Lipid lowering drugs
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Questions and Answers

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?

  • 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'?

  • Chylomicron cholesterol
  • High density lipoprotein cholesterol
  • Low density lipoprotein cholesterol (correct)
  • Esterified cholesterol

    • What is the recommended LDL score for most people?

    <p>Below 100</p> Signup and view all the answers

    What is the primary synthetic site for cholesterol?

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

    What is the largest source of cholesterol absorption?

    <p>Biliary secretion</p> Signup and view all the answers

    What percentage of cholesterol is normally absorbed?

    <p>50%</p> Signup and view all the answers

    What is the role of low density lipoproteins (LDL) in the body?

    <p>To carry cholesterol in the blood</p> Signup and view all the answers

    What type of diet tends to raise the level of LDL cholesterol?

    <p>High saturated fats and trans fats diet</p> Signup and view all the answers

    Which lipoprotein is considered 'good cholesterol'?

    <p>High density lipoprotein cholesterol</p> Signup and view all the answers

    What is the recommended LDL level for coronary patients according to recent studies?

    <p>&lt; 70 mg/dL</p> Signup and view all the answers

    What must cholesterol undergo in order to be absorbed?

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

    Which lipoprotein carries up to a third of blood cholesterol?

    <p>High-Density Lipoproteins (HDL)</p> Signup and view all the answers

    What does HDL help prevent from building up inside the arteries?

    <p>Low-density lipoproteins (LDL)</p> Signup and view all the answers

    Which factors are associated with high triglyceride levels in the body?

    <p>Being overweight and physically inactive</p> Signup and view all the answers

    What score of triglycerides puts you at risk for metabolic syndrome?

    <p>150 or higher</p> Signup and view all the answers

    By what percentage does dietary therapy reduce LDL cholesterol?

    <p>7-10%</p> Signup and view all the answers

    What is the first enzyme in the synthesis of cholesterol from acetyl CoA?

    <p>3-hydroxy-3-methyl-glutaryl-CoA reductase</p> Signup and view all the answers

    What iis side effect of HMG CoA Reductase Inhibitors?

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

    What percentage of cholesterol is carried by high-density lipoproteins?

    <p>Up to a third</p> Signup and view all the answers

    Which condition is metabolic syndrome linked to?

    <p>Both heart disease and diabetes</p> Signup and view all the answers

    Which type of diet is recommended for the treatment of hypertriglyceridemia?

    <p>Low fat diet</p> Signup and view all the answers

    What is the recommended treatment for hypertriglyceridemia in patients with diabetes mellitus?

    <p>Optimize glycemic control</p> Signup and view all the answers

    Which drug therapy is recommended for patients with triglyceride levels above 1000 mg/dl?

    <p>Drug combination of statin+resins or statins and fibrates</p> Signup and view all the answers

    What is the recommended treatment for hypertriglyceridemia in patients with triglyceride levels less than 200?

    <p>Statin, resin or niacin</p> Signup and view all the answers

    What is the recommended treatment for hypertriglyceridemia in patients with triglyceride levels between 200-400?

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

    What is the recommended combination for drug therapy in patients with hypertriglyceridemia?

    <p>Statin+Resins/Ezitamibe</p> Signup and view all the answers

    What drug therapy can be given to patients with hypercholesterolemia?

    <p>Statins/Ezit+niacin</p> Signup and view all the answers

    Which fibric acid derivative increases clearance of triglyceride-rich lipoproteins through downregulation of Apo CIII and increased LPL activity?

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

    Which fibric acid derivative is associated with side effects such as myopathy, hepatitis, gallstones, nausea, and diarrhea?

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

    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?

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

    Which lipoprotein does Niacin help to increase?

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

    What is the mechanism of action of Niacin?

    <p>Activation of LPL and accelerated TG rich lipoprotein clearance</p> Signup and view all the answers

    What are the side effects of Niacin?

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

    What are the contraindications for Niacin use?

    <p>Active liver disease, alcoholism, pregnancy</p> Signup and view all the answers

    What is the recommended daily dose of Niacin?

    <p>1.5 - 6 gms/day divided t.i.d. IR niacin</p> Signup and view all the answers

    What is the benefit of Niacin on HDL levels?

    <p>Benefit on HDL seen at &lt; 1.5 gms/day</p> Signup and view all the answers

    When should Niacin be taken?

    <p>With meals</p> Signup and view all the answers

    What should be avoided when taking Niacin?

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

    What is a possible but VERY RARE side effect of Niacin?

    <p>Toxic ambliopia</p> Signup and view all the answers

    What is a contraindication for Niacin use in pregnant women?

    <p>Active liver disease</p> Signup and view all the answers

    Which of the following is a side effect of Bile Acid Sequestrants?

    <p>Decrease absorption of other drugs like digoxin or warfarin</p> Signup and view all the answers

    Which of the following drugs is indicated for the treatment of hypercholesterolemia?

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

    Which lipoprotein is increased by Bile Acid Sequestrants?

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

    Which of the following drugs is considered the safest agent for reducing cholesterol?

    <p>Bile Acid Binding resins</p> Signup and view all the answers

    Bile Acid sequestrants does not affect which of the following?

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

    What is the mechanism of action of Fibric acid derivative?

    <p>They work by increasing the clearance of triglyceride-rich lipoprotein through downregulation of Apo CIII and increase LPL activity</p> Signup and view all the answers

    Which of the following leads to a decreased absorption of other drugs like digoxin, warfarin, HCTZ, beta blockers, thyroxine and penicillin G?

    <p>Bile Acid sequestrants</p> Signup and view all the answers

    Who is the ideal candidate for Bile Acid Binding Resins?

    <p>Young, healthy patients</p> Signup and view all the answers

    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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    Test your knowledge on the link between high cholesterol and cardiovascular diseases in this informative quiz. Learn about the risks of plaque buildup and its connection to coronary artery disease, heart attacks, strokes, and even Alzheimer's disease.

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