P.03 Hyperlipidemias and Atherosclerosis Quiz
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Questions and Answers

What is denoted by increased levels of triglycerides?

  • Hyperlipoproteinemias
  • Atherosclerosis
  • Hyperlipemia (correct)
  • Dyslipidemia

    • What type of cells are filled with cholesteryl esters as a result of endocytosis of modified lipoproteins in atherosclerosis?

  • Macrophages and smooth muscle cells (correct)
  • T lymphocytes and B lymphocytes
  • Plasma cells and natural killer cells
  • Endothelial cells and fibroblasts

    • What is the primary cause of reduction in acute coronary events following vigorous lipid-lowering treatment?

  • Mitigation of the inflammatory activity of macrophages (correct)
  • Reduction in platelet activation
  • Decrease in accumulation of foam cells and collagen
  • Enhanced endothelial function

    • What is the main effect of High Density Lipoproteins (HDL) in the context of atherosclerosis?

    <p>A and B</p> Signup and view all the answers

    What is the impact of diabetes as a major risk factor in the context of atherosclerosis?

    <p>Impairs nitric oxide release from the vascular endothelium</p> Signup and view all the answers

    How does cigarette smoking contribute to coronary disease in relation to High Density Lipoproteins (HDL)?

    <p>Reduces HDL levels</p> Signup and view all the answers

    Which lipoprotein is chiefly catabolized in hepatocytes and other cells through receptor mediated endocytosis?

    <p>Low Density Lipoproteins (LDL)</p> Signup and view all the answers

    What are the major clinical sequelae of hyperlipidemias?

    <p>Acute pancreatitis and atherosclerosis</p> Signup and view all the answers

    Which pathway involves hydrolysis by the lipoprotein lipase (LPL) system for removal of triglycerides from chylomicrons and VLDL?

    <p>Pathway shared with VLDL</p> Signup and view all the answers

    Which lipoprotein species contain apolipoprotein B-100, conveying lipid to the arterial wall?

    <p>Low density lipoproteins (LDL), Very low density lipoproteins (VLDL), and Lipoprotein (a) [LP(a)]</p> Signup and view all the answers

    What is the role of Lp(a) lipoprotein in atherosclerosis?

    <p>Inhibits thrombolysis and contributes to coronary disease</p> Signup and view all the answers

    Which cellular components in atherosclerosis are filled with cholesteryl esters due to endocytosis of modified lipoproteins?

    <p>Macrophages and smooth muscle cells</p> Signup and view all the answers

    Which type of remnant lipoprotein can contribute to atherosclerosis by entering the artery wall?

    <p>Containing the B-48 protein (apo B-48)</p> Signup and view all the answers

    What are the metabolic disorders that involve elevations in any lipoprotein species?

    <p>Hyperlipoproteinemias or hyperlipidemias</p> Signup and view all the answers

    What is formed during the catabolism of chylomicrons that can also enter the artery wall, contributing to atherosclerosis?

    <p>Remnant lipoprotein containing the B-48 protein (apo B-48)</p> Signup and view all the answers

    Which lipoprotein contains apolipoprotein B-100, conveying lipid to the arterial wall?

    <p>(VLDL) Very low density lipoproteins</p> Signup and view all the answers

    What is the primary reason for treating patients with triglycerides above 700mg/dL?

    <p>To prevent acute pancreatitis because the LPL clearance mechanism is saturated at this level</p> Signup and view all the answers

    What is a characteristic of patients with hypertriglyceridemia and reduced levels of HDL-C?

    <p>They tend to have cholesterol-rich VLDL of small particle diameter</p> Signup and view all the answers

    Which proteins or factors are associated with severe lipemia in primary chylomicronemia?

    <p>Apo A-V and ANGPTL4</p> Signup and view all the answers

    What is the main purpose of using METFORMIN in the management of patients with hypertriglyceridemia?

    <p>To address insulin resistance, which is a component of the metabolic syndrome</p> Signup and view all the answers

    What is not present in the serum of normal individuals who have fasted 10 hours?

    <p>Chylomicrons</p> Signup and view all the answers

    What is a characteristic feature of atherosclerosis in relation to primary hypertriglyceridemias?

