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41-405: Fenofibrate (sold under the brand name Tricor among others, is an oral medication of the fibrate class used to treat abnormal blood lipid levels . It is less commonly used compared than statins because it treats a different type of cholesterol abnormality to statins. While statins have strong evidence for reducing heart disease and death, there is evidence to suggest that fenofibrate also reduces

82-404: A stethoscope . The pulse may vary due to exercise, fitness level, disease, emotions, and medications. The pulse also varies with age. A newborn can have a heart rate of 100–⁠160 bpm, an infant (0–⁠5 months old) a heart rate of 90–⁠150 bpm, and a toddler (6–⁠12 months old) a heart rate of 80–140 bpm. A child aged 1–⁠3 years old can have a heart rate of 80–⁠130 bpm, a child aged 3–⁠5 years old

123-513: A column of mercury measured off in millimeters . In the United States and UK, the common form is millimeters of mercury, while elsewhere SI units of pressure are used. There is no natural 'normal' value for blood pressure, but rather a range of values that on increasing are associated with increased risks. The guideline acceptable reading also takes into account other co-factors for disease. Therefore, elevated blood pressure ( hypertension )

164-422: A deteriorating patient and prevent adverse outcomes. There are four primary vital signs which are standard in most medical settings: The equipment needed is a thermometer , a sphygmomanometer , and a watch . Although a pulse can be taken by hand, a stethoscope may be required for a clinician to take a patient's apical pulse. Temperature recording gives an indication of core body temperature , which

205-407: A glass or electronic thermometer. Note that rectal temperature measures approximately 0.5 °C higher than oral temperature, and axillary temperature approximately 0.5 °C less than oral temperature. Aural and skin temperature measurements require special devices designed to measure temperature from these locations. While 37 °C (99 °F) is considered "normal" body temperature, there

246-466: A heart rate of 80–⁠120 bpm, an older child (age of 6–10) a heart rate of 70–⁠110 bpm, and an adolescent (age 11–⁠14) a heart rate of 60–105 bpm. An adult (age 15+) can have a heart rate of 60–100 bpm. Average respiratory rates vary between ages, but the normal reference range for people age 18 to 65 is 16–20 breaths per minute. The value of respiratory rate as an indicator of potential respiratory dysfunction has been investigated but findings suggest it

287-457: A protective effect against diabetic microvascular complications. Clinical trials do support their use as monotherapy agents. Fibrates reduce the number of non-fatal heart attacks, but do not improve all-cause mortality and are therefore indicated only in those not tolerant to statins. Although less effective in lowering LDL levels, the ability of fibrates to increase HDL and lower triglyceride levels seems to reduce insulin resistance when

328-511: A severely depressed HDL-C level is detected, fibrate therapy should be withdrawn, and the HDL-C level monitored until it has returned to baseline. Most fibrates can cause mild stomach upset and myopathy (muscle pain with CPK elevations). Fibrates decrease the synthesis of bile acid by down-regulation of cholesterol 7 alpha-hydroxylase and sterol 27-hydroxylase expression, therefore making it easier for cholesterol to precipitate and increasing

369-422: Is available in several formulations and is sold under several brand names, including: The formulations may differ in terms of pharmacokinetic properties, particularly bioavailability ; some must be taken with meals, whereas others may be taken without regard to food. The choline salt of fenofibrate is available in the United States, sold as Trilipix, and may be taken without regard to meals. Fenofibric acid

410-568: Is no specific treatment for overdose with fenofibric acid delayed-release capsules. General supportive care is indicated, including monitoring of vital signs and observation of clinical status". Additionally, hemodialysis should not be considered as an overdose treatment option because fenofibrate heavily binds to plasma proteins and does not dialyze well. These drug interactions with fenofibrate are considered major and may need therapy modifications: "In summary, enhanced catabolism of triglyceride-rich particles and reduced secretion of VLDL underlie

451-513: Is normally tightly controlled ( thermoregulation ), as it affects the rate of chemical reactions. Body temperature is maintained through a balance of the heat produced by the body and the heat lost from the body. Temperature can be recorded in order to establish a baseline for the individual's normal body temperature for the site and measuring conditions. Temperature can be measured from the mouth, rectum, axilla (armpit), ear, or skin. Oral, rectal, and axillary temperature can be measured with either

