Which administration strategy can a patient implement to reduce flushing, the most common adverse effect of niacin therapy?

Intermittent claudication is a condition in which leg pain is produced upon increased activity and ischemia to tissues, but then the pain is reduced with rest. This is because the blood flow to the leg muscles is insufficient to meet the increased demand during exercise, but adequate at rest.Intermittent claudication is a common symptom of peripheral artery disease (PAD), which is a narrowing of the arteries that supply blood to the legs.

Choice B, sporadic ischemia, is wrong because it is not a specific medical term for a condition that causes leg pain.

Ischemia means reduced blood flow to a part of the body, which can cause pain, but it can be caused by various factors and affect different organs.

Choice C, angina, is wrong because it is a term for chest pain caused by reduced blood flow to the heart, not the legs.

Angina can also be triggered by physical activity and relieved by rest, but it is not related to PAD or leg ischemia.

Choice D, restless leg syndrome, is wrong because it is a condition that causes an uncomfortable urge to move the legs, usually at night or when lying down.

Restless leg syndrome does not cause pain or ischemia in the legs, and it is not improved by rest.It is thought to be related to a problem with the nervous system or iron deficiency.

Atorvastatin is a type of statin, which are the most potent antilipidemic agents and have proven to lower the risk of myocardial infarction. Statins work by inhibiting an enzyme called HMG-CoA reductase, which is involved in the synthesis of cholesterol in the liver.By reducing the production of cholesterol, statins lower the levels of low-density lipoprotein (LDL) and triglycerides, and slightly increase the levels of high-density lipoprotein (HDL) in the blood.

Choice B, niacin, is wrong because niacin is not as effective as statins in lowering LDL and preventing cardiovascular events.Niacin is a water-soluble vitamin that can lower LDL and triglycerides, and increase HDL, but it can also cause flushing, itching, and liver toxicity.

Choice C, gemfibrozil, is wrong because gemfibrozil is a type of fibric acid derivative, which are mainly used to lower triglycerides and increase HDL, but have little effect on LDL.

Fibric acid derivatives work by activating a receptor called PPAR-alpha, which regulates the metabolism of lipids in the liver and muscle.Fibric acid derivatives can also increase the risk of gallstones and muscle damage.

Choice D, ezetimibe, is wrong because ezetimibe is a selective cholesterol absorption inhibitor, which blocks the absorption of dietary and biliary cholesterol in the intestine.Ezetimibe can lower LDL by about 15-20%, but it has not been shown to reduce the risk of myocardial infarction on its own.Ezetimibe is usually combined with a statin for better efficacy and safety.

Normal ranges for lipid levels are:

• Total cholesterol: less than 200 mg/dL

• LDL cholesterol: less than 100 mg/dL

• HDL cholesterol: more than 40 mg/dL for men and more than 50 mg/dL for women

• Triglycerides: less than 150 mg/dL