    <p>Transfer of cholesteryl esters to the triglyceride-rich lipoprotein particles</p> Signup and view all the answers

    What is the presumptive diagnosis for patients with lipemia who demonstrate a pronounced decrease in triglycerides 72 hours after elimination of daily dietary fat?

    <p>Primary chylomicronemia</p> Signup and view all the answers

    What is a significant association with metabolic syndrome in patients with hypertriglyceridemia?

    <p>Increased levels of small, dense LDL</p> Signup and view all the answers

    Which lipoprotein species contain apolipoprotein B-100, conveying lipid to the arterial wall in atherosclerosis?

    <p>Low-Density Lipoproteins (LDL)</p> Signup and view all the answers

    What is the primary treatment for patients with Familial Combined Hyperlipoproteinemia (FCH) who do not normalize lipid levels with diet alone?

    <p>Reductase inhibitor alone</p> Signup and view all the answers

    Which lipoprotein is chiefly catabolized in hepatocytes and other cells through receptor-mediated endocytosis?

    <p>Low-Density Lipoproteins (LDL)</p> Signup and view all the answers

    What is denoted by increased levels of triglycerides?

    <p>'Mixed Lipemia' pattern</p> Signup and view all the answers

    What are the major clinical sequelae commonly associated with hyperlipidemias?

    <p>Eruptive xanthomas and pancreatitis</p> Signup and view all the answers

    Match the lipid disorder with its primary characteristic feature:

    <p>Familial Hypertriglyceridemia = Presence of mixed lipemia (fasting chylomicronemia and elevated VLDL) Familial Combined Hyperlipoproteinemia (FCH) = Approximate doubling in VLDL secretion and increased incidence of coronary disease Familial Dysbetalipoproteinemia = Decreased levels of LDL and accumulation of remnants of chylomicrons and VLDL Eruptive xanthomas = Centripetal obesity and insulin resistance</p> Signup and view all the answers

    Match the treatment approach with the corresponding lipid disorder:

    <p>Niacin, fibrate, or marine omega 3-fatty acids = Familial Hypertriglyceridemia Dietary restriction, weight reduction, exercise, fibrate = Familial Combined Hyperlipoproteinemia (FCH) Weight loss, decreased fat and alcohol consumption, fibrate or niacin = Familial Dysbetalipoproteinemia Marked restriction of total dietary fat, abstention from alcohol = Eruptive xanthomas</p> Signup and view all the answers

    Match the clinical feature with the associated lipid disorder:

    <p>Hepatosplenomegaly, hypersplenism = Familial Hypertriglyceridemia Tuberous or tuberoeruptive xanthomas = Familial Dysbetalipoproteinemia Elevated levels of VLDL, LDL, or both = Familial Combined Hyperlipoproteinemia (FCH) Variably present lipemia retinalis, epigastric pain, pancreatitis = Eruptive xanthomas</p> Signup and view all the answers

    Match the aggravating factor with the associated lipid disorder:

    <p>Estrogens = Familial Hypertriglyceridemia Alcohol and other factors increasing VLDL secretion = Familial Combined Hyperlipoproteinemia (FCH) Hypothyroidism = Familial Dysbetalipoproteinemia Insulin resistance = Eruptive xanthomas</p> Signup and view all the answers

    Match the diagnostic feature with the corresponding lipid disorder:

    <p>Pronounced decrease in triglycerides after elimination of daily dietary fat = Familial Hypertriglyceridemia Increased secretion of VLDL as a dominant trait = Familial Combined Hyperlipoproteinemia (FCH) Absence of the ε3 and ε4 alleles of apo E, ε2/ε2 genotype = Familial Dysbetalipoproteinemia Presence of centripetal obesity = Eruptive xanthomas</p> Signup and view all the answers

    Match the recommended medication with the corresponding lipid disorder:

    <p>Marine omega 3-fatty acids = Familial Hypertriglyceridemia Reductase inhibitor alone or in combination with niacin or fenofibrate = Familial Combined Hyperlipoproteinemia (FCH) Weight loss and decreased fat consumption usually sufficient; fibrate or niacin may be needed = Familial Dysbetalipoproteinemia Most patients require treatment with a fibrate = Eruptive xanthomas</p> Signup and view all the answers

    Match the primary dietary approach with the corresponding lipid disorder:

    <p>Marked restriction of total dietary fat, avoidance of alcohol and exogenous estrogens = Familial Hypertriglyceridemia Diet alone not sufficient; reductase inhibitor alone or in combination with niacin or fenofibrate usually required = Familial Combined Hyperlipoproteinemia (FCH) Decreased fat, cholesterol and alcohol consumption usually sufficient; fibrate or niacin may be needed = Familial Dysbetalipoproteinemia Primarily dietary restriction, weight reduction, exercise, supplementation with marine omega 3-fatty acids; most patients also require a fibrate = Eruptive xanthomas</p> Signup and view all the answers

    Match the associated condition with the corresponding lipid disorder:

    <p>Pregnancy may cause marked increase in triglycerides = Familial Hypertriglyceridemia Associated with impaired glucose tolerance and hypothyroidism = Familial Dysbetalipoproteinemia Increased incidence of coronary disease = Familial Combined Hyperlipoproteinemia (FCH) Aggravated by estrogens and other factors increasing VLDL secretion = Eruptive xanthomas</p> Signup and view all the answers

    What is the characteristic cholesterol level range in most heterozygotes with LDL receptor deficient familial hypercholesterolemia?

    <p>260-500 mg/dL</p> Signup and view all the answers

    What are the typical levels of cholesterol in homozygous familial hypercholesterolemia, which can lead to coronary disease in childhood?

    <p>Exceed 1000 mg/dL</p> Signup and view all the answers

    What are the characteristic clinical manifestations of homozygous familial hypercholesterolemia?

    <p>Elevated plaque-like xanthomas of the aortic valve, digital webs, buttocks, and extremities</p> Signup and view all the answers

    What is a characteristic feature of homozygous familial hypercholesterolemia in comparison to heterozygous familial hypercholesterolemia?

    <p>Levels of cholesterol exceeding 1000mg/dL</p> Signup and view all the answers

    What treatment approach can normalize LDL in heterozygous familial hypercholesterolemia?

    <p>Reductase inhibitors or combined drug regimens</p> Signup and view all the answers

    Which emerging therapy employs an antisense strategy targeted at apo B-100 in patients with combined heterozygosity for alleles producing non-functional and kinetically impaired receptors?

    <p>MIPOMERSEN</p> Signup and view all the answers

    Which drug may partially respond in homozygotes and those with combined heterozygosity who retain even minimal function of their receptors?

    <p>All of the above</p> Signup and view all the answers

    Which enzyme therapy effectively restores the hydrolysis of cholesteryl esters in liver, normalizing plasma lipoprotein levels?

    <p>Sebelipase alfa</p> Signup and view all the answers

    What is the primary treatment for patients with familial hypoalphalipoproteinemia?

    <p>Niacin</p> Signup and view all the answers

    In the presence of hypertriglyceridemia, why is HDL cholesterol low?

    <p>Exchange of cholesteryl esters from HDL into triglyceride-rich lipoprotein</p> Signup and view all the answers

    What is the characteristic feature of Tangier disease and LCAT deficiency?

    <p>Severely low levels of HDL-C</p> Signup and view all the answers

    Which medication increases HDL in many patients with low levels of HDL cholesterol?

    <p>Niacin</p> Signup and view all the answers

    What is the impact of PCSK9 monoclonal antibodies on levels of Lp(a) in patients?

    <p>They reduce levels of Lp(a) by about 25%</p> Signup and view all the answers

    How do fibrates or Niacin exert beneficial effects in patients with Lp(a) hyperlipoproteinemia?

    <p>By reducing VLDL production</p> Signup and view all the answers

    Which lipid disorder is associated with increased atherogenesis and arterial thrombus formation?

    <p>Lp(a) hyperlipoproteinemia</p> Signup and view all the answers

    What is the response to reductase inhibitors in patients with familial ligand-defective apolipoprotein B-100?

    <p>Variable response</p> Signup and view all the answers

    In familial combined hyperlipoproteinemia, what may be necessary to add to normalize LDL?

    <p>Niacin or Ezetimibe</p> Signup and view all the answers

    What is the characteristic serum cholesterol level in some persons with familial combined hyperlipoproteinemia?

    <p>Less than 350mg/dL</p> Signup and view all the answers

    What effect does reduction of LDL-C below 100mg/dL have on the risk attributable to Lp(a)?

