Ios 3/4 Exam 3

Front 1

what are the two sources of cholesterol?

Back 1

dietary intake
endogenous synthesis

Front 2

what organ is the major source of de novo synthesis of cholesterol?

Back 2

the liver

Front 3

how much cholesterol is reabsorbed from the cholesterol that is secreted into bile?

Back 3

50%

Front 4

which form of HMG-CoA reductase is more active, the unphosphorylated or phosphorylated form?

Back 4

unphosphorylated

Front 5

what effect does insulin have on HMG-CoA reductase?

Back 5

it dephosphorylates it, making it more active

Front 6

what is the function of Apo CII? where is Apo CII present?

Back 6

Apo CII is an activator of capillary lipoprotein lipase. it is located on the coat of chylomicrons.

Front 7

IDL (intermediate density lipoprotein) mostly bind to hepatic receptors and are repackaged as VLDL. what is the name of this hepatic receptor?

Back 7

Apo-E

Front 8

What are the two different possible fates of IDL?

Back 8

LDL or going back to the liver to be repackaged as VLDL.

Front 9

What is the name of the receptor on the liver and peripheral tissue that interacts with LDL?

Back 9

Apo B-100

Front 10

what is the potential effect of administering a statin with grapefruit juice?

Back 10

decrease metabolism of statin via inhibition of cyp3a4 by grapefruit juice --> increased serum levels of statin --> increased toxicity.

Front 11

what type of biotransformation reaction does ezetimibe have to go through before it becomes active? where does this occur?

Back 11

glucuronidation in the intestine

Front 12

what are the side effects associated with nicotinic acid?

Back 12

1. abnormal hepatic function
2. intense flushing and pruritis
3. decreased glucose tolerance
4. cardiac arrhythmias and palpitations

Front 13

what are two contraindications for nicotinic acid?

Back 13

1. previous liver disease
2. pregnancy

Front 14

which two fibric acid derivatives are considered pro drugs? what biotransformation reaction must they undergo before becoming active?

Back 14

clofibrates and fenofibrate - undergo ester hydrolysis

Front 15

what is the equation for total cholesterol?

Back 15

HDL + LDL + TG/5

Front 16

when is calculating LDL using the HDL +LDL + TG/5 equation not appropriate/accurate?

Back 16

when TG levels are above 400 mg/dL

Front 17

what does the 30 per 30 rule refer to?

Back 17

with every 30 mg/dL reduction in LDL you get a 30% reduction in heart disease risk.

Front 18

what is considered normal TG levels?

Back 18

less than 150 mg/dL

Front 19

what drugs can cause elevated TG?

Back 19

bile acid-binding resins
oral estrogens
oral retinoids
protease inhibitors
non-ISA beta-blockers (not clinically significant)

Front 20

why do we need to monitor TSH and vitamin D in patients receiving statin therapy?

Back 20

hypothyroidism and vitamin D deficiency can increase risk of statin-induced myopathy

Front 21

what are two ways to manage patients with myalgia (but not myopathy) while on statin therapy?

Back 21

concurrent use of CoQ-10 or alternating day dosing of long helflife statins (atorvastatin and rosuvastatin).

Front 22

what is the criteria for myopathy?

Back 22

myalgia + elevations in serum CK greater than 10xULN

Front 23

what is the criteria for rhabdomyolysis?

Back 23

CK greater than 1000o IU/L or
CK greater than 10xULN and elevation in SCr or medical intervention with IV hydration therapy (coca cola urine)

Front 24

how often is fasting lipid panel monitored in statin therapy?

Back 24

baseline, 6 weeks after starting or changing dose, once or twice a year when on stable dose.

Front 25

if statin therapy is used in combination with these two drugs, CK measurements should be taken when combination therapy begins. what are these two drugs?

Back 25

fibrate or niacin

Front 26

which two statins are metabolized by CYP3A4?

Back 26

simvastatin and lovastatin.

Front 27

what are two contradictions for statin therapy?

Back 27

pregnancy and active liver disease

Front 28

what is the max dose of simvastatin when co-administerd with gemfibrozil?

Back 28

10mg/day

Front 29

double the dose of a statin has what general effect on LDL?

Back 29

6% additional LDL reduction from baseline a.k.a an additional 10 point reduction in LDL.

Front 30

what is the max starting dose of atorvastatin?

Back 30

40

Front 31

which three statins need to be dosed in the evening to maximize effect?

Back 31

lovastatin, simvastatin and fluvastatin

Front 32

which statin requires adminsitration with food to assure sufficient absorption?

Back 32

immediate-release lovastatin

Front 33

are bile acid sequestrants considered safe in pregnancy?

Back 33

yes

Front 34

what are common side effects for colestipol, cholestyramine and colesevelam?

Back 34

constipation and GI upset

Front 35

which of the three bile acid sequestrants has less binding interactions?

Back 35

colesevelam