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492-442: Is not recommended. It works by multiple mechanisms. It was patented in 1969, and came into medical use in 1975. It is available as a generic medication . In 2022, it was the 88th most commonly prescribed medication in the United States, with more than 7   million prescriptions. Fenofibrate is mainly used for primary hypercholesterolemia or mixed dyslipidemia . Fenofibrate may slow the progression of diabetic retinopathy and

533-420: Is of limited value. Respiratory rate is a clear indicator of acidotic states, as the main function of respiration is removal of CO 2 leaving bicarbonate base in circulation. Blood pressure is recorded as two readings: a higher systolic pressure, which occurs during the maximal contraction of the heart, and the lower diastolic or resting pressure. In adults, a normal blood pressure is 120/80, with 120 being

574-503: Is some variance between individuals. Most have a normal body temperature set point that falls within the range of 36.0 to 37.5 °C (96.8 to 99.5 °F). The main reason for checking body temperature is to solicit any signs of systemic infection or inflammation in the presence of a fever . Fever is considered temperature of 37.8 °C (100.0 °F) or above. Other causes of elevated temperature include hyperthermia , which results from unregulated heat generation or abnormalities in

615-428: Is the rate at which the heart beats while pumping blood through the arteries, recorded as beats per minute (bpm). It may also be called "heart rate". In addition to providing the heart rate, the pulse should also be evaluated for strength and obvious rhythm abnormalities. The pulse is commonly taken at the wrist ( radial artery ). Alternative sites include the elbow ( brachial artery ), the neck ( carotid artery ), behind

656-477: Is used in addition to diet to reduce elevated low-density lipoprotein cholesterol (LDL), total cholesterol , triglycerides (TG), and apolipoprotein B (apo B), and to increase high-density lipoprotein cholesterol (HDL) in adults with primary hypercholesterolemia or mixed dyslipidemia. It is used in tandem with diet for treatment of adults with severe hypertriglyceridemia . Improving glycemic control in diabetics showing fasting chylomicronemia usually reduces

697-490: Is variously defined when the systolic number is persistently over 140–160 mmHg. Low blood pressure is hypotension . Blood pressures are also taken at other portions of the extremities. These pressures are called segmental blood pressures and are used to evaluate blockage or arterial occlusion in a limb (see Ankle brachial pressure index ). In the U.S., in addition to the above four, many providers are required or encouraged by government technology-in-medicine laws to record

738-411: The dyslipidemia is associated with other features of the metabolic syndrome ( hypertension and diabetes mellitus type 2 ). They are therefore used in many hyperlipidemias . Due to a rare paradoxical decrease in HDL-C seen in some patients on fenofibrate, as per US FDA label change, it is recommended that the HDL-C levels be checked within the first few months after initiation of fibrate therapy. If

779-407: The thiazolidinediones , a novel class of anti-diabetic drugs that also act on PPARs (more specifically PPARγ ) Fibrates are a substrate of (metabolized by) CYP3A4 . Fibrates have been shown to extend lifespan in the roundworm C. elegans . Vital signs Vital signs (also known as vitals ) are a group of the four to six most crucial medical signs that indicate the status of

820-502: The body's vital (life-sustaining) functions. These measurements are taken to help assess the general physical health of a person, give clues to possible diseases, and show progress toward recovery. The normal ranges for a person's vital signs vary with age, weight, sex , and overall health . There are four primary vital signs : body temperature , blood pressure , pulse ( heart rate ), and breathing rate ( respiratory rate ), often notated as BT, BP, HR, and RR. However, depending on

861-399: The body's heat exchange mechanisms. Temperature depression ( hypothermia ) also needs to be evaluated. Hypothermia is classified as temperature below 35 °C (95 °F). It is also recommended to review the trend of the patient's temperature over time. A fever of 38 °C does not necessarily indicate an ominous sign if the patient's previous temperature has been higher. The pulse

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902-439: The clinical setting, the vital signs may include other measurements called the "fifth vital sign" or "sixth vital sign." Early warning scores have been proposed that combine the individual values of vital signs into a single score. This was done in recognition that deteriorating vital signs often precede cardiac arrest and/or admission to the intensive care unit . Used appropriately, a rapid response team can assess and treat

