Hyperlipidemia

Question 1

VLDL

Answer 1

liver

delivers hepatic TGs to peripheral tissue

Question 2

LDL

Answer 2

formed from IDL

delivers hepatic cholesterol to peripheral tissues

Question 3

chylomicrons

Answer 3

intestine

delivers dietary TGs to peripheral tissue and cholesterol to the liver

Question 4

Lp(a)

Answer 4

LDL + protein (a) that resembles plasminogen

found in atherosclerosis and CAD (inhibits thrombolysis)

Question 5

desired LDL level

Answer 5

160

Question 6

desired HDL level

Answer 6

men: > 40
women: >50
high: >60

Question 7

desired TG level

Answer 7

200

Question 8

LDL receptor

Answer 8

in liver and peripheral tissues

bind ApoB

Question 9

apolipoproteins

Answer 9

hydrophobic core with cholesteryl esters and TGs surrounded by unesterfied cholesterol, phospholipids and apoproteins

Question 10

CETP

Answer 10

found on vascular surface

transfers cholesterol esters to other lipoprotein particles

Question 11

LPL

Answer 11

degrades TGs circulating in chylomicrons and VLDLs

Question 12

ApoC-II

Answer 12

cofactor for LPL

Question 13

ApoC-III

Answer 13

inhibits lipoportein binding to receptors

Question 14

PPAR-a

Answer 14

nuclear transcription factor

upregulates LPL and HDL

Question 15

ApoB-48

Answer 15

intestine

found in chylomicrons

Question 16

ApoB-100

Answer 16

liver
found in VLDL, IDL, LDL
ligand for LDL receptors

Question 17

primary chylomicronemia

Answer 17

apoC-II or LPL defect
elevated chylomicrons, VLDL
pancreatitis

Question 18

familial hypertriglyceridemia

Answer 18

LPL defect (defective VLDL metabolism)
elevated VLDL, TG
pancreatitis

Question 19

familial dysbetalipoproteinemia

Answer 19

defective metabolism of VLDL, chylomicrons, ApoE defect
elevated IDL, VLDL, cholesterol, TG
atherosclerosis

Question 20

familal combined hyperlipidemia

Answer 20

increased ApoB
elevated VLDL, LDL
premature atherosclerosis

Question 21

familial hypercholesterolemia

Answer 21

LDL receptor, ApoB defet
elevated LDL
premature atherosclerosis

Question 22

desirable total cholesterol

Answer 22

240

Question 23

secondary hyperlipidemia causes: hypertriglyceridemia

Answer 23

DM, alcohol, severe nephrosis, estrogen, uremia, corticosteroids, myxedema, hypopituitarism, acromegaly, immunoglobulin-lipoprotein complex disorders, lipodystrophy, protease inhibitors

Question 24

secondary hyperlipidemia causes: hypercholesterolemia

Answer 24

hypothyroidism, early nephrosis, resolving lipemia, immunoglobulin-lipoprotein complex disorders, anorexia, cholestasis, hypopituitarism, corticosteroids

Question 25

dietary management of hyperlipidemia

Answer 25

limit calories from fat and cholesterol eat complex carbs and fiber weight reduction, calorie restriction and alcohol restriction

Question 26

dietary factors that influence hyperlipidemia

Answer 26

increased TGs: excess calories, alcohol, total fat increased LDL: cholesterol, saturated, and trans fat increased VLDL: sucrose and fructose

Question 27

statins

Answer 27

competitive and reversible HMG-CoA reductase inhibitors and upregulate LDL receptors (promote ER to Golgi transport and cleavage of SREBP) strongest effect on LDL UGT1A1 responsible for biotransformation of all statins reduce CHD risk AE: rhabdomyolysis (creatinine and kidney failure), teratogen, hepatic, GI distress, sleep disturbance/memory loss

Question 28

bile acid resins

Answer 28

bind bile acids and prevent reabsorption | AE: GI, bad taste, hypertriglyceridemia, prevents absorption of other drugs and fat soluble vitamins

Question 29

ezetimibe

Answer 29

prevents absorption of dietary cholesterol

Question 30

niacin

Answer 30

inhibits release of FFA from adipocytes, decrease TG syn., decrease VLDL, increase transfer of cholesterol from macrophage to HDL, and enhances LPL to convert VLDL to LDL decrease LDL and TG reduces Lp (a) and increases HDL reduces VLDL synthesis AE: flushing (less for ER), hepatic, GI, hyperucemia, insulin resistance, myositis, eyes (conjunctivitis, cystoid macular edema, retinal detachment), and skin (dry, pruritus, ichthyosis, acanthuses nigricans)

Question 31

lovastatin

Answer 31

metabolized by CYP3A4 | intermediate potency and efficacy

Question 32

simvastatin

Answer 32

metabolized by CYP3A4 intermediate potency and efficacy

Question 33

pravastatin

Answer 33

metabolized by sulfating, oxidation and glucoronidation | low potency, low efficacy

Question 34

atorvastatin

Answer 34

metabolized by CYP3A4 (and beta oxidation and glucoronidation) long T1/2 high potency, high efficacy

Question 35

rosuvastatin

Answer 35

metabolized by CYP2C9 (and glucoronidation) long T1/2 high potency, high efficacy

Question 36

fluvastatin

Answer 36

metabolized by CYP2C9

Question 37

fibrates

Answer 37

bind PPARalpha nuclear receptor: upregulates LPL and HDL | AE: gallstones, myopathy, increased liver enzymes, reflux, diarrhea, possible teratogen

Question 38

gemfibrozil

Answer 38

metabolized by glucoronidation (UGT1A1) | reduces statin metabolism UGT1A1 responsible for biotransformation of all statins

Question 39

fenofibrate

Answer 39

active metabolite: fenofibiric acid | CI: renal disease

Question 40

N-3 fatty acids

Answer 40

decrease TG, BP, platelet anti-arrhythmic reduce CHD sources: fatty fish, fish oils, walnuts, flaxseed, rapeseed, soybean, canola oil