    <p>Decreases the risk attributable to Lp(a)</p> Signup and view all the answers

    What is the primary treatment for patients with Lp(a) hyperlipoproteinemia who demonstrate high levels of Lp(a)?

    <p>Niacin</p> Signup and view all the answers

    Match the lipid disorder with the associated characteristic feature:

    <p>Familial Ligand-Defective Apolipoprotein B-100 = Impairment of LDL endocytosis Familial Combined Hyperlipoproteinemia (FCH) = Elevation in LDL with serum cholesterol less than 350mg/dL Lp(a) Hyperlipoproteinemia = Increased risk of atherogenesis and arterial thrombus formation Tangier Disease = Absence of high-density lipoprotein (HDL) cholesterol in serum</p> Signup and view all the answers

    Match the treatment approach with the corresponding lipid disorder:

    <p>Familial Ligand-Defective Apolipoprotein B-100 = Variable response to reductase inhibitors, potential benefit from fibrates or Niacin Familial Combined Hyperlipoproteinemia (FCH) = Dietary and drug treatment, often with a reductase inhibitor, addition of Niacin or Ezetimibe may be necessary Lp(a) Hyperlipoproteinemia = Niacin, low-dose aspirin, PCSK9 monoclonal antibodies Tangier Disease = No specific enzyme therapy, minimal response to some drugs</p> Signup and view all the answers

    Match the clinical feature with the associated lipid disorder:

    <p>Hypertriglyceridemia and reduced levels of HDL-C = Familial Ligand-Defective Apolipoprotein B-100 Elevation in LDL with serum cholesterol less than 350mg/dL = Familial Combined Hyperlipoproteinemia (FCH) Increased risk of atherogenesis and arterial thrombus formation = Lp(a) Hyperlipoproteinemia Absence of high-density lipoprotein (HDL) cholesterol in serum = Tangier Disease</p> Signup and view all the answers

    Match the diagnostic feature with the corresponding lipid disorder:

    <p>Tendon xanthomas = Familial Ligand-Defective Apolipoprotein B-100 Serum cholesterol less than 350mg/dL = Familial Combined Hyperlipoproteinemia (FCH) Increased levels of Lp(a) = Lp(a) Hyperlipoproteinemia Absence of high-density lipoprotein (HDL) cholesterol in serum = Tangier Disease</p> Signup and view all the answers

    Match the lipid disorder with its primary characteristic feature:

    <p>Cholesteryl Ester Storage Disease = Accumulation of cholesteryl esters in liver and certain other cell types HDL Deficiency = Extremely low levels of HDL cholesterol Familial Hypoalphalipoproteinemia = Levels of HDL cholesterol usually below 35 mg/dL in men and 45mg/dL in women Familial Combined Hyperlipoproteinemia = Inability to normalize lipid levels with diet alone</p> Signup and view all the answers

    Match the diagnostic feature with the corresponding lipid disorder:

    <p>Elevated LDL-C, low levels of HDL-C, and often modest hypertriglyceridemia = Cholesteryl Ester Storage Disease Extremely low levels of HDL cholesterol = HDL Deficiency Levels of HDL cholesterol usually below 35 mg/dL in men and 45mg/dL in women = Familial Hypoalphalipoproteinemia Inability to normalize lipid levels with diet alone = Familial Combined Hyperlipoproteinemia</p> Signup and view all the answers

    Match the clinical feature with the associated lipid disorder:

    <p>Premature atherosclerosis and low HDL may be the only identified risk factor = HDL Deficiency Associated with extremely low levels of HDL = HDL Deficiency Levels of HDL cholesterol usually below 35 mg/dL in men and 45mg/dL in women = Familial Hypoalphalipoproteinemia Increased atherogenesis and arterial thrombus formation = Familial Combined Hyperlipoproteinemia</p> Signup and view all the answers

    Match the recommended medication with the corresponding lipid disorder:

    <p>Recombinant replacement enzyme therapy, sebelipase alfa = Cholesteryl Ester Storage Disease Special attention to avoidance or treatment of other risk factors; Niacin increases HDL in many patients = HDL Deficiency Aggressive LDL reduction indicated; treatment of hypertriglyceridemia increases the HDL-C level = Familial Hypoalphalipoproteinemia Reductase inhibitors and fibric acid derivatives exert lesser effects; may require addition to normalize LDL = Familial Combined Hyperlipoproteinemia</p> Signup and view all the answers

