Chapter 15 and 16

Question 1

What is coronary heart disease (CHD)?

Answer 1

Coronary Heart Disease is the cause of premature death in developed countries

Question 2

Modifiable Risk Factors of CHD

Answer 2

hyperlipidemia
hypertension
cigarette smoking
a low level of HDL cholesterol

Question 3

Non modifiable Risk Factors pf CHD

Answer 3

male gender
family history of premature CHD
aging (men over 45, women over 55)

Question 4

Steps in pathogenesis of atherosclerosis

Answer 4

1) damage to endothelium, followed by invasion of macrophages
2) Endothelial and macrophage growth factors stimulate smooth muscle cells to migrate to the tunica intima and proliferate
3) Oxidized cholesterol accumulates in and around macrophages (foam cells) and muscle cells
4) Collagen and elastic fibers form a connective
tissue matrix that results in a fibrous plaque

Question 5

Cholesterol

Answer 5

precursor to steroid compounds that fulfill vital physiologic functions. “Sterols” make ”steroids” and vitamin D

Question 6

Triglycerides

Answer 6

composed of fatty acids and glycerol, are oxidized to generate energy for muscle contraction and metabolic reactions

Question 7

What can all cells do?

Answer 7

synthesize cholesterol

Question 8

What is the central site of processing for lipoprotein metabolism?

Answer 8

liver

Question 9

Three sources where cholesterol is derived

Answer 9

(1) biosynthesis from acetyl-CoA
(2) delivery of dietary cholesterol by chylomicron remnants
(3) endocytosis of low-density–lipoprotein (LDL) cholesterol by LDL receptors

Question 10

Ezetimibe

Answer 10

inhibits the absorption of dietary and biliary cholesterol from the intestines

Question 11

Statins

Answer 11

HMG-CoA reductase inhibitors that block the rate-limiting step in cholesterol biosynthesis

Question 12

Bile acid–binding resins

Answer 12

inhibit the reabsorption of bile acids from the gut

Question 13

Niacin

Answer 13

inhibits the secretion of very-low-density lipoproteins (VLDLs) from the liver, and fibrates such as gemfibrozil stimulate lipoprotein lipase to increase
the hydrolysis of VLDL triglycerides and the delivery of fatty acids to adipose and other tissues

Question 14

Exercise

Answer 14

increases lipoprotein lipase activity and lowers
triglyceride levels while increasing HDL levels

Question 15

Fish Oil

Answer 15

A prescription-strength formulation of omega-3 carboxylic acid (Epanova) is also available

Question 16

Mechanism of Action of Fish Oil

Answer 16

The reduction of the synthesis of triglycerides in the liver may be caused because eicosapentaenoic acid and docosahexaenoic acid are poor substrates for the enzymes responsible for the synthesis of triglycerides

Question 17

Lovastatin and Simvastatin

Answer 17

inactive prodrugs that must be converted to active metabolites in the liver, whereas the other
statins are active compounds

Question 18

Rosuvastatin

Answer 18

most potent statin currently
available after atorvastatin

Question 19

Statins

Answer 19

most important drugs for treating hypercholesterolemia

Question 20

Rosuvastatin and Atorvastatin

Answer 20

greatest effect on triglyceride levels and can be useful in treating patients with mixed hyperlipidemia

Question 21

Simvastatin

Answer 21

had a lower rate of death, myocardial infarction,
stroke, and revascularization procedures

Question 22

What is the earliest stages of statin-induced myopathy and consists of muscle ache or weakness without elevated creatine kinase levels?

Answer 22

Myalgia

Question 23

Bile acid–binding resins that are
moderately effective drugs for hypercholesterolemia and have an excellent safety
record

Answer 23

Cholestyramine, colestipol, and colesevelam

Question 24

Evolocumab and alirocumab are monoclonal antibodies to a protease enzyme that
destroys LDL receptors in the liver. This enzyme is known as

Answer 24

proprotein convertase subtilisin/kexin type 9 (PCSK9)

Question 25

When a small blood vessel is injured…

Answer 25

hemorrhage is prevented by vasoconstriction followed by formation of a platelet plug and a fibrin clot

Question 26

After the vessel is repaired…

Answer 26

the clot is removed via the process of fibrinolysis

Question 27

Arterial thrombi

Answer 27

often overlaid on a disrupted atherosclerotic plaque that exposes blood to plaque material that initiates platelet aggregation and coagulation

Question 28

coronary artery atherosclerosis can promote

Answer 28

the formation of thrombi that obstruct blood flow and cause myocardial infarction (death of tissue from lack of blood supply)

Question 29

Formation of thrombi in cerebral arteries can cause an

Answer 29

ischemic stroke

Question 30

Venous thrombi

Answer 30

initiated by venous blood pooling and sluggish blood flow that promotes expression of adhesion factors on the surface of venous endothelial cells

Question 31

Pulmonary embolism (PE)

Answer 31

thrombi can dislodge from leg veins and travel to
the lungs. Pathologic Thrombus Formation

Question 32

Thrombin

Answer 32

proteolytically cleaves small peptides from fibrinogen, allowing fibrinogen to polymerize and form a fibrin clot
potent platelet activator and mitogen

Question 33

Warfarin

Answer 33

Inhibits synthesis of coagulation factors whose formation is dependent on vitamin K

Question 34

ecchymoses

Answer 34

Patients should be instructed to report any signs of bleeding, including hematuria and bleeding into the skin