Pharmacology Quiz: Antihyperlipidemic Drugs!
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- 1.
Which of the following is true concerning lipoproteins?
- A.
They serve to transport lipids from tissue to tissue and participate in lipid metabolism.
- B.
The inside of the particles has varying amounts of neutral lipids, cholesterol esters, and triacylglycerols.
- C.
There are 5 major classes that have specific physiological and anatomical significance. The classes are chylomicrons, VLDL, IDL, LDL, and HDL.
- D.
All of the above are true concerning lipoproteins.
Correct Answer
D. All of the above are true concerning lipoproteins.Explanation
Lipoproteins serve to transport lipids from tissue to tissue and participate in lipid metabolism. The inside of the particles contains varying amounts of neutral lipids, cholesterol esters, and triacylglycerols. There are 5 major classes of lipoproteins, namely chylomicrons, VLDL, IDL, LDL, and HDL, each having specific physiological and anatomical significance. Therefore, all of the statements mentioned above are true concerning lipoproteins.Rate this question:
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- 2.
Which type of lipoprotein is the largest particle of low density, and who's main function is to transport dietary lipids to tissues for use and storage?
- A.
LDLs
- B.
HDLs
- C.
Chylomicrons
- D.
IDLs
- E.
VLDLs
Correct Answer
C. ChylomicronsExplanation
Chylomicrons are the largest particles of low density lipoprotein (LDL). Their main function is to transport dietary lipids to tissues for use and storage. LDLs, HDLs, IDLs, and VLDLs are all types of lipoproteins, but chylomicrons specifically serve the purpose mentioned in the question.Rate this question:
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- 3.
Which apolipoprotein components of chylomicrons stimulate lipase?
- A.
CII and E
- B.
AI and AII
- C.
B-48 and E
- D.
CIII and AIV
Correct Answer
A. CII and EExplanation
CII and E are the apolipoprotein components of chylomicrons that stimulate lipase. Apolipoprotein CII activates lipoprotein lipase, an enzyme that breaks down triglycerides in chylomicrons into free fatty acids and glycerol. Apolipoprotein E is responsible for the recognition and uptake of chylomicron remnants by the liver. Together, CII and E play crucial roles in the metabolism and clearance of chylomicrons from the bloodstream.Rate this question:
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- 4.
Which lipoprotein has a half-life of about 3 days and is synthesized from IDL. It is high in cholesterol and cholesterol esters. Its main function is to deliver cholesterol to extra-hepatic tissues and high levels are bad.
- A.
VLDLs
- B.
LDLs
- C.
HDLs
- D.
Chylomicrons
- E.
IDLs
Correct Answer
B. LDLsExplanation
LDLs get oxidized in the arteries and form plaques.Rate this question:
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- 5.
Which apolipoprotein is the major one in LDLs?
- A.
CII
- B.
B-100
- C.
CIII
Correct Answer
B. B-100Explanation
The major apolipoprotein is Apo B-100 which is recognized by the LDL surface receptor in the liver and extrahepatic tissues.Rate this question:
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- 6.
Which lipoprotein is synthesized in the liver and has a half-life of about 12 hours? It functions to transport free fatty acids from the liver to peripheral tissues.
- A.
Chylomicrons
- B.
IDLs
- C.
HDLs
- D.
LDLs
- E.
VLDLs
Correct Answer
E. VLDLsExplanation
On the tissue surface LPL hydrolyzes the triglycerides for transport into the tissues. The rest of the VLDL lipoprotein interacts with HDL to obtain more Apoc C and more Apo E, eventually forming IDL, a precursor for LDL. High levels of VLDL (triglycerides > 1000mg/dl) indicate a risk for pancreatitis.Rate this question:
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- 7.
What are high levels of VLDL (triglycerides >1000mg/dl) indicative of?
- A.
A risk for heart disease.
- B.
A risk for pancreatitis.
- C.
A risk for stroke.
- D.
A risk for gout.
Correct Answer
B. A risk for pancreatitis.Explanation
High levels of VLDL (triglycerides >1000mg/dl) are indicative of a risk for pancreatitis. Pancreatitis is a condition characterized by inflammation of the pancreas. Elevated levels of VLDL can lead to the accumulation of triglycerides in the pancreas, causing inflammation and potentially leading to pancreatitis. This condition can be serious and may require medical intervention. It is important to monitor and manage VLDL levels to reduce the risk of pancreatitis and its associated complications.Rate this question:
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- 8.
Which lipoprotein is formed from the LPL hydrolysis of triglycerides from VLDL? It is either taken up by the liver via LDL receptors or converted to LDL lipoproteins and its main function is as an intermediate for the synthesis of LDL.