    Match the associated condition with the corresponding lipid disorder:

    <p>Accumulation of cholesteryl esters in liver and certain other cell types leading to hepatomegaly with subsequent fibrosis = Cholesteryl Ester Storage Disease Premature atherosclerosis and low HDL may be the only identified risk factor = HDL Deficiency Levels of HDL cholesterol usually below 35 mg/dL in men and 45mg/dL in women = Familial Hypoalphalipoproteinemia Increased atherogenesis and arterial thrombus formation = Familial Combined Hyperlipoproteinemia</p> Signup and view all the answers

    What is the impact of omega-3 fatty acids from fish oils on triglyceride levels?

    <p>They lead to a profound reduction in triglycerides</p> Signup and view all the answers

    What is the effect of omega-6 fatty acids present in vegetable oil on triglycerides?

    <p>They cause triglycerides to increase</p> Signup and view all the answers

    How can homocysteine levels be reduced in many patients?

    <p>Restriction of total protein intake</p> Signup and view all the answers

    What is the recommended action for individuals with elevated levels of Lp(a)?

    <p>Reduction of high levels of homocysteine</p> Signup and view all the answers

    Why should consumption of red meat be minimized?

    <p>To reduce the production of tetramethyl amine oxide</p> Signup and view all the answers

    What is the impact of alcohol on triglyceride levels in the context of hypertriglyceridemia?

    <p>It increases hepatic secretion of VLDL</p> Signup and view all the answers

    What is the recommended limit for cholesterol intake in patients with hyperlipoproteinemia?

    <p>Less than 200mg/dL</p> Signup and view all the answers

    In the context of dietary management, what should predominantly constitute the intake of fats?

    <p>Cis-monounsaturated fats</p> Signup and view all the answers

    What is the recommended proportion of total calories from fat in the daily intake for patients with hyperlipoproteinemia?

    <p>Between 20-25%</p> Signup and view all the answers

    What physiological response occurs during weight loss in relation to LDL and VLDL levels?

    <p>LDL and VLDL levels decrease</p> Signup and view all the answers

    Why should reductase inhibitors be avoided in pregnant and lactating women?

    <p>They may inhibit myelination of the central nervous system in fetuses and infants.</p> Signup and view all the answers

    What is the most effective function of reductase inhibitors?

    <p>Lowering LDL levels</p> Signup and view all the answers

    When is it usually recommended to initiate reductase inhibitor therapy for children with heterozygous familial hypercholesterolemia?

    <p>After 7 or 8 years of age</p> Signup and view all the answers

    What is the standard practice regarding the initiation of reductase inhibitor therapy after acute coronary syndromes?

    <p>It is initiated regardless of lipid levels.</p> Signup and view all the answers

    What are Lovastatin and Simvastatin classified as?

    <p>Inactive lactone prodrugs</p> Signup and view all the answers

    What is the significant difference in the plasma half-life of atorvastatin compared to pravastatin?

    <p>Atorvastatin has a plasma half-life of 14 hours, while pravastatin has a plasma half-life of 1 to 3 hours</p> Signup and view all the answers

    Which statin exhibits almost complete absorption after ingestion?

    <p>Fluvastatin</p> Signup and view all the answers

    What is the primary mechanism through which HMG-CoA reductase inhibitors reduce LDL?

    <p>Impair the synthesis of isoprenoids such as ubiquinone and dolichol</p> Signup and view all the answers

    Which factor contributes to the preferential activity of some statins in the liver?

    <p>Tissue-specific differences in uptake</p> Signup and view all the answers

    In which patient population should special monitoring be implemented when initiating statin therapy?

    <p>Patients with hepatic derangement or liver problems</p> Signup and view all the answers

    What is the recommended daily dose range for Atorvastatin?

    <p>10–80 mg</p> Signup and view all the answers

    Which statin is twice as potent as other statins and is given in doses of 5–80 mg daily?

    <p>Simvastatin</p> Signup and view all the answers

    In which patient population should the use of statins be restricted?

    <p>Pregnant and lactating women</p> Signup and view all the answers

    What action did the U.S. Food and Drug Administration (FDA) take in 2011 regarding simvastatin?

