperlipidemic agents such as clofibrate play a key role in treating dyslipidemia by primarily lowering triglycerides and modifying lipoprotein metabolism. This concise introduction for B. Pharm students highlights clofibrate’s classification among fibrates, its mechanism of action via PPARα activation, conversion to the active metabolite clofibric acid, pharmacokinetics, therapeutic uses, adverse effects (myopathy, gallstones, hepatic dysfunction), and important drug interactions (warfarin, statins). Emphasis on monitoring parameters, formulation considerations, and patient counseling prepares students for clinical practice and exams. Clear understanding of these aspects ensures safe dispensing and rational therapy selection. Now let’s test your knowledge with 30 MCQs on this topic.
Q1. Which receptor is primarily activated by clofibrate to exert its lipid-lowering effects?
- HMG-CoA reductase
- PPARα (Peroxisome proliferator-activated receptor alpha)
- LDL receptor
- Cyclooxygenase-2
Correct Answer: PPARα (Peroxisome proliferator-activated receptor alpha)
Q2. Clofibrate is converted in the body to which active metabolite responsible for its pharmacological action?
- Clofibrate itself is active; no metabolite
- Clofibric acid
- Gemfibrozil
- Fenofibric ester
Correct Answer: Clofibric acid
Q3. The primary lipid parameter reduced by clofibrate is:
- LDL cholesterol
- HDL cholesterol
- Triglycerides
- Total cholesterol
Correct Answer: Triglycerides
Q4. Which of the following best describes a major mechanism by which fibrates lower triglyceride levels?
- Inhibition of HMG-CoA reductase
- Activation of lipoprotein lipase and reduced VLDL synthesis
- Binding bile acids in the intestine
- Blocking intestinal cholesterol absorption
Correct Answer: Activation of lipoprotein lipase and reduced VLDL synthesis
Q5. Which adverse effect is classically associated with clofibrate and other fibrates?
- Renal tubular acidosis
- Gallstone formation (cholelithiasis)
- Hyperkalemia
- Bronchospasm
Correct Answer: Gallstone formation (cholelithiasis)
Q6. Co-administration of clofibrate with which drug class increases the risk of myopathy and rhabdomyolysis?
- Proton pump inhibitors
- Statins (HMG-CoA reductase inhibitors)
- ACE inhibitors
- Beta-blockers
Correct Answer: Statins (HMG-CoA reductase inhibitors)
Q7. Clofibrate affects warfarin therapy mainly by which mechanism?
- Increasing warfarin renal clearance
- Displacing warfarin from plasma proteins and altering metabolism, enhancing anticoagulant effect
- Directly inhibiting vitamin K epoxide reductase
- Reducing warfarin absorption from the gut
Correct Answer: Displacing warfarin from plasma proteins and altering metabolism, enhancing anticoagulant effect
Q8. Which laboratory parameter should be monitored before and during clofibrate therapy?
- Serum sodium only
- Serum transaminases (LFTs) and creatine kinase (CK)
- Fasting blood glucose only
- Serum amylase only
Correct Answer: Serum transaminases (LFTs) and creatine kinase (CK)
Q9. Clofibrate belongs to which chemical/pharmacological class?
- Bile acid sequestrant
- Fibrate (fibric acid derivative)
- HMG-CoA reductase inhibitor
- Niacin derivative
Correct Answer: Fibrate (fibric acid derivative)
Q10. Compared to statins, fibrates like clofibrate are most effective for which dyslipidemic pattern?
- Isolated high LDL cholesterol
- High triglycerides and low HDL levels (hypertriglyceridemia)
- Familial hypercholesterolemia Type IIa
- Pure hypercholesterolemia with normal triglycerides
Correct Answer: High triglycerides and low HDL levels (hypertriglyceridemia)
Q11. A key counseling point for patients on clofibrate is to report:
- Persistent cough
- Muscle pain or weakness and dark urine
- Excessive thirst
- Blurred vision
Correct Answer: Muscle pain or weakness and dark urine
Q12. Clofibrate’s effect on HDL cholesterol is typically:
- Significant decrease
- Modest increase
- No change
- Immediate large increase
Correct Answer: Modest increase
Q13. The metabolism of clofibrate primarily involves:
- Hydrolysis to an active acid followed by glucuronidation and renal excretion
- CYP3A4-mediated hydroxylation only
- Exhalation as unchanged drug
- Conjugation with glutathione exclusively
Correct Answer: Hydrolysis to an active acid followed by glucuronidation and renal excretion
Q14. Which population should use clofibrate with caution or is relatively contraindicated?
- Patients with active gallbladder disease or biliary obstruction
- Young healthy adults with isolated low HDL
- Patients with seasonal allergies
- Those with mild myopia
Correct Answer: Patients with active gallbladder disease or biliary obstruction
Q15. In clinical pharmacology, clofibrate is known to cause peroxisome proliferation in the liver; this is linked to which long-term concern in rodent studies?
- Increased bone density
- Hepatocellular carcinoma in rodents
- Neurodegeneration
- Renal cysts
Correct Answer: Hepatocellular carcinoma in rodents
Q16. Which of the following drug interactions is relevant because bile acid sequestrants can affect fibrate absorption?
- Co-administration with digoxin
- Concurrent use of cholestyramine may reduce absorption of clofibrate
- Combined therapy with ACE inhibitors
- Simultaneous use with proton pump inhibitors enhances clofibrate absorption
Correct Answer: Concurrent use of cholestyramine may reduce absorption of clofibrate
Q17. Clofibrate was historically associated with which unexpected outcome in large clinical trials that influenced its use?
