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GI - Week 3 > Hyperlipoproteinemia treatment > Flashcards

Hyperlipoproteinemia treatment Flashcards

1
Q

The three major functions of this type of protein are:
1. absorption of dietary cholesterol, fatty acids, fat soluble vitamins
2. transportation of triglycerides, cholesterol, and vitamins from liver to periphery
3. transportation of cholesterol from periphery to liver/intestine

A

Lipoproteins

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2
Q

This lipoprotein metabolic pathway transports dietary lipids to the periphery and liver

A

Exogenous pathway

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3
Q

This lipoprotein metabolic pathway transports hepatic lipids to the periphery

A

Endogenous pathway

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4
Q

Are chylomicrons typically present in the blood after fasting?

A

No
its presence after a 12 hr fast can suggest disorders of lipoprotein metabolism

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5
Q

This type of lipoprotein transports excess cholesterol from the periphery back to the liver for excretion in the bile

A

High-density lipoprotein (HDL)
“good lipoprotein”

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6
Q

Does high-density lipoprotein (HDL) transport excess cholesterol to or from the liver?

A

To the liver from the periphery; for excretion in the bile

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7
Q

Nascent HDLs capture cholesterol and esterify by this enzyme, which leads to the formation of mature HDLs

A

Lecithin-cholesterol acyltransferase (LCAT)

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8
Q

Mature HDLs are selectively taken up by the liver via this receptor

A

SR-BI
(scavenger receptor class BI)

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9
Q

Some HDL cholesterol can be transferred by this protein from HDLs to VLDLs and chylomicrons to be taken up by the liver

A

Cholesteryl ester transfer protein (CETP)

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10
Q

Tuberous xanthomas are characteristic lesions of this condition involving polygenic mutations

A

Familial hypercholesterolemia

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11
Q

These lesions appear as firm, painless, reddish-yellow nodules primarily on extensor surfaces of joints and pressure areas of the body
Characteristic of familial hypercholesterolemia

A

Tuberous xanthomas

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12
Q

Should plasma lipid and lipoprotein levels be measured after a meal or fasting?

A

Fasting (12 hour overnight fast)

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13
Q

What is a low HDL value?

A

<40 mg/dl

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14
Q

Does hypertriglyceridemia increase the risk of coronary heart disease?

A

Yes when in combination with metabolic syndrome

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15
Q

Does hypercholesterolemia increase the risk of coronary artery disease?

A

Yes = high blood cholesterol and/or LDL raises TWICE the risk of coronary artery disease and for cerebrovascular disease

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16
Q

This is the preferred treatment for lowering LDL

A

HMG CoA reductase inhibitors (statins)

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17
Q

Statins are linked to increased myopathy if taken with this

A

Grapefruit

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18
Q

Statins are linked to increase in adverse effect this if taken with grapefruit

A

Myopathy

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19
Q

This enzyme is the key regulatory point in cholesterol biosynthesis

A

HMG CoA reductase

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20
Q

HMG CoA reductase reduces HMG CoA to form this
Requires 2 NADPH

A

Mevalonate

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21
Q

This type of hyperlipoproteinemia drug halts the progression and promotes regression of atherosclerotic lesions

A

Statins

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22
Q

Hepatotoxicity is a common adverse effect of this type of drug for hyperlipidemia
Liver function tests (serum transaminase levels) >3x are common

A

Statins

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23
Q

If a patient on statins has elevated serum transaminase levels >3x, should you continue the drug?

A

Yes, continue drug unless patient has symptoms of liver disease

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24
Q

Is diabetes a common adverse effect of statins?

A

yes
(small risk increases with higher doses)

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25
Hepatotoxicity and diabetes are common adverse effects of this drug for hyperlipidemia
Statins
26
This is a serious adverse effect of statins, and is dose dependent
Myopathy
27
Myopathy is a serious adverse effect of this type of drug for hyperlipidemia Muscle weakness with CK >10x Rhabdomyolysis is the extreme form usually associated with myoglobinuria and brown urine (renal failure)
Statins
28
Are statins safe for use in pregnancy?
No - pregnancy category X
29
This is the absolute contraindication of statins
Active or chronic liver disease
30
cyclosporine, macrolide antibiotics, antifungals, cytochrome p450 inhibitors, and protease inhibitors are relative contraindications of this type of drug for hyperlipidemia
Statins
31
Cholestyramine is this type of drug
Bile acid sequestrant
32
Colesevelam is this type of drug
Bile acid sequestrant
33
Colestipol is this type of drug
Bile acid sequestrant
34
Bile acid sequestrant have a risk of significant elevation of this
Triglycerides
35
This type of drug for hyperlipidemia has common drug interactions related to disruption of drug absorption
Bile acid sequestrant
36
Are bile acids positively or negatively charged?
Negatively so positively charged resins (in bile acid sequestrants) bind negatively charged bile acids
37
The MOA of this type of drug for hyperlipidemia is that positively charged resins bind negatively charged bile acids
Bile acid sequestrant
38
With this type of drug for hyperlipidemia, compensatory increase in HMG CoA reductase partially offsets its effect
Bile acid sequestrant
39
Dysbetalipoproteinemia (type III hyperlipoproteinemia) and triglycerides >400mg/dl are contraindications of this type of drug for hyperlipidemia Drug binding occurs; administer drugs 1 hr before or 3-4 hrs after May interfere with fat soluble vitamin absorption
Bile acid sequestrant
40
This drug is a selective cholesterol absorption inhibitor
Ezetimibe
41
Ezetimibe is a selective inhibitor of absorption of this
cholesterol
42
This drug for hyperlipidemia targets Niemann-Pick C1 like 1 (NPC1L1) transporter
Ezetimibe
43
Do Bile acid sequestrants interfere with the absorption of fat soluble vitamin absorptions?
Yes
44
Does Ezetimibe interfere with the absorption of fat soluble vitamins?
No also doesn't interfere with triglycerides or bile acids
45
Serious adverse effects of Ezetimibe are rare, but this may occur, especially when used with other lipid lowering agents
Myopathy
46
Vytorin is a combination of these two drugs
Ezetimibe and Simvastatin
47
This is a combination drug of Ezetimibe and Simvastatin
Vytorin
48
Should Vytorin be given to women in childbearing years in the absence of contraception?
No
49
This vitamin inhibits triglyceride synthesis, reduces LDL synthesis/levels, and reduces HDL clearance
Niacin (Vitamin B3)
50
Niacin (Vit B3) inhibits this enzyme to reduce lipolysis of triglycerides, lowering free fatty acids
Lipase
51
This treatment for hyperlipidemia has a short half life (1 hr), so requires multiple daily dosing or sustained release preparation use
Niacin (Vit B3)
52
Flushing and pruritus are adverse effects of this drug for hyperlipidemia Greatest incidence early in therapy or w/ dosage adjustment
Niacin (Vit B3)
53
Flushing and pruritus are adverse effects of Niacin (Vit B3), and there is increased risk with use of either of these 2 substances
Caffeine and ethanol
54
This adverse effect of Niacin (Vit B3) has increased risk with caffeine and ethanol use; reduced by aspirin taken 30 min before
Flushing and pruritus
55
Flushing and pruritus from Niacin (Vit B3) can be reduced by taking this 30 minutes before
Aspirin
56
Flushing and pruritus, dyspepsia, hepatotoxicity, hyperglycemia in diabetes, and hyperuricemia are adverse effects of this drug for hyperlipidemia
Niacin (Vit B3)
57
These two conditions are absolute contraindications of Niacin (Vit B3)
Liver disease and Gout
58
Liver disease and Gout are absolute contraindications of this drug for hyperlipoproteinemia Relative contraindications include diabetes, hyperuricemia, and peptic ulcer disease
Niacin (Vit B3)
59
This class of drugs is similar in efficacy to statins or niacin in lowering triglycerides and raising HDL Has no effect on overall mortality, but non-fatal myocardial infarctions are reduced
Fibric acid derivatives (fibrates)
60
MOA of this type of drug for hyperlipoproteinemia is that it binds peroxisome proliferator-activated receptor alpha (PPARa) in the liver
Fibric acid derivatives (fibrates)
61
Fibric acid derivatives (fibrates) MOA is that they bind this ligand-activated transcription factor that regulates the expression of genes involved in fatty acid beta oxidation
Peroxisome proliferator-activated receptor alpha (PPARa)
62
Rashes, bone marrow toxicity, myopathy and rhabdomyolysis, and hepatotoxicity are adverse effects of this type of drug for hyperlipoproteinemia
Fibric acid derivatives (fibrates)
63
Gemfibrozil is this type of drug
Fibric acid derivatives (fibrates)
64
Gemfibrozil is a potent inhibitor of these two cytochromes
CYP 2C8 and 2C9
65
This Fibric acid derivative (fibrate) is a potent inhibitor of CYP 2C8 and 2C9
Gemfibrozil
66
This type of drug for hyperlipoproteinemia increases biliary excretion of cholesterol, leading to an elevated risk of stone formation (cholelithiasis)
Fibric acid derivatives (fibrates)
67
This type of drug for hyperlipoproteinemia has significant drug interactions - including warfarin, statins, and oral antidiabetic drugs
Fibric acid derivatives (fibrates)
68
Fibric acid derivatives (fibrates) interact with Warfarin, as they displace it from this
Albumin
69
Fibric acid derivatives (fibrates) interfere with the breakdown of this type of drug, resulting in higher blood levels and thus a greater likelihood of muscle toxicity
Statins
70
These two conditions are absolute contraindications of Fibric acid derivatives (fibrates)
Severe renal and liver diseases
71
Are Fibric acid derivatives (fibrates) recommended during breastfeeding?
No
72
This type of drug for hyperlipoproteinemia increases the risk of thromboembolic disease
Fibric acid derivatives (fibrates)
73
This type of drug for hyperlipoproteinemia lowers triglycerides, and also reduces platelet aggregation and antiarrhythmic effects
Omega-3 fatty acid ethyl esters (fish oil)
74
Adverse effects of this type of drug for hyperlipoproteinemia include diarrhea, bad after taste and "fishy burps", and excess bleeding
Omega-3 fatty acid ethyl esters (fish oil)
75
This is a herbal supplement for patients with elevated LDL cholesterol levels who cannot tolerate statins
Red Yeast Rice
76
Red Yeast Rice contains this, which is an inhibitor of HMG CoA reductase
Monacolin K
77
This treatment for hyperlipoproteinemia contains monacolin K, an inhibitor of HMG CoA reductase
Red Yeast Rice
78
Monacolin K is present in Red Yeast Rice, and is an inhibitor of this
HMG CoA reductase
79
Red Yeast Rice should not be taken with this type of drug, due to increased risk of muscle and joint problems
Statins

GI - Week 3 (6 decks)

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