Hyperlipidemia

Question 1

Total number of cholesterol in blood

Answer 1

240mg/dl

Question 2

Total number of TAG in blood

Answer 2

150mg/dl

Question 3

Types of HL

Answer 3

1- primary ( familial): genetically determined
2- secondary

Question 4

Types of primary and describe them

Answer 4

Type1= +chylomicron ( familial hyperchylomicronemia)

Type2a =+ldl (familial hypercholestrolemia)
Type2b =+ldl & vldl ( familial compined hyperlipidimia)

Type4 =+vldl ( familial hyper triglyceridimia)

Type5 =+ vldl & chylomicron ( familial mixed hyperlipidimia )

Question 5

Secondary HL

Answer 5

Hyper cholesterolimia : hypothyrodism, nephrotic syndrome and drugs

Hyper triglyceridimia : alcohol 🍺, dm , gout and chronic renal failure

Question 6

Ldl pathway

Answer 6

1- utilized by the tissues well
2- return again to liver ( ldl receptor )
3- deposited subintimal causing atherosclerosis

Question 7

Hdl function

Answer 7

Collect unestrified cholesterol and estrificated and then return it to liver eg ldl

Question 8

حدوتة ال metabolism

Answer 8

حدوتة مصرية

Question 9

Lines of lipid lowering drugs

Answer 9

1- intestinal cholesterol absorption inhibitors
Bile acid seqestrant ( binding resin) : cholestyramine and colestipol

2- HMG CoA reductase inhibitors
Statins

3- activator of lipoprotein lipase
fibracic acid derivatives ( fibrates)

4- lipolysis inhibitors
Niasin ( vitamin b3)

Question 10

Mechanism of cholestyramine

Answer 10

Forming complex with bile acids => - enterohepatic absorbtion of it
- cholesterol

Question 11

Therapeutic uses of cholestyramine

Answer 11

1- hyper cholesterolimia ( type 2a)
Very effective as it reduces (10% -20%) of cholestrol in blood

2- diarrhea due to bile acid malabsorptions
3- pruritis of obstructive jaundice

Question 12

Adverse effects of cholestyramine

Answer 12

1- GIT upset ( most common) : vomitting and nausea and steatorrhea
2 reduce fat soluble vitamins
3- reduces absorption of anion drugs like digitalis and warfarin

Question 13

Mechanism of ezetimibe

Answer 13

Selective inhibitor of intestinal cholesterol and even if there is no dietary cholesterol it inhibits the reabsorbtion of cholesterol in bile excretion

Question 14

Therapeutic uses of ezetimibe

Answer 14

Hyper cholesterolimia : very effective as it reduces (25%) of cholesterol blood

Question 15

Advers effect of ezetimibe

Answer 15

Reversible hepatic dysfunction: tests must be done regularly

Question 16

Mechanism of statins

Answer 16

HMG CoA reductase enzyme competitive inhibitor => - cholesterol &+ ldl return to liver

Question 17

Therapeutic uses of statins

Answer 17

Hyper cholesterolimia

Question 18

Adverse effects of statins

Answer 18

H: hepatic dysfunction: it should be stoped if liver enzymes are >3 folds the upper normal
M: myopathy, myositis, rhabdomyolysis in skeletal and cardiac muscle leading to cpk increase

G: Git upset ( most common) vomiting and nausea

CoA : cataract especially in middle aged persons

Reductase : renal dysfunction ( especially with lovastatin

Question 19

Best time taking statins

Answer 19

In night as cholesterol biosynthesis occurs at night , especially with semvastatin which has shorter half life

Question 20

Contraindications with statins

Answer 20

Pregnancy as it’s teratogenic

Question 21

Mechanism of fibrates

Answer 21

Activate (PPAR -a) gene leading to +++ lipoprotein lipase enzyme => — TAGs

Question 22

Therapeutic uses of fibrates

Answer 22

Hyper triglyceridimia
Fenofibrate has antidieurtic action in people with diabetes insipdus

Question 23

Adverse effects of fibrates

Answer 23

Git upset ( most common)
Myopathy so its contraindicated with statins
Hepatic dysfunction
Skin rash and dermatologic reactions

Question 24

Mechanism of niasin ( vitamin b3)

Answer 24

Inhibit lipolysis of adipose tissue
Inhibit fatty acid synthesis by liver => – TAGs

Question 25

Therapeutic uses of niasin

Answer 25

Must be combined with other drugs to make effective effect treating hyperlipidima

Question 26

Adverse effects of niasin

Answer 26

Skin flushing and burning sensation due to ++ histamine and PGs release but it can be treated by asprin 30 minutes before

Git irritation ( histamine ++ hcl)
Hyperurcimia
Hyperglycemia

Question 27

Contraindications of niasin

Answer 27

Peptic ulcer

Question 28

How is type 1 (hyperchylomicronimia ) treated

Answer 28

It’s treated mainly by diet control