943-595: The combination of statins and fibrates results in a significantly greater reduction in LDL-C and triglyceride levels and greater increases in high-density lipoprotein cholesterol (HDL-C) compared with monotherapy with either drug. Fibrates are used in accessory therapy in many forms of hypercholesterolemia , but the combination of some fibrates (e.g., gemfibrozil) with statins is contraindicated due to an increased risk of rhabdomyolysis . Fibrates stimulate peroxisome proliferator activated receptor (PPAR) alpha, which controls

984-585: The expression of gene products that mediate the metabolism of triglycerides (TG) and high-density lipoprotein (HDL). As a result, synthesis of fatty acids, TG and VLDL is reduced, whilst that of lipoprotein lipase, which catabolises TG, is enhanced. In addition, production of Apo A1 and ATP binding cassette A1 is up-regulated, leading to increased reverse cholesterol transport via HDL. Consequently, fibrates reduce TG by up to 50% and increase HDL-C by up to 20%, but LDL-C changes are variable. Fewer large-scale trials have been conducted with fibrates than with statins and

1025-813: The hypotriglyceridemic effect of fibrates, whereas their effect on HDL metabolism is associated with changes in HDL apolipoprotein expression." Fenofibrate is a fibrate derivative, a prodrug comprising fenofibric acid linked to an isopropyl ester. It lowers lipid levels by activating peroxisome proliferator-activated receptor alpha (PPARα). PPARα activates lipoprotein lipase and reduces apoprotein CIII, which increases lipolysis and elimination of triglyceride-rich particles from plasma. PPARα also increases apoproteins AI and AII, reduces VLDL- and LDL-containing apoprotein B, and increases HDL-containing apoprotein AI and AII. Fenofibrate

1066-402: The knee ( popliteal artery ), or in the foot ( dorsalis pedis or posterior tibial arteries). The pulse is taken with the index finger and middle finger by pushing with firm yet gentle pressure at the locations described above, and counting the beats felt per 60 seconds (or per 30 seconds and multiplying by two). The pulse rate can also be measured by listening directly to the heartbeat using

1107-483: The mechanism of action of fibrates remained unelucidated until the 1990s, when it was discovered that fibrates activate peroxisome proliferator-activated receptors (PPARs) , especially PPARα . The PPARs are a class of intracellular receptors that modulate carbohydrate and fat metabolism and adipose tissue differentiation . Activating PPARs induces the transcription of a number of genes that facilitate lipid metabolism . Fibrates are pharmacologically related to

1148-558: The need for invasive treatment such as laser therapy in patients with type 2 diabetes with pre-existing retinopathy. It was initially indicated for diabetic retinopathy in patients with type 2 diabetes and diabetic retinopathy in Australia. The large scale, international FIELD and ACCORD-Eye trials found that fenofibrate therapy reduced required laser treatment for diabetic retinopathy by 1.5% over 5 years , as well as reducing progression by 3.7% over 4 years. Further studies looking at

1189-781: The need for pharmacologic intervention. Statins remain the first line for treatment of blood cholesterol. AHA guidelines from 2013 did not find evidence for routine use of additional medications. Additionally, in 2016, the FDA filed "Withdrawal of Approval of Indications Related to the Coadministration With Statins in Applications for Niacin Extended-Release Tablets and Fenofibric Acid Delayed Release Capsules" noting "the Agency has concluded that

1230-468: The patient's height, weight, and body mass index . In contrast to the traditional vital signs, these measurements are not useful for assessing acute changes in state because of the rate at which they change; however, they are useful for assessing the impact of prolonged illness or chronic health problems. The definition of vital signs may also vary with the setting of the assessment. Emergency medical technicians (EMTs), in particular, are taught to measure

1271-474: The results are less conclusive, but reduced rates of cardiovascular disease have been reported with fibrate therapy in the subgroup of patients with low HDL-C levels and elevated TG (e.g. TG > 2.3 mmol/L (200 mg/dL)). Fibrates are usually well tolerated but share a similar side-effect profile to statins. In addition, they may increase the risk of cholelithiasis and prolong the action of anticoagulants. Accumulating evidence suggests that they may also have

