Lesson C2 - Drugs used for the Treatment & Prevention of Atherosclerosis

Question 1

One of the functions of the coronary arteries in the heart is to supply oxygen-carrying blood to
the heart. In atherosclerosis, a fatty sludge infiltrates the inner coronary artery walls so that the

Answer 1

narrowed coronary artery will carry less blood

Question 2

the narrowed coronary arteries cannot supply sufficient oxygen-carrying blood and the individual
experiences pain in the chest known as

Answer 2

angina pectoris

Question 3

With increased blockage of the coronary artery,
a portion of the heart muscle may be deprived of oxygen-carrying blood leading to irreversible
damage to a portion of the heart muscle, a condition referred to as

Answer 3

myocardial infarction

commonly referred to as a heart attack

Question 4

The three major types of lipids are

Answer 4

cholesterol (C), cholesterol esters (CE), and

triglycerides (TG).

Question 5

Cholesterol is a

Answer 5

waxy, fat-like, ring-structured chemical present in all cells in the body. It is a
component of cell membranes and it is used for the synthesis of sex hormones, bile salts and
vitamin D.

Question 6

Cholesterol only endangers health if the concentration in the blood is
elevated and if it infiltrates arterial walls, narrowing the lumen, decreasing blood flow, and hence
decreasing the amount of

Answer 6

oxygen available

Question 7

Fats (C, CE and TG) are insoluble in water and they are therefore packaged for transport as

Answer 7

lipoproteins

Question 8

Chylomicrons: These are the largest of the lipoproteins. They are formed in the intestine and
carry

Answer 8

triglycerides of dietary origin.

Question 9

Very low density lipoproteins (VLDL): These lipoproteins are secreted by the liver and carry

Answer 9

triglycerides to body tissues.

Question 10

Low density lipoproteins (LDL): LDL is sometimes referred to as the “bad” lipoprotein
because it is taken up by macrophages (large white blood cells) and play a role in increasing fatty
deposits inside the arteries and

Answer 10

thickening the inside of blood vessels.

Question 11

High density lipoproteins (HDL): HDL is referred to as the “good” lipoprotein because it

Answer 11

transports cholesterol away from the arteries to the liver where cholesterol is biotransformed into
bile acids and excreted. In this way, HDL helps to protect against heart disease.

Question 12

Secondary Hyperlipoproteinemias- These arise as complications of more generalized metabolic disturbances such as diabetes
mellitus, hypothyroidism, or

Answer 12

chronic ingestion of large amounts of alcohol.

Question 13

Primary Hyperlipoproteinemias

Answer 13

-This type of hyperlipoproteinemia arises from an inherited single-gene defect inherited in a
predictable Mendelian fashion.

• Hyperlipoproteinemias may be caused by a combination of subtle genetic factors acting together with environmental insults.

Question 14

Desirable levels of total cholesterol in adults is considered to be less than

Answer 14

200 mg/dL

5.5 mmol/L

Question 15

Borderline to high levels in adults are considered to be

Answer 15

200-239 mg/dL

Question 16

High levels in adults are considered to be greater than or equal to

Answer 16

240 mg/dL

Question 17

An accurate heart-risk

assessment requires a detailed blood lipid (fat) analysis and a calculation of the

Answer 17

HDL/LDL ratio.

Question 18

The following needs to be done in conjunction with lowering of lipids:

Answer 18

(a) Cessation of smoking.
(b) Therapy of hypertension.
(c) Institution of physical fitness program.
(d) Control of blood glucose in diabetics.
(e) Therapy of hypothyroidism.
(f) Therapy of alcohol dependence

Question 19

The diet should be low in

Answer 19

cholesterol and saturated fats

Question 20

There are four major drugs used in the treatment of the hyperlipoproteinemias

Answer 20

cholestyramine,

gemfibrozil, niacin (nicotinic acid) and lovastatin (and several related compounds, e.g. simvastatin).

Question 21

Cholestyramine is a large, insoluble, positively-charged resin that binds bile acids in the intestine
and prevents their

Answer 21

reabsorption

Question 22

Cholesterol is metabolized in the liver to bile acids which are then excreted into the

Answer 22

intestine

Question 23

. Cholestyramine is therefore useful in hyperlipoproteinemias
in which

Answer 23

LDL levels are elevated

Question 24

The major therapeutic use of gemfibrozil is in the treatment of

Answer 24

f hypertriglyceridemia

Question 25

VLDL is
elevated. Gemfibrozil decreases levels of VLDL in plasma due to causing enhanced breakdown
of triglycerides and

Answer 25

decreased secretion of VLDL by the liver.

Question 26

Niacin inhibits secretion of VLDL from the liver, and since LDL is a product of VLDL, it also
decreases production of

Answer 26

LDL.

Question 27

Niacin (Nicotinic Acid, Vitamin B3)

Answer 27

is the most effective agent in increasing levels of HDL.

Question 28

Lovastatin and related compounds – simvastatin, fluvastatin, atorvastatin and pravastatin (this 
class has been referred to as

Answer 28

statins

Question 29

Lovastatin and related compounds inhibit the enzyme which catalyzes the rate-limiting step in

Answer 29

cholesterol biosynthesis. This enzyme is known as HMG-CoA reductase

Question 30

Lovastatin and related compounds

Answer 30

is the most effective in lowering LDL and total cholesterol.

Question 31

It is known that lowering cholesterol levels in

patients with high cholesterol levels decreases the risk of

Answer 31

coronary heart disease.

Question 32

statins – have certainly resulted in major improvements in the treatment of the

Answer 32

hyperlipoproteinemias