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Questions and Answers
Which of the following is a major risk factor for coronary artery disease, heart attacks, and strokes?
Which of the following is a major risk factor for coronary artery disease, heart attacks, and strokes?
- Low cholesterol
- Low lipids
- High cholesterol
- High lipids (correct)
What does high cholesterol lead to?
What does high cholesterol lead to?
- Narrowing of the arteries (correct)
- Decreased plaque buildup
- Reduced risk of Alzheimer's disease
- Reduced risk of heart attacks
Which type of cholesterol is considered 'bad cholesterol'?
Which type of cholesterol is considered 'bad cholesterol'?
- Chylomicron cholesterol
- High density lipoprotein cholesterol
- Low density lipoprotein cholesterol (correct)
- Esterified cholesterol
What is the recommended LDL score for most people?
What is the recommended LDL score for most people?
What is the primary synthetic site for cholesterol?
What is the primary synthetic site for cholesterol?
What is the largest source of cholesterol absorption?
What is the largest source of cholesterol absorption?
What percentage of cholesterol is normally absorbed?
What percentage of cholesterol is normally absorbed?
What is the role of low density lipoproteins (LDL) in the body?
What is the role of low density lipoproteins (LDL) in the body?
What type of diet tends to raise the level of LDL cholesterol?
What type of diet tends to raise the level of LDL cholesterol?
Which lipoprotein is considered 'good cholesterol'?
Which lipoprotein is considered 'good cholesterol'?
What is the recommended LDL level for coronary patients according to recent studies?
What is the recommended LDL level for coronary patients according to recent studies?
What must cholesterol undergo in order to be absorbed?
What must cholesterol undergo in order to be absorbed?
Which lipoprotein carries up to a third of blood cholesterol?
Which lipoprotein carries up to a third of blood cholesterol?
What does HDL help prevent from building up inside the arteries?
What does HDL help prevent from building up inside the arteries?
Which factors are associated with high triglyceride levels in the body?
Which factors are associated with high triglyceride levels in the body?
What score of triglycerides puts you at risk for metabolic syndrome?
What score of triglycerides puts you at risk for metabolic syndrome?
By what percentage does dietary therapy reduce LDL cholesterol?
By what percentage does dietary therapy reduce LDL cholesterol?
What is the first enzyme in the synthesis of cholesterol from acetyl CoA?
What is the first enzyme in the synthesis of cholesterol from acetyl CoA?
What iis side effect of HMG CoA Reductase Inhibitors?
What iis side effect of HMG CoA Reductase Inhibitors?
What percentage of cholesterol is carried by high-density lipoproteins?
What percentage of cholesterol is carried by high-density lipoproteins?
Which condition is metabolic syndrome linked to?
Which condition is metabolic syndrome linked to?
Which type of diet is recommended for the treatment of hypertriglyceridemia?
Which type of diet is recommended for the treatment of hypertriglyceridemia?
What is the recommended treatment for hypertriglyceridemia in patients with diabetes mellitus?
What is the recommended treatment for hypertriglyceridemia in patients with diabetes mellitus?
Which drug therapy is recommended for patients with triglyceride levels above 1000 mg/dl?
Which drug therapy is recommended for patients with triglyceride levels above 1000 mg/dl?
What is the recommended treatment for hypertriglyceridemia in patients with triglyceride levels less than 200?
What is the recommended treatment for hypertriglyceridemia in patients with triglyceride levels less than 200?
What is the recommended treatment for hypertriglyceridemia in patients with triglyceride levels between 200-400?
What is the recommended treatment for hypertriglyceridemia in patients with triglyceride levels between 200-400?
What is the recommended combination for drug therapy in patients with hypertriglyceridemia?
What is the recommended combination for drug therapy in patients with hypertriglyceridemia?
What drug therapy can be given to patients with hypercholesterolemia?
What drug therapy can be given to patients with hypercholesterolemia?
Which fibric acid derivative increases clearance of triglyceride-rich lipoproteins through downregulation of Apo CIII and increased LPL activity?
Which fibric acid derivative increases clearance of triglyceride-rich lipoproteins through downregulation of Apo CIII and increased LPL activity?
Which fibric acid derivative is associated with side effects such as myopathy, hepatitis, gallstones, nausea, and diarrhea?
Which fibric acid derivative is associated with side effects such as myopathy, hepatitis, gallstones, nausea, and diarrhea?
Which fibric acid derivative is contraindicated in patients with gallstones, pregnancy and heptic insufficiency and should be used with caution in patients on inhibitors of CYP 3A4?
Which fibric acid derivative is contraindicated in patients with gallstones, pregnancy and heptic insufficiency and should be used with caution in patients on inhibitors of CYP 3A4?
Which lipoprotein does Niacin help to increase?
Which lipoprotein does Niacin help to increase?
What is the mechanism of action of Niacin?
What is the mechanism of action of Niacin?
What are the side effects of Niacin?
What are the side effects of Niacin?
What are the contraindications for Niacin use?
What are the contraindications for Niacin use?
What is the recommended daily dose of Niacin?
