Dyslipidemia Qs
A 35-year-old woman appears to have familial combined hyperlipidemia. Her serum concentrations of total cholesterol, LDL cholesterol, and triglyceride are elevated. Her serum concentration of HDL cholesterol is somewhat reduced. Which of the following is a major toxicity associated with gemfibrozil therapy? A Bloating and constipation B Cholelithiasis C Hyperuricemia D Liver damage E Severe cardiac arrhythmia
A major toxicity of the fibrates is increased risk of gallstone formation, which may be due to enhanced biliary excretion of cholesterol. The answer is B.
. You see a 43-year-old man long-distance truck driver in the clinic who complains of serious allergic rhinitis. Which of the following would be the best antihistamine to prescribe? A Diphenhydramine B Fexofenadine C Meclizine D Promethazine
B Fexofenadine
A patient is prescribed niacin to reduce his/her triglyceride and LDL-C levels. The side effect(s) of niacin that most commonly limits patient compliance include A bloating. B flushing and dyspepsia. C tinnitus. D dry cough. E chills.
B flushing and dyspepsia.
A 33-year-old man has been prescribed medication for hyperlipidemia. He has been noted to have bleeding from his gums and easy bruisability. His prothrombin time is elevated. Which of the following agents is most likely to be involved? A Atorvastatin B Cholestyramine C Gemfibrozil D Niacin
B. Cholestyramine interferes with the absorption of lipid-soluble vitamins such as vitamin K, leading to decreased levels of vitamin K-dependent coagulation factors.
A 52-year-old man was found to have a total cholesterol of 380 mg/dL and triglycerides of 230 mg/dL in spite of three months of low saturated fat diet. The man had been suffering from hemophilia since birth and from external hemorrhoids for two years. An antihyperlipidemic therapy was prescribed. Which of the following drugs would be contraindicated in this patient? Lovastatin Cholestyramine Ezetimibe Niacin Gemfibrozil
Cholestyramine can cause severe constipation and is therefore contraindicated in case ofhemorrhoids. In addition the drug is also contraindicated in case of any coagulation defect,since it decreases the intestinal absorption of vit K.
High doses of this drug can cause metabolic acidosis Colestipol Ezetimibe Gemfibrozil Niacin Lovastatin
Colestipol
Question 1 of 10 A 35-year-old woman appears to have familial combined hyperlipidemia. Her serum concentrations of total cholesterol, LDL cholesterol, and triglyceride are elevated. Her serum concentration of HDL cholesterol is somewhat reduced. The patient is started on gemfibrozil. Which of the following is a major mechanism of gemfibrozil's action? A Increased excretion of bile acid salts B Increased expression of high-affinity LDL receptors C Increased secretion of VLDL by the liver D Increased triglyceride hydrolysis by lipoprotein lipase E Reduced uptake of dietary cholesterol
D Increased triglyceride hydrolysis by lipoprotein lipase
A patient is prescribed fenofibrate as part of his therapy to raise his/her HDL-C levels. Fenofibrate most likely acts by A inhibiting HMG-CoA reductase. B binding cell membrane receptors that leads to lowering of adipocyte hormone-sensitive lipase activity. C sequestering bile acids in the small intestine. D binding PPARα receptors in liver and brown adipose tissue. E inhibiting cholesterol uptake from the small intestine.
D binding PPARα receptors in liver and brown adipose tissue.
A 21-year-old woman recently diagnosed with familial combined hyperlipidemia, started a treatment with lovastatin. Which of the following molecular actions most likely mediated the therapeutic efficacy of the drug in the patient's disease? Down-regulation of hepatic LDL receptors Increased synthesis of lipoprotein lipase Decreased synthesis of mevalonic acid Decreased storage of LDL in hepatic endosomes Increased plasma levels of hepatic aminotransferases Increased plasma levels of creatine phosphokinase
Decreased synthesis of mevalonic acid
A 35-year-old woman appears to have familial combined hyperlipidemia. Her serum concentrations of total cholesterol, LDL cholesterol, and triglyceride are elevated. Her serum concentration of HDL cholesterol is somewhat reduced. If this patient is pregnant, which of the following drugs should be avoided because of a risk of harming the fetus? A Cholestyramine B Ezetimibe C Fenofibrate D Niacin E Pravastatin
E Pravastatin
A 57-year-old woman was found to have triglyceride levels of 630 mg/dL during a follow-up visit.. A therapy with gemfibrozil was prescribed. Which of the following cellular structures most likely represents the site of action of this drug? Smooth endoplasmic reticulum Nucleus Cell membrane Cytoplasm Rough endoplasmic reticulum Mitochondria
Fibrates bind to and activate a nuclear receptor (the peroxisome proliferator-activated receptoralpha) in hepatocytes, skeletal muscle and the heart. Activation of this receptor in turn activates transcription of genes which modulate protein expression. The main consequence is the increased expression of lipoprotein lipase.
This drug activates a nuclear transcription receptor Cholestyramine Ezetimibe Gemfibrozil Niacin Lovastatin
Gemfibrozil
A 35-year-old woman appears to have familial combined hyperlipidemia. Her serum concentrations of total cholesterol, LDL cholesterol, and triglyceride are elevated. Her serum concentration of HDL cholesterol is somewhat reduced. Which of the following drugs is most likely to increase this patient's triglyceride and VLDL cholesterol concentrations when used as monotherapy? A Atorvastatin B Cholestyramine C Ezetimibe D Gemfibrozil E Niacin
In some patients with familial combined hyperlipidemia and elevated VLDL, the resins increase VLDL and triglyceride concentrations even though they also lower LDL cholesterol. The answer is B.
A 55-year-old obese woman was found to have a cholesterol level of 360 mg/dL despite many months of lovastatin treatment. The physician decided to add ezetimibe to the therapeutic regimen. Which of the following cells represents the main site of action of the added drug? Adipocytes Capillary endothelial cells Platelets Hepatocytes Intestinal epithelial cells
Intestinal epithelial cells
A 49-year-old man was found to have the following lipid profile during a routine visit: LDL cholesterol 180 mg/dL (normal < 200), HDL cholesterol 14 mg/dL (normal > 35), triglycerides 150 mg/dL (normal < 200). The man weighted 134 Kg and was a heavy cigarette-smoker. Which of the following antihyperlipidemic drugs would be most appropriate for this patient? Gemfibrozil Lovastatin Cholestyramine Niacin Ezetimibe
Niacin has the greatest ability to raise HDL
A 46-year-old man, suffering from familial hypercholesterolemia, was found to have a total cholesterol of 430 mg/dL in spite of many months of treatment with lovastatin. Triglyceride levels were normal. The physician decided to add niacin to the therapeutic regimen. Which of the following molecular action most likely mediated the therapeutic efficacy of the drug in the patient's disease? Inhibition of VLDL production by the hepatocyte Inhibition of HDL synthesis by the liver Increase of circulating fibrinogen Stimulation of lipolysis in adipose tissue Decreased absorption of exogenous cholesterol
Niacin inhibits VLDL production by the hepatocyte, which in turn decreases production of LDL.
A 52-year-old obese man suffering from gout and hypertension was found to have LDL cholesterol of 360 mg/dL and a serum uric acid of 15.5 mg/dL during a follow-up visit. Other laboratory values were within normal limits. A lipid-lowering therapy is prescribed. Which of the following antihyperlipidemic drugs would be relatively contraindicated in this patient? Cholestyramine Niacin Ezetimibe Lovastatin Gemfibrozil
Niacin is contraindicated in patients suffering from gout and hyperuricemia because it tends toincrease uric acid levels.
A 54-year-old obese man had a plasma LDL cholesterol of 270 mg/dL in spite of 4 month therapy with lovastatin. The physician decided to add cholestyramine to the patient's regimen. Recently the patient was found to have a stage I hypertension and he was currently taking propranolol and hydrochlorothiazide. Which of the following changes in the pharmacokinetics of these two drugs most likely occurred because of cholestyramine administration? Renal elimination of propranolol increased Renal elimination of hydrochlorothiazide decreased Oral bioavailability of propranolol increased Oral bioavailability of hydrochlorothiazide decreased Volume of distribution of propranolol increased Volume of distribution of hydrochlorothiazide decreased
Oral bioavailability of hydrochlorothiazide decreased
A 24-year-old woman suffering from familial hypertriglyceridemia was screened with a blood profile during a follow-up visit. Relevant laboratory test results were: uric acid 15 mg/dL (normal 4-8.5), total cholesterol 170 mg/dL (normal < 200), triglycerides 1230 mg/dL (normal < 200). A lipid-lowering drug was prescribed. Which of the following was most likely the mechanism of action of that drug? Decrease of lipid synthesis on adipose tissue Down-regulation of LDL receptors in the liver Inhibition HMG-CoA reductase activity in the liver Stimulation of lipoprotein lipase synthesis Decreased absorption of exogenous cholesterol
Stimulation of lipoprotein lipase synthesis The prescribed drug was most likely a fibrate. In fact fibrates are the drugs of first choice whenthere is a big, isolated increase in triglyceride level. Moreover in this patient niacin iscontraindicated because of hyperuricemia, resins can cause an increase in triglyceride leveland statins should be avoided in a woman in fertile age. The major mechanism of actionrecognized for fibrates is to increase the synthesis of lipoprotein lipase.
A 43-year-old man has heterozygous familial hypercholesterolemia. His serum concentrations of total cholesterol and LDL are markedly elevated. His serum concentration of HDL cholesterol, VLDL cholesterol, and triglycerides are normal or slightly elevated. The patient's mother and older brother died of myocardial infarctions before the age of 50. This patient recently experienced mild chest pain when walking upstairs and has been diagnosed as having angina of effort. The patient is somewhat overweight. He drinks alcohol most evenings and smokes about 1 pack of cigarettes per week. After being counseled about lifestyle and dietary changes, the patient was started on atorvastatin. During his treatment with atorvastatin, it is important to routinely monitor serum concentrations of which of the following? A Blood urea nitrogen B Alanine and aspartate aminotransferase C Platelets D Red blood cells E Uric acid
The 2 primary adverse effects of the HMG-CoA reductase inhibitors are hepatotoxicity and myopathy. Patients taking these drugs should have liver function tests performed before starting therapy, and at regular intervals as needed during therapy. Serum concentrations of alanine and aspartate aminotransferase are used as markers of hepatocellular toxicity. The answer is B. Or LTF test
This drug can sometimes cause hypertriglyceridemia Cholestyramine Ezetimibe Gemfibrozil Niacin Lovastatin
cholestyramine
