Hyperlipoproteinaemias and Hypolipidaemic Drugs
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Questions and Answers

What role does lecithin: cholesterol acyltransferase (LCAT) play in the metabolism of cholesterol?

  • It enhances the secretion of cholesterol from the liver.
  • It prevents the transfer of cholesterol back to VLDL or IDL.
  • It promotes the degradation of excess cholesterol in tissues.
  • It facilitates the incorporation of cholesterol into high density lipoproteins (HDL). (correct)

    • Which class of drugs is primarily used for reducing cholesterol synthesis in the liver?

  • Bile acid sequestrants
  • Sterol absorption inhibitors
  • HMG-CoA reductase inhibitors (correct)
  • Lipoprotein lipase activators

    • What classification do hyperlipoproteinaemias associated with diabetes and nephrotic syndrome fall under?

  • Primary hyperlipoproteinaemias
  • Secondary hyperlipoproteinaemias (correct)
  • Familial hyperlipoproteinaemias
  • Monogenic hyperlipoproteinaemias

    • What is the primary consequence of excessive lipoprotein degradation in the body?

    <p>Increased risk of atherosclerosis and skin xanthomas.</p> Signup and view all the answers

    Which type of hyperlipoproteinaemia can arise due to a single genetic defect?

    <p>Monogenic hyperlipoproteinaemia</p> Signup and view all the answers

    Which of the following drugs acts as a lipolysis and triglyceride synthesis inhibitor?

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

    Which lipoproteins are primarily associated with atherogenic risk when elevated?

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

    How does HDL contribute to cardiovascular health?

    <p>By facilitating the removal of cholesterol from tissues.</p> Signup and view all the answers

    What is the primary mechanism through which nicotinic acid reduces VLDL production in the liver?

    <p>Inhibiting triglyceride synthesis</p> Signup and view all the answers

    Which of the following is a known adverse effect of nicotinic acid when taken in large doses?

    <p>Flushing and itching</p> Signup and view all the answers

    Why is nicotinic acid contraindicated during pregnancy?

    <p>It has not been proven safe for fetal development</p> Signup and view all the answers

    Which drug is most effective in reducing plasma triglyceride (TG) levels?

    <p>Nicotinic acid</p> Signup and view all the answers

    What is the recommended starting dose of nicotinic acid?

    <p>100 mg TDS</p> Signup and view all the answers

    How does nicotinic acid primarily affect lipoprotein Lp (a)?

    <p>Inhibits its synthesis</p> Signup and view all the answers

    Which patient condition presents a risk of postural hypotension when nicotinic acid is taken?

    <p>Hypertension on antihypertensives</p> Signup and view all the answers

    What is the effect of nicotinic acid on cholesterol levels?

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

    What type of hyperlipoproteinaemia is characterized by a deficiency of lipoprotein lipase?

    <p>Familial lipoprotein lipase deficiency</p> Signup and view all the answers

    Which of the following types of hyperlipoproteinaemia is the most common?

    <p>Polygenic hypercholesterolaemia</p> Signup and view all the answers

    In which disorder are IDL and chylomicron remnants elevated?

    <p>Familial dysbetalipoproteinaemia</p> Signup and view all the answers

    What is the main carrier of plasma cholesterol?

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

    What factor primarily causes Type IV hyperlipidaemia?

    <p>Multifactorial influences</p> Signup and view all the answers

    In familial hypercholesterolaemia, what is the primary issue affecting LDL uptake?

    <p>Deficiency of LDL receptor</p> Signup and view all the answers

    Which of the following plasma lipid components does NOT have an elevated level in Type IIa hypercholesterolaemia?

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

    What is the most notable side effect of statins?

    <p>Muscle aches</p> Signup and view all the answers

    What is the average half-life (t½) of atorvastatin compared to other statins?

    <p>18–24 hours</p> Signup and view all the answers

    Which type of hyperlipoproteinaemia is classified as 'very rare'?

    <p>Familial lipoprotein lipase deficiency</p> Signup and view all the answers

    Which statin is known to be hydrophilic?

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

    What is the maximum daily dose of atorvastatin?

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

    Which condition is contraindicated for statin use?

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

    What concurrent medication is indicated to have the least interaction with statins?

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

    What is the main mechanism that causes muscle-related adverse effects with statins?

    <p>Increased CPK levels</p> Signup and view all the answers

    What is a notable characteristic of pravastatin at low doses?

    <p>Equally potent as lovastatin</p> Signup and view all the answers

    What is the primary route of excretion for gemfibrozil?

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

    Which of the following is NOT a common side effect of gemfibrozil?

    <p>Bleeding tendency</p> Signup and view all the answers

    Which of the following statements about fenofibrate is correct?

    <p>It is suitable for patients with raised triglyceride levels.</p> Signup and view all the answers

    What dosage of gemfibrozil is recommended for patients with markedly raised triglyceride levels?

    <p>300 mg three times daily</p> Signup and view all the answers

    Gemfibrozil is contraindicated in which of the following conditions?

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

    What effect does the combination of gemfibrozil with a statin have?

    <p>Increases the risk of myopathy</p> Signup and view all the answers

    Which of the following side effects is least associated with fenofibrate?

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

    What is the elimination half-life of fenofibrate?

    <p>20 hours</p> Signup and view all the answers

    What was the primary reason for the discontinuation of torcetrapib development?

    <p>Higher rates of cardiovascular events.</p> Signup and view all the answers

    How is ezetimibe mainly excreted from the body?

    <p>In feces after enterohepatic circulation.</p> Signup and view all the answers

    What is the calculated plasma half-life of ezetimibe?

    <p>22 hours.</p> Signup and view all the answers

    What is the maximum LDL cholesterol lowering effect that can be achieved with ezetimibe when used alone?

    <p>15-20%.</p> Signup and view all the answers

    What is the main therapeutic role of ezetimibe in treating hypercholesterolemia?

    <p>To supplement statins without increasing their dose.</p> Signup and view all the answers

    What effect do statins have on cardiovascular mortality and morbidity?

    <p>They lower mortality and morbidity when LDL cholesterol is high.</p> Signup and view all the answers

    Which of the following studies indicated the prophylactic use of statins in CAD patients?

    <p>HPS, 2002.</p> Signup and view all the answers

    What is a significant risk factor for coronary artery disease (CAD)?

    <p>High plasma cholesterol levels.</p> Signup and view all the answers

    Study Notes

    Hyperlipoproteinaemias

    • Types of primary hyperlipoproteinaemias are categorized (I, IIa, IIb, III, IV, V) based on elevated plasma lipoproteins and lipids.
    • Genetic (G) or Multifactorial (MF) causes are noted for each type, with varying degrees of prevalence.
    • Elevated plasma lipoproteins (LDL, VLDL, IDL, Chylomicron remnants) are linked to specific disorders.
    • Cholesterol (CH) and triglycerides (TG) levels are affected differently across the types.

    Classification of Hypolipidaemic Drugs

    • HMG-CoA reductase inhibitors (statins) lower cholesterol synthesis, including lovastatin, simvastatin, atorvastatin, rosuvastatin, and pitavastatin.
    • Bile acid sequestrants (resins), such as cholestyramine and colestipol, reduce bile acid absorption.
    • Lipoprotein lipase activators (fibrates), like clofibrate, gemfibrozil, bezafibrate, and fenofibrate, activate lipoprotein lipase to lower triglycerides.
    • Nicotinic acid inhibits sterol absorption and reduces triglycerides.
    • Ezetimibe, inhibits cholesterol absorption.

    Mechanism of Action and Lipid-Lowering Effects

    • Statins reduce cholesterol synthesis by inhibiting HMG-CoA reductase, leading to increased LDL uptake and decreased LDL cholesterol (LDL-C).
    • Statins also show effects on HDL and triglycerides (TG).
    • Bile acid sequestrants reduce cholesterol by increasing its excretion.
    • Fibrates enhance lipoprotein lipase activity, decreasing triglycerides.
    • Nicotinic acid reduces VLDL production and increases HDL cholesterol.
    • Ezetimibe directly lowers cholesterol absorption.

    Adverse Effects

    • Statins can cause muscle aches, liver abnormalities, and rarely rhabdomyolysis.
    • Fibrates can cause gastrointestinal discomfort.
    • Bile acid sequestrants may cause gastrointestinal issues.
    • Nicotinic acid is associated with flushing and other effects.

    Treatment Considerations

    • Statins are often the first-line treatment for hyperlipidemia.
    • Treatment decisions consider genetic factors, type of hyperlipidemia, and individual patient's needs.
    • Treatment may continue indefinitely depending on patient profile.
    • Combination therapies may be considered.
    • Monitoring is important during treatment and adjustments to the treatment regimen may be made based on individual responses.

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    Hyperlipidemia Drugs and Plasma Expanders PDF

    Description

    This quiz covers the classification of hyperlipoproteinaemias, detailing the different types based on elevated plasma lipoproteins and their genetic and multifactorial causes. Additionally, it explores various hypolipidaemic drugs, including statins and fibrates, and their mechanisms in lowering cholesterol and triglyceride levels.

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