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1312-453: The risk for gallstones . In combination with statin drugs, fibrates cause an increased risk of rhabdomyolysis , idiosyncratic destruction of muscle tissue, leading to kidney failure . The less lipophilic statins are less prone to cause this reaction, and are probably safer to be combined with fibrates than the more lipophilic statins are. Drug toxicity includes acute kidney injury . Although used clinically since at least 1962,

1353-674: The risk of below ankle amputations in patients with Type 2 diabetes without microvascular disease. The FIELD study reported that fenofibrate at doses of 200 mg daily, reduced the risk for any amputation by 37% independent of glycaemic control, presence or absence of dyslipidaemia and its lipid-lowering mechanism of action. However, the cohort of participants who underwent amputations were more likely to have had previous cardiovascular disease (e.g. angina , myocardial infarction ), longer duration of diabetes and had baseline neuropathy. Fenofibrate has an off-label use as an added therapy of high blood uric acid levels in people who have gout . It

1394-518: The risk of heart disease and death. However, this seems only to apply to specific populations of people with elevated triglyceride levels and reduced high-density lipoprotein (HDL) cholesterol. Its use is recommended together with dietary changes. Common side effects include liver problems , breathing problems, abdominal pain, muscle problems, and nausea. Serious side effects may include toxic epidermal necrolysis , rhabdomyolysis , gallstones , and pancreatitis . Use during pregnancy and breastfeeding

1435-478: The risks, and the approvals for this indication should be withdrawn." Fenofibrate is contraindicated in: The most common adverse events (>3% of patients with coadministered statins) are When fenofibrate and a statin are given as combination therapy, it is recommended that fenofibrate be given in the morning and the statin at night, so that the peak dosages do not overlap. Musculoskeletal Hepatotoxicity Nephrotoxicity Biliary Coagulation/Bleeding "There

1476-400: The role of fenofibrate in the progression of diabetic retinopathy as the primary outcome is warranted to understand its role in this condition. Although no statistically significant cardiovascular risk benefits were identified in these trials, benefits may accrue to add on therapy to patients with high triglyceride dyslipidaemia currently taking statin medications. Fenofibrate appears to reduce

1517-411: The systolic and 80 being the diastolic reading. Usually, the blood pressure is read from the left arm unless there is some damage to the arm. The difference between the systolic and diastolic pressure is called the pulse pressure . The measurement of these pressures is now usually done with an aneroid or electronic sphygmomanometer . The classic measurement device is a mercury sphygmomanometer, using

1558-480: The totality of the scientific evidence no longer supports the conclusion that a drug-induced reduction in triglyceride levels and/or increase in HDL cholesterol levels in statin-treated patients results in a reduction in the risk of cardiovascular events. Consistent with this conclusion, FDA has determined that the benefits of niacin ER tablets and fenofibric acid DR capsules for coadministration with statins no longer outweigh

1599-639: The vital signs of respiration, pulse, skin, pupils , and blood pressure as "the 5 vital signs" in a non-hospital setting. The "fifth vital sign" may refer to a few different parameters. There is no standard "sixth vital sign"; its use is more informal and discipline-dependent. Children and infants have respiratory and heart rates that are faster than those of adults as shown in the following table : Monitoring of vital parameters most commonly includes at least blood pressure and heart rate , and preferably also pulse oximetry and respiratory rate . Multimodal monitors that simultaneously measure and display

1640-647: Was developed by Groupe Fournier SA of France. In the United States, Tricor was reformulated in 2005. This reformulation was controversial, seen as an attempt to stifle competition from generic equivalents, and was the subject of antitrust litigation by Teva . Fibrate Fibrates improve atherogenic dyslipidemia characterized by high triglyceride and/or low HDL-C levels and elevated concentrations of small dense LDL particles, with or without high LDL-C levels. Fibrates may be compared to statin drugs, which reduce LDL-cholesterol (LDL-C) and have only limited effects on other lipid parameters. Clinical trials have shown that

1681-582: Was one of the 12 compounds identified in sludge samples taken from 12 wastewater treatment plants in California that were associated with estrogenic activity in in vitro . Fenofibrate was first synthesized in 1974, as a derivative of clofibrate , and was initially offered in France. It was initially known as procetofen, and was later renamed fenofibrate to comply with World Health Organization International Nonproprietary Name guidelines. Fenofibrate

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