- Marked reduction in mortality without side effects
- No effect on lipid levels
- Possible increase in noncardiovascular mortality in some studies
- Universal cure of atherosclerosis
Correct Answer: Possible increase in noncardiovascular mortality in some studies
Q18. Which dosing consideration is correct for clofibrate compared to newer fibrates like fenofibrate?
- Clofibrate is given as an intravenous infusion daily
- Clofibrate often required higher doses and more frequent dosing and has largely been replaced by better-tolerated fibrates
- Clofibrate is topical only
- Clofibrate dosing is identical to that of statins
Correct Answer: Clofibrate often required higher doses and more frequent dosing and has largely been replaced by better-tolerated fibrates
Q19. Which effect of fibrates on lipoproteins contributes to decreased triglyceride-rich VLDL?
- Inhibition of intestinal cholesterol absorption
- Upregulation of lipoprotein lipase and increased fatty acid oxidation
- Direct degradation of LDL particles
- Chelation of dietary fat in the gut
Correct Answer: Upregulation of lipoprotein lipase and increased fatty acid oxidation
Q20. Which adverse hepatic effect necessitates monitoring during fibrate therapy?
- Hepatotoxicity indicated by rising transaminases
- Acute pancreatitis from low triglycerides
- Hypoglycemia
- Decreased bilirubin production
Correct Answer: Hepatotoxicity indicated by rising transaminases
Q21. A pharmacology student asks why clofibrate increases gallstone risk. The best explanation is:
- Clofibrate reduces bile acid synthesis causing cholesterol crystallization
- Clofibrate directly forms stones in the bladder
- Clofibrate increases urinary calcium leading to gallstones
- Clofibrate increases biliary cholesterol secretion leading to supersaturation
Correct Answer: Clofibrate increases biliary cholesterol secretion leading to supersaturation
Q22. Which clinical scenario is an appropriate therapeutic indication for clofibrate or other fibrates?
- Isolated severe hypertriglyceridemia to reduce pancreatitis risk
- Acute bacterial infection
- Type I hypersensitivity
- As monotherapy for very high LDL in familial hypercholesterolemia
Correct Answer: Isolated severe hypertriglyceridemia to reduce pancreatitis risk
Q23. Which pharmacokinetic property of clofibrate influences dosing in renal impairment?
- It is exclusively exhaled unchanged
- Active metabolite (clofibric acid) is partly renally excreted and may accumulate in renal impairment
- It is only metabolized in the lungs
- It binds irreversibly to hemoglobin
Correct Answer: Active metabolite (clofibric acid) is partly renally excreted and may accumulate in renal impairment
Q24. Which laboratory change is expected with effective fibrate therapy?
- Marked increase in triglycerides
- Reduction in serum triglycerides and modest rise in HDL
- Large increase in LDL without other changes
- Immediate normalization of all lipid fractions
Correct Answer: Reduction in serum triglycerides and modest rise in HDL
Q25. Which statement about clofibrate’s formulation and storage is correct for dispensing practice?
- Clofibrate tablets require refrigeration at all times
- Clofibrate is usually provided as oral tablets and stored at room temperature away from moisture
- Clofibrate must be stored under nitrogen and light-protected only in hospital pharmacies
- Clofibrate is administered as an inhaler
Correct Answer: Clofibrate is usually provided as oral tablets and stored at room temperature away from moisture
Q26. Which mechanism explains fibrate-induced potentiation of warfarin anticoagulation?
- Induction of vitamin K production
- Displacement of warfarin from albumin and inhibition of warfarin metabolism
- Increased renal excretion of warfarin
- Enhanced platelet aggregation
Correct Answer: Displacement of warfarin from albumin and inhibition of warfarin metabolism
Q27. Which patient counseling point is specific to fibrate therapy to reduce gallstone risk?
- Take the dose with a high-fat meal to reduce gallstones
- Maintain a balanced diet and report right upper quadrant pain suggestive of gallstones
- Avoid all fruits while on therapy
- Drink alcohol to prevent gallstone formation
Correct Answer: Maintain a balanced diet and report right upper quadrant pain suggestive of gallstones
Q28. Which structural feature classifies clofibrate as a fibrate?
- It is a bile acid analog
- It contains a fibric acid ester that is hydrolyzed to fibric acid
- It is a polypeptide
- It contains a steroid nucleus
Correct Answer: It contains a fibric acid ester that is hydrolyzed to fibric acid
Q29. In terms of clinical outcome evidence, fibrates are most convincingly shown to reduce:
- All-cause mortality in all patient groups
- Risk of pancreatitis in severe hypertriglyceridemia
- Immediate regression of atherosclerotic plaques
- Incidence of erectile dysfunction
Correct Answer: Risk of pancreatitis in severe hypertriglyceridemia
Q30. Which monitoring frequency is appropriate after initiating clofibrate therapy in a B. Pharm recommended plan?
- No monitoring required after start
- Baseline LFTs and CK, then periodic monitoring (e.g., 4–12 weeks after start and periodically thereafter)
- Daily liver biopsies for the first month
- Only monitor blood pressure weekly
Correct Answer: Baseline LFTs and CK, then periodic monitoring (e.g., 4–12 weeks after start and periodically thereafter)
I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.
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