- A.
HDLs
- B.
VLDLs
- C.
LDLs
- D.
IDLs
- E.
Chylomicrons
Correct Answer
D. IDLsExplanation
IDLs, or intermediate-density lipoproteins, are formed from the hydrolysis of triglycerides from VLDL by LPL. They can either be taken up by the liver via LDL receptors or converted to LDL lipoproteins. Their main function is to serve as an intermediate for the synthesis of LDL.Rate this question:
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- 9.
Which lipoprotein is synthesized in the liver and intestine and is the smallest lipoprotein?
- A.
IDLs
- B.
VLDLs
- C.
HDLs
- D.
Chylomicrons
- E.
LDLs
Correct Answer
C. HDLsExplanation
HDLs, or high-density lipoproteins, are synthesized in the liver and intestine and are the smallest lipoprotein. HDLs are responsible for transporting cholesterol from the body's tissues back to the liver, where it can be eliminated from the body. They are often referred to as "good cholesterol" because they help remove excess cholesterol from the bloodstream, reducing the risk of cardiovascular diseases.Rate this question:
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- 10.
Which lipoprotein is considered a scavenger for cholesterol?
- A.
HDLs
- B.
LDLs
- C.
VLDLS
- D.
Chylomicrons
- E.
IDLs
Correct Answer
A. HDLsExplanation
HDLs, or high-density lipoproteins, are considered a scavenger for cholesterol. They function by removing excess cholesterol from the bloodstream and tissues and transporting it back to the liver for disposal. This process helps to prevent the buildup of cholesterol in the arteries and reduces the risk of cardiovascular diseases. HDLs are often referred to as "good cholesterol" because higher levels of HDLs are associated with a lower risk of heart disease.Rate this question:
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- 11.
Which apolipoprotein is important in HDLs?
- A.
AIV
- B.
B-100
- C.
CII
- D.
E
- E.
AI
Correct Answer
E. AIExplanation
AI is recognized by a scavenger receptor (SR-BI) on the liver and thus takes HDL into the liver. NO B-100!Rate this question:
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- 12.
What is the function of LCAT (lecithin cholesterol acyl transferase) and where is it located?
- A.
Transfer of cholesteryl esters from HDL to LDL and VLDL - Plasma
- B.
Hydrolysis of triglycerides in HDL and IDL - Liver
- C.
Esterification of free cholesterol to cholesteryl esters - Plasma
- D.
Hydrolysis of chylomicrons and VLDL triglycerides - Capillary Endothelium
Correct Answer
C. Esterification of free cholesterol to cholesteryl esters - PlasmaExplanation
LCAT (lecithin cholesterol acyl transferase) is an enzyme responsible for the esterification of free cholesterol to cholesteryl esters. This process occurs in the plasma. Esterification of cholesterol is important for its transport in the bloodstream and its incorporation into lipoproteins such as HDL (high-density lipoprotein). By converting free cholesterol into cholesteryl esters, LCAT facilitates the formation of HDL particles, which are involved in the reverse cholesterol transport pathway, removing excess cholesterol from peripheral tissues and delivering it to the liver for excretion.Rate this question:
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- 13.
What is the function and location of CETP (cholesterol ester transport protein)?
- A.
Transfer of cholesteryl esters from HDL to LDL and VLDL - Plasma
- B.
Hydrolysis of triglycerides in HDL and IDL - Liver
- C.
Esterification of free cholesterol to cholesteryl esters - Plasma
- D.
Hydrolysis of chylomicrons and VLDL triglycerides - Capillary Endothelium
Correct Answer
A. Transfer of cholesteryl esters from HDL to LDL and VLDL - PlasmaExplanation
CETP (cholesterol ester transport protein) functions in transferring cholesteryl esters from HDL to LDL and VLDL in the plasma. This process helps in redistributing cholesterol throughout the body by moving it from HDL (high-density lipoprotein) to LDL (low-density lipoprotein) and VLDL (very low-density lipoprotein). The location of this function is in the plasma, where the exchange of cholesteryl esters occurs between different lipoproteins.Rate this question:
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- 14.
What is the function and location of lipoprotein lipase?
- A.
Transfer of cholesteryl esters from HDL to LDL and VLDL - Plasma
- B.
Hydrolysis of triglycerides in HDL and IDL - Liver
- C.
Esterification of free cholesterol to cholesteryl esters - Plasma
- D.
Hydrolysis of chylomicrons and VLDL triglycerides - Capillary Endothelium
Correct Answer
D. Hydrolysis of chylomicrons and VLDL triglycerides - Capillary EndotheliumExplanation
Lipoprotein lipase is responsible for hydrolyzing triglycerides in chylomicrons and VLDL in the capillary endothelium. This enzyme breaks down these triglycerides into free fatty acids and glycerol, which can then be used by cells for energy or storage. This process occurs in the capillary endothelium, which is the thin layer of cells that lines the interior surface of blood vessels.Rate this question:
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- 15.
What is the function and location of hepatic lipase?
- A.
Transfer of cholesteryl esters from HDL to LDL and VLDL - Plasma
- B.
Hydrolysis of triglycerides in HDL and IDL - Liver
- C.
Esterification of free cholesterol to cholesteryl esters - Plasma
- D.
Hydrolysis of chylomicrons and VLDL triglycerides - Capillary Endothelium
Correct Answer
B. Hydrolysis of triglycerides in HDL and IDL - LiverExplanation
Hepatic lipase is responsible for the hydrolysis of triglycerides in HDL (high-density lipoprotein) and IDL (intermediate-density lipoprotein). It is primarily located in the liver. This enzyme plays a crucial role in lipid metabolism by breaking down triglycerides into free fatty acids and glycerol, which can then be utilized by the body for energy production or stored in adipose tissue. The hydrolysis of triglycerides by hepatic lipase in the liver helps regulate the levels of lipoproteins in the bloodstream, contributing to overall lipid homeostasis.Rate this question:
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- 16.
What starts the development of atherosclerosis?
- A.
Transport of LDLs from the arterial lumen into endothelial cells and into the space that underlies the arterial epithelium.
- B.
An injury to the artery.
- C.
Low potassium levels in the blood.
- D.
A and B
- E.
A, B, and C
- F.
A and C
Correct Answer
D. A and BExplanation
Underneath the arterial epithelium, the LDLs can undergo oxidation and the oxidized LDLs cause major problems.Rate this question:
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- 17.
What do oxidized LDLs do?
- A.
Attract monocytes from the cirulation in the sub-endothelial space, after which the monocytes undergo conversion to macrophages.
- B.
Inhibit macrophage mobility, thereby keeping macrophages at the site of atherogenesis which generates free radicals to further oxidize the attached LDLs.
- C.
Undergo uptake by macrophages.
- D.
Are cytotoxic and hence can damage the endothelium directly.
- E.
All of the above are correct.
Correct Answer
E. All of the above are correct.Explanation
Oxidized LDLs have multiple effects in the body. They attract monocytes from the circulation to the sub-endothelial space, where the monocytes are converted into macrophages. These macrophages play a key role in the development of atherosclerosis. Oxidized LDLs also inhibit macrophage mobility, keeping them at the site of atherogenesis. This allows the macrophages to generate free radicals, which further oxidize the attached LDLs. Additionally, oxidized LDLs are taken up by macrophages and can be cytotoxic, causing damage to the endothelium. Therefore, all of the statements mentioned are correct.Rate this question:
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- 18.
What type of cells to macrophages becomes as they engulf more and more cholesterol, becoming large and vacuolated?
- A.
Plasma Cells.
- B.
Neutrophils.
- C.
Xanthoma Cells.
- D.
Super macrophages.
- E.
Foam Cells.
- F.
C and E.
Correct Answer
F. C and E. -
- 19.
Which drug to treat hyperlipidemia acts by inhibiting the mobilization of free fatty acids (FFA) from peripheral adipose tissue to the liver?
- A.
Statins
- B.
Fibric Acids
- C.
Niacin (Nicotinic Acid)
- D.
Bile acid-binding Resins
- E.
Ezetimibe
Correct Answer
C. Niacin (Nicotinic Acid)Explanation
The mobilization of FFA from peripheral adipose tissue to the liver is inhibited by nicotinic acid. The conversion of VLDL to LDL is decreased as a consequence of this decrease or an additional hepatic effect via nicotinic acid and the synthesis and secretion of VLDLs are reduced. Although the mechanism is unknown, nicotinic acid also increases serum HDL cholesterol concentrations by up to 30%.Rate this question:
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- 20.
Which antihyperlipidemic is most effective when given in combination with other drugs?
- A.
Niacin
- B.
Bile acid-binding resins
- C.
Ezetimibe
- D.
Statins
- E.
Fibric Acids
Correct Answer
A. NiacinExplanation
If a bile acid-binding resin is added, 40-60% reduction in LDL. In triple therapy with bile acid-binding resin plus a statin, it decreases LDL by 70% or more.Rate this question:
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- 21.
What is the drug of choice for lowering VLDL levels in patients at risk of pancreatitis and for mixed elevations of LDLs and VLDLs and low levels of