    <p>Issued labeling for scaled dosing</p> Signup and view all the answers

    What is the recommended daily dose range for Rosuvastatin?

    <p>5–40 mg</p> Signup and view all the answers

    For which statin did the U.S. Food and Drug Administration (FDA) issue labeling for scaled dosing in 2011?

    <p>Simvastatin</p> Signup and view all the answers

    Which statin appears to be about half as potent as lovastatin on a mass basis?

    <p>Fluvastatin</p> Signup and view all the answers

    What dose-response curve tends to level off in the upper part of the dosage range in patients with moderate to severe hypercholesterolemia?

    <p>Fluvastatin</p> Signup and view all the answers

    Which drug may increase plasma levels of Fluvastatin and Rosuvastatin?

    <p>Ketoconazole</p> Signup and view all the answers

    Which statins are the statins of choice for use with verapamil, ketoconazole group of antifungal agents, macrolides, and cyclosporine?

    <p>Pravastatin and Rosuvastatin</p> Signup and view all the answers

    Which enzyme therapy effectively restores the hydrolysis of cholesteryl esters in the liver, normalizing plasma lipoprotein levels?

    <p>Lipoprotein lipase (LPL) system</p> Signup and view all the answers

    What should be measured in patients receiving potentially interacting drug combinations?

    <p>Plasma creatine kinase activity</p> Signup and view all the answers

    What can reduce the plasma concentrations of the 3A4-dependent reductase inhibitors?

    <p>Thiazolidinediones</p> Signup and view all the answers

    Which drug increases HDL in many patients with low levels of HDL cholesterol?

    <p>Gemfibrozil</p> Signup and view all the answers

    Which drug may partially respond in homozygotes and those with combined heterozygosity who retain even minimal function of their receptors?

    <p>Simvastatin</p> Signup and view all the answers

    In which patient population should special monitoring be implemented when initiating statin therapy?

    <p>Patients ingesting more than 1 liter of grapefruit juice daily</p> Signup and view all the answers

    What occurs rarely as a hypersensitivity syndrome that includes a lupus-like disorder, dermatomyositis, peripheral neuropathy, and autoimmune myopathy?

    <p>Hypersensitivity syndromes</p> Signup and view all the answers

    Which enzyme is responsible for the catabolism of lovastatin, simvastatin, and atorvastatin?

    <p>CYP3A4</p> Signup and view all the answers

    What is the primary cause of hepatic toxicity associated with statins?

    <p>Elevated serum aminotransferase activity</p> Signup and view all the answers

    Which statin exhibits almost complete absorption after ingestion?

    <p>Atorvastatin</p> Signup and view all the answers

    What is the impact of long-term statin treatment on the incidence of type 2 diabetes?

    <p>Significantly increases the risk of type 2 diabetes</p> Signup and view all the answers

    What are the characteristic clinical manifestations of myopathy in patients receiving reductase inhibitors?

    <p>Generalized discomfort or weakness in skeletal muscles</p> Signup and view all the answers

    How does excess intake of alcohol impact the hepatotoxic effects of statins?

    <p>Aggravates hepatotoxic effects</p> Signup and view all the answers

    What is the most effective agent for increasing HDL and reducing Lp(a) in most patients?

    <p>Niacin</p> Signup and view all the answers

    Which medication should be avoided in patients with hepatic or renal dysfunction and used with caution in patients at higher risk such as women, obese patients, and Native Americans?

    <p>Fenofibrate</p> Signup and view all the answers

    What is the mechanism of action of Niacin in inhibiting VLDL secretion and decreasing production of LDL?

    <p>Enhances clearance of VLDL via the LPL pathway</p> Signup and view all the answers

    What is the recommended daily dosage of niacin for patients with hypercholesterolemia?

    <p>2–6 g</p> Signup and view all the answers

    What side effect occurs after each dose when niacin is started or the dose increased, and can be mitigated by taking aspirin beforehand?

    <p>Cutaneous vasodilation and sensation of warmth</p> Signup and view all the answers

    Which adverse effects are rare for fibrates?

    <p>Decreases in white blood count or hematocrit</p> Signup and view all the answers

    Which fibrate is the fibrate of choice for use in combination with a statin?

