DAST 3 EXAM 1
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| ____ has the highest concentration of cholesterol esters | show 🗑
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| ___ has the highest concentration of triacyglycerol | show 🗑
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| ___ has the lowest concentration of triacyglycerol | show 🗑
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| show | LDL
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| ____ is the largest in size of the lipoproteins | show 🗑
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| show | HDL
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| show | HDL
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| show | chylomicron
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| chylomicrons have ___ levels of fatty acids and ___ levels of cholesterol | show 🗑
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| show | acetyl CoA , carbohydrate metabolism
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| show | fatty acid esters and glycerol
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| ____ hydrolzes fats into smaller fatty acids which are slubilized by ____ | show 🗑
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| cholesterol is needed for the synthesis of: | show 🗑
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| show | acetyl CoA
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| show | 3-hydroxy-3-methylglutaryl
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| cholesterol is oxidatively cleaved by the enzyme ____ to form pregnenolone (which is the precursor of all other endogenous steroids) | show 🗑
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| show | 7-alpha-hydroxylase
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| show | 7-alpha-hydroxyase
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| Triglycerides are formed from ___ and ___ | show 🗑
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| show | fibrates
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| show | Niacin
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| show | Bile acid sequestrants (cholestyramine, colestipol and colesevelam)
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| show | bind to bile acid (glcocholic acid or taurocholic acid) --> increase fecal excretion--> removes feedback inhibition of 7-alpha hydroxylase and increases the hepatic conversion of cholesterol to bile acids
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| show | bile acid sequestrants
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| normal pKa for amines in bile acid sequestrants is ____ and thus all should be ionized at intestinal pH | show 🗑
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| _____ lowers plasma cholesterol levels by inhibiting the absorption of cholesterol at the brush border of the small intestine, specifically by binding to a transport protein in the wall causing reduction in transport and absorption | show 🗑
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| show | Fibrates
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| ___ inhibits lipolysis of adipose tissues, lowering cholesterol and tyiglyceride levels | show 🗑
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| show | decrease
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| If the ester is change to n ether on the bicyclic (ring A ) of HMG CoA RI threre is a ____ in the drugs activity | show 🗑
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| adding a methyl group to the bicylic ring of HMG CoA RI will ___ the drugs activity | show 🗑
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| the Fluorine cannot be ___ with the central ring on the ring B HMG CoA RI structure because it will reduce activity | show 🗑
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| the absolute stereochemistry of the 3 and 5 hydroxy groups of HMG CoA RI must be the same as that found in: | show 🗑
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| show | dimish or fail to improve
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| ____ are lipid protein particles that carry exogenous lipids | show 🗑
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| show | VLDL
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| show | lipoprotein lipase
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| one or more abnormalities of blood lipids | show 🗑
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| show | 1. naturally occuring sterol
2. bile salts precursor
3. synthesis of steroid hormones
4. cell membrane formation
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| ___ are the energy store in adipose tissue | show 🗑
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| triglyerides are synthesized from ___ and ___ | show 🗑
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| show | phospholipids
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| show | triglycerides
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| ___ removes triglycerides from chylomicrons | show 🗑
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| show | chylomicrons
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| show | VLDL
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| show | 1/5
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| show | small
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| VLDL remnants are formed from the action of _____ and are more ___ rich | show 🗑
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| what hapens to the VLDL remnants after they are formed by lipoprotein lipase? | show 🗑
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| VLDL transport most of ____ | show 🗑
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| show | LDL
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| show | half are removed from circulation by the liver and the other half are taken up by peripheral cells or deposited in the intimal spaces of arteries (atherosclerosis)
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| ____on LDL surface binds to ____ on the liver cells in order for uptake and clearing of excess blood lipids to occur. | show 🗑
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| how is cholesterol delivered to the liver from HDL? | show 🗑
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| show | chylomicrons (VLDL is also high)
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| show | LDL
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| ____ transports cholesterol from cells TO the liver | show 🗑
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| desirable value for total cholesterol | show 🗑
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| borderline-high value for total cholesterol | show 🗑
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| high value for total cholesterol | show 🗑