What is the recommended daily dose of Niacin?
What is the benefit of Niacin on HDL levels?
What is the benefit of Niacin on HDL levels?
When should Niacin be taken?
When should Niacin be taken?
What should be avoided when taking Niacin?
What should be avoided when taking Niacin?
What is a possible but VERY RARE side effect of Niacin?
What is a possible but VERY RARE side effect of Niacin?
What is a contraindication for Niacin use in pregnant women?
What is a contraindication for Niacin use in pregnant women?
Which of the following is a side effect of Bile Acid Sequestrants?
Which of the following is a side effect of Bile Acid Sequestrants?
Which of the following drugs is indicated for the treatment of hypercholesterolemia?
Which of the following drugs is indicated for the treatment of hypercholesterolemia?
Which lipoprotein is increased by Bile Acid Sequestrants?
Which lipoprotein is increased by Bile Acid Sequestrants?
Which of the following drugs is considered the safest agent for reducing cholesterol?
Which of the following drugs is considered the safest agent for reducing cholesterol?
Bile Acid sequestrants does not affect which of the following?
Bile Acid sequestrants does not affect which of the following?
What is the mechanism of action of Fibric acid derivative?
What is the mechanism of action of Fibric acid derivative?
Which of the following leads to a decreased absorption of other drugs like digoxin, warfarin, HCTZ, beta blockers, thyroxine and penicillin G?
Which of the following leads to a decreased absorption of other drugs like digoxin, warfarin, HCTZ, beta blockers, thyroxine and penicillin G?
Who is the ideal candidate for Bile Acid Binding Resins?
Who is the ideal candidate for Bile Acid Binding Resins?
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Study Notes
Cholesterol and Lipoproteins
- High cholesterol is a major risk factor for coronary artery disease, heart attacks, and strokes.
- High cholesterol leads to the buildup of plaque in the arteries, increasing the risk of heart disease and stroke.
Types of Cholesterol
- Low-density lipoproteins (LDL) are considered "bad cholesterol" because they carry cholesterol from the liver to the peripheral tissues, contributing to the buildup of plaque in the arteries.
- High-density lipoproteins (HDL) are considered "good cholesterol" because they help remove excess cholesterol from the bloodstream and transport it to the liver for excretion.
- The recommended LDL score for most people is <100 mg/dL.
- The recommended LDL level for coronary patients according to recent studies is <70 mg/dL.
Cholesterol Synthesis and Absorption
- The primary synthetic site for cholesterol is the liver.
- The largest source of cholesterol absorption is dietary cholesterol.
- Normally, 30-60% of dietary cholesterol is absorbed.
- Cholesterol must undergo emulsification in the small intestine to be absorbed.
Lipoproteins and Their Functions
- LDL carries up to a third of blood cholesterol.
- HDL helps prevent the buildup of plaque in the arteries by removing excess cholesterol from the bloodstream.
- Low levels of HDL are associated with high triglyceride levels.
Triglycerides and Metabolic Syndrome
- Factors associated with high triglyceride levels in the body include obesity, physical inactivity, cigarette smoking, and a diet high in carbohydrates.
- A triglyceride level of >150 mg/dL puts you at risk for metabolic syndrome.
- Metabolic syndrome is linked to an increased risk of type 2 diabetes and cardiovascular disease.
Diet and Treatment of Hypertriglyceridemia
- A diet low in carbohydrates and high in omega-3 fatty acids is recommended for the treatment of hypertriglyceridemia.
- The recommended treatment for hypertriglyceridemia in patients with diabetes mellitus is a combination of diet, exercise, and medication.
- For patients with triglyceride levels above 1000 mg/dL, drug therapy with fibrates or niacin is recommended.
- For patients with triglyceride levels between 200-400 mg/dL, omega-3 fatty acid supplements may be recommended.
- For patients with triglyceride levels less than 200 mg/dL, diet and exercise are often recommended as the first line of treatment.
Medications for Hypercholesterolemia and Hypertriglyceridemia
- HMG-CoA reductase inhibitors (statins) are commonly used to lower LDL cholesterol.
- The side effect of HMG-CoA reductase inhibitors is muscle pain (myalgia).
- Fibrates (e.g. gemfibrozil, fenofibrate) are used to lower triglyceride levels.
- Niacin (vitamin B3) is used to increase HDL levels.
- The mechanism of action of Niacin is to inhibit the breakdown of apolipoprotein A1, leading to increased HDL levels.
- The side effects of Niacin include flushing, pruritus, and gastrointestinal disturbances.
- The recommended daily dose of Niacin is 1-2 grams.
Bile Acid Sequestrants
- Bile Acid Sequestrants (e.g. cholestyramine, colesevelam) are used to lower LDL cholesterol.
- The mechanism of action of Bile Acid Sequestrants is to bind to bile acids in the gut, increasing their excretion and reducing the amount of cholesterol available for absorption.
- Bile Acid Sequestrants do not affect triglyceride levels.
- The ideal candidate for Bile Acid Binding Resins is a patient with a high LDL cholesterol level and a low triglyceride level.
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