    <p>Fenofibrate</p> Signup and view all the answers

    What is the risk of myopathy when fibrates are given with reductase inhibitors?

    <p>High risk</p> Signup and view all the answers

    Which statement about niacin's impact on lipid metabolism is true?

    <p>Poorly understood effects on lipid metabolism</p> Signup and view all the answers

    What is the primary purpose for using Gemfibrozil or Fenofibrate?

    <p>To treat hypertriglyceridemia that results from treatment with antiviral protease inhibitors</p> Signup and view all the answers

    Which drug is absorbed quantitatively from the intestine and undergoes enterohepatic circulation?

    <p>Gemfibrozil</p> Signup and view all the answers

    Which drug is most commonly used and has a plasma half-life of 20 hours?

    <p>Fenofibrate</p> Signup and view all the answers

    What is the primary effect of fibrates in the liver and striated muscle?

    <p>Increase in oxidation of fatty acids</p> Signup and view all the answers

    Which lipoprotein shows only modest reductions in most patients when treated with fibrates?

    <p>LDL</p> Signup and view all the answers

    In which patients does HDL cholesterol increase moderately when treated with fibrates?

    <p>Patients with low HDL cholesterol levels</p> Signup and view all the answers

    What is the primary function of fibrates as ligands for the nuclear transcription receptor PPAR-α?

    <p>Upregulate LPL and apo A-I</p> Signup and view all the answers

    What is the impact of fibrates on the oxidation of fatty acids in the liver and striated muscle?

    <p>Increase in oxidation of fatty acids</p> Signup and view all the answers

    What action does the liver take on some of the drug gemfibrozil?

    <p>Modifies it to hydroxymethyl, carboxyl, or quinol derivatives</p> Signup and view all the answers

    What proportion of fenofibrate is excreted in the urine as glucuronide?

    <p>60%</p> Signup and view all the answers

    What does fenofibrate hydrolyze completely in the intestine?

    <p>Lipoproteins</p> Signup and view all the answers

    What is the primary purpose of bile acid-binding resins such as colestipol and cholestyramine?

    <p>To bind bile acids in the intestinal lumen and prevent their reabsorption</p> Signup and view all the answers

    What is the potential consequence of using bile acid-binding resins in individuals with combined hyperlipidemia?

    <p>An increase in VLDL levels</p> Signup and view all the answers

    Apart from its cholesterol-lowering effects, when might bile acid-binding resins like colestipol and cholestyramine be helpful for patients?

    <p>Relieving pruritus in patients with cholestasis and bile salt accumulation</p> Signup and view all the answers

    What is the mechanism by which bile acid-binding resins impact the conversion of cholesterol to bile acids in the liver?

    <p>By enhancing 7α- hydroxylation in the liver</p> Signup and view all the answers

    In what scenario might colesevelam, a bile acid-binding resin, be used along with other drugs?

    <p>To achieve further hypocholesterolemic effect when combined with other drugs</p> Signup and view all the answers

    What is the recommended maximum daily dose of colestipol in 1-g tablets?

    <p>16 g</p> Signup and view all the answers

    How should granular resins be taken?

    <p>Mixed with juice or water and allowed to hydrate for 1 minute</p> Signup and view all the answers

    What side effect should be frequently monitored in patients taking resins and anticoagulants?

    <p>Prothrombin time</p> Signup and view all the answers

    Which drugs' absorption may be impaired by the resin?

    <p>Digitalis glycosides and ascorbic acid</p> Signup and view all the answers

    What should be avoided in patients with diverticulitis when using resins?

    <p>Resins</p> Signup and view all the answers

    What is the primary target of ezetimibe's mechanism of action?

    <p>Transport protein NPC1L1</p> Signup and view all the answers

    What is the average reduction in LDL cholesterol with ezetimibe alone in patients with primary hypercholesterolemia?

    <p>18%</p> Signup and view all the answers

    What is the synergistic effect of ezetimibe when combined with reductase inhibitors?

    <p>Greater reduction in LDL cholesterol</p> Signup and view all the answers

    What happens to plasma concentrations of ezetimibe when administered with fibrates?

    <p>They increase</p> Signup and view all the answers

    What is the predominant route of excretion for ezetimibe?

    <p>Feces</p> Signup and view all the answers

    What is the approximate peak time for ezetimibe to reach blood levels after absorption?

    <p>12-14 hours</p> Signup and view all the answers

    What happens to the half-life of ezetimibe when it is administered with cholestyramine?

    <p>It decreases</p> Signup and view all the answers

    Which drug is available but currently restricted to patients with homozygous familial hypercholesterolemia?

    <p>Lomitapide</p> Signup and view all the answers

    What is the essential role of microsomal triglyceride transfer protein (MTP) in the liver and intestine?

    <p>Adding triglycerides to VLDL and chylomicrons</p> Signup and view all the answers

    What is a potential adverse effect of lomitapide in some individuals?

    <p>Accumulation of triglycerides in the liver</p> Signup and view all the answers

    What is the primary therapeutic target of mipomersen?

    <p>Apo B-100</p> Signup and view all the answers

    What is the mechanism of action of PCSK9 inhibitors such as evolocumab and alirocumab?

    <p>Reduction of LDL levels</p> Signup and view all the answers

    In which patient population is the use of PCSK9 inhibitors restricted?

    <p>Patients with familial hypercholesterolemia or clinical atherosclerotic cardiovascular disease</p> Signup and view all the answers

    What is the mode of administration for lomitapide?

    <p>Oral administration once daily 2 hours after the evening meal</p> Signup and view all the answers

    In which patient population is the use of PCSK9 inhibitors restricted?

    <p>Patients with homozygous familial hypercholesterolemia</p> Signup and view all the answers

    What is the primary cause of reduction in acute coronary events following vigorous lipid-lowering treatment?

    <p>Reduction in LDL levels</p> Signup and view all the answers

    Apart from its cholesterol-lowering effects, when might bile acid-binding resins like colestipol and cholestyramine be helpful for patients?

    <p>In reducing triglyceride levels</p> Signup and view all the answers

    Which enzyme is responsible for the catabolism of lovastatin, simvastatin, and atorvastatin?

    <p>Cytochrome P450</p> Signup and view all the answers

    What does fenofibrate hydrolyze completely in the intestine?

    <p>Triglycerides</p> Signup and view all the answers

    What is the recommended maximum daily dose of colestipol in 1-g tablets?

    <p>$20g$</p> Signup and view all the answers

    What are the characteristic clinical manifestations of myopathy in patients receiving reductase inhibitors?

    <p>Muscle pain and weakness</p> Signup and view all the answers

    What type of remnant lipoprotein can contribute to atherosclerosis by entering the artery wall?

    <p>IDL remnants</p> Signup and view all the answers

    What are Lovastatin and Simvastatin classified as?

    <p>Reductase inhibitors</p> Signup and view all the answers

    What is the standard practice regarding the initiation of reductase inhibitor therapy after acute coronary syndromes?

    <p>Initiate immediately following the event</p> Signup and view all the answers

    What is the impact of CETP inhibition?

    <p>Diminution of HDL particles</p> Signup and view all the answers

    What is the role of AMP kinase activation in cells?

    <p>Increasing insulin sensitivity</p> Signup and view all the answers

    What is the primary function of cyclodextrins?

    <p>Solubilizing hydrophobic drugs for delivery</p> Signup and view all the answers

    What is the consequence of CETP inhibition on the accumulation of HDL particles?

    <p>Lack of cardioprotective effect</p> Signup and view all the answers

    What is the potential benefit of AMP kinase activation for management of the metabolic syndrome and diabetes?

    <p>Improving LDL-C levels</p> Signup and view all the answers

    Which lipoprotein particles are affected by CETP inhibition?

    <p>Triglyceride-rich lipoproteins</p> Signup and view all the answers

    What is the approved usage of cyclodextrins?

    <p>Solubilizing hydrophobic drugs for delivery</p> Signup and view all the answers

    How does AMP kinase activation affect cholesterol and triglyceride biosynthesis?

    <p>Inhibits both cholesterol and triglyceride biosynthesis</p> Signup and view all the answers

    What happens to the transport of cholesteryl esters to the liver when CETP is inhibited?

    <p>It reduces transport to the liver</p> Signup and view all the answers

    What is a potential area for clinical trials related to AMP kinase activation?

    <p>Management of metabolic syndrome and diabetes</p> Signup and view all the answers

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