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| show | less than 100 mg/dL is optimal, 100-129 mg/dL is near or above optimal
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| show | 130-159 mg/dL
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| high value for LDL | show 🗑
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| desirable value for HDL | show 🗑
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| high value for HDL | show 🗑
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| show | less than 120 mg/dL is desirable and less than 150 is normal
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| show | 150-199 mg/dL
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| high value for triglycerides | show 🗑
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| show | Polygenic Hypercholesterolemia
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| the main parameter for Polygenic Hypercholesterolemia is LDL values of ____ and TG values of _____ | show 🗑
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| _____ is due to an increase in VLDL synthesis, a decrease in LPL activiity and a decrease in VLDL removal and results in increased TG, increased remnant VLDL, increased small dense LDL and decreased HDL | show 🗑
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| show | HDL-C greater than 40 mg/dL
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| ____ the due to dysfunctional or absent LDL receptors results in increased LDL-C | show 🗑
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| show | LDL-C 250-450 mg/dL
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| the number one secondary cause of hypercholesterolemia is _____ | show 🗑
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| dietary changes should be initiated first in patients with hyperipoproteinemia unless _____ or ____ | show 🗑
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| what 3 things can increase LDL? | show 🗑
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| show | total fat, alcohol and excess calories
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| show | sucrose and fructose
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| what can increase hepatic secretion of VLDL? | show 🗑
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| patients should be advised to limi total calories from fat to ___% | show 🗑
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| show | less than 7
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| ----_ fats should predominate the diet for management of dyslipidemia. | show 🗑
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| show | pregnant, lactating or women likely to become pregnant
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| show | warfarin or indandione anticoagulants
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| drugs are rarely inicated for those ____ years old | show 🗑
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| what are the pharmacological effects of statins? | show 🗑
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| show | Lovastatin and Simvastatin
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| ___ is alsmost completely absorbed | show 🗑
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| plasma half life of most statins is 1-3 hours except for ___ and ___ due to a fluorine atom on the ring structure | show 🗑
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| show | 1. serum transaminases elevation
2. muscle toxicity (myalgia, myopathy, rhabdomyolysis myolobbinuria and acute tubular necrosis)
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| show | Fibric Acid Derivatives.
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| ____ is a fibric acid derivative that is tightly bound to plasma proteins, undergoes enterohepatic circulation, crosses the placenta and is 70% excreted as parent drug by the kidneys | show 🗑
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| show | Fenofibrate
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| Drrugs that decrease statin metabolism: | show 🗑
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| ____ can reduce renal clearance of statins by reducing glucoronidation | show 🗑
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| show | fibric acid derivatives
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| show | fibric acid derivatives
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| show | 1. hypertriglyceridemias
2. dysbetalipoproteinemia
3. hypercholesterolemia/mixed dyslipidemia
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| show | 1. GI symtpoms
2. INCREASED LFT
3. MYALGIA (especially when used with statins)
4. increased risk of cholesterol gallstones (use caution in pts with biliary tract disease)
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| show | apolipoproteins and phospholipids
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| nascent HDL is converted to HDL3 by the enzyme _____ | show 🗑
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| show | pick up free cholesterol from various extrahepatic tissues
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| the two primary components of all plaques are ____ and _____ | show 🗑
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| show | 1. form fatty streak
2. influx of monocytes
3. macrophage uptake of LDL particles
4. foam cell formation. intima grows and thickens
5. plauque ruptures and forms clot
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| what are 4 secondary causes of lipid disorders? | show 🗑
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| show | lab testing and risk factor stratification
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| ____ is the primary target for treatment and treatment strategies should be based on _____ risk | show 🗑
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| ___ participates in retrieval of cholesterol from the artery wall and inhibit the oxidation of atherogenic lipoproteins | show 🗑
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| atherogenic lipoproteins can aggregate ischemia by: | show 🗑
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| lipoproteins have a hydrophobic core containing ___ and _____ | show 🗑
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| lipoproteins have a hydrophilic outer layer composed of ___,____ and ___ | show 🗑
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| show | surface lipids and small apoproteins
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| ____ is formed from LPL an the (a) protein, linked by a disulfide bridge. | show 🗑
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| show | familial hypercholesterolemia
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| ___ is used to reduce VLDL production | show 🗑
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| ___ and ___ are inactive lactone prodrugs that are hydrolyzed in the GIT to the active beta-hydroxyl derivative | show 🗑
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| show | atorvastatin, fluvastatin and rosuvastatin
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| ____ reduce prenylation od Rho and Rab (useful in Alziemers treatment) proteins | show 🗑
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| chemistry and PK of Niacin | show 🗑
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| ____ inhibits VLDL secretion in turn decreasing the production of LDL | show 🗑
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| ___ is the most effective agent for increasing HDL and is the only agent that may reduce Lp(a) | show 🗑
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| ___ function as ligands for the nuclear transcription receptor PPAR-alpha, causing an increase in oxidation of fatty acids in liver and striated muscle and increased lipolysis of lipoprotein tryglyceride via LPL. | show 🗑
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| show | Ezetimibe
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| Discuss the pathogenesis of atherosclerosis: | show 🗑
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| what are the 4 D's that are secondary causes of lipid disorders? | show 🗑
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| show | high sensitivity C reactive protein
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| hs-CRP is increased by ____ and decreased by _____ | show 🗑
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| what are 3 emerging risk markers for lipid disorders? | show 🗑
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| how should you measure hs-CRP? | show 🗑
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| how do you interperet risk levels of hs-CRP? | show 🗑
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| show | Lp(a)
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| show | increase with inflammation and genetics.
decrease with niacin, estrogen and genetics.
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| show | homocysteine
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| show | less than 200 mg/dL
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| show | 200-239 mg/dL
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| show | greater than or equal to 240 mg/dL
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| show | less than 100
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| show | 100-129
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| show | 130-159
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| show | 160-189
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| show | greater than or equal to 190
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| show | 200-499
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| show | 150-199
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| show | less than 150
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| very high TG | show 🗑
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| LDL should be directly obtained if TG levels are ____ | show 🗑
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| if a nonfasting measureent is used for FLP, only ___ and ___ are accurate. ___ will be falsely low and ____ will be falsely high. | show 🗑
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| show | 1. FLP
2. Determine presence of atherosclerotic disease
3. determine # of risk factors (if none or 1 go to step 5, if 2+ calculate FRS)
4. calculate framingham risk score
5. determine tx
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| CHD Risk Equivalents | show 🗑
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| Clinical CHD: | show 🗑
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| Major risk factor: men ___ years old and women ____ years old | show 🗑
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| show | less than 40, less than 50
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| show | 1. age
2. family history of premature CHD- in male les than 55 and females less than 65
3. smoker
4. HTN (BP greater/equal to 140/90)
5. Reduced HDL
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| you should calculate a 10 year framingham risk score if: | show 🗑
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| you should NOT calculate a 10 yearr framingham risk score if: | show 🗑
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| show | over 20%, less than 100
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| moderately high risk patients have a framingham score of ____, and an LAL goal of ____ | show 🗑
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| moderate risk patients have a framingham score of ____ and an LDL goal of _____ | show 🗑
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| show | 0-1- risk factors (no framingham score needed), less than 160
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| show | (LDL(observed) – LDL (desired)) X 100% / ( LDL (observed))
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| basic components of therapeutic lifestyle changes include ___, ____ and _____ | show 🗑
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| show | statins (beneficial effects that go above and beyond LDL lowering)
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| show | Ros> Ator> sim/Pit > Lov > Prav > Flu
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| show | Stellar
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| the Rule of 6 occurs with _____ and is defined as | show 🗑
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| show | 205 * 0.38 (20 mg simvastatin shows -38% reduction from chart) = 127 mg/dL. Increasing it 40mg will lower LDL another 6% (127 * 0.06)
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| ____ is the only statin that should be given with food | show 🗑
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| when should you monitor liver function tests with statins? | show 🗑
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| what are the 3 statins msot likely to cause drug interactions? | show 🗑
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| do not start new patients on simvastatin _____mg daily | show 🗑
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| what was included in the ATP III update? | show 🗑
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| the ___ trial showed a benefit in treating high risk patients with statins | show 🗑
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| show | PROSPER
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| show | ALLHAT
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| show | PROVE-IT
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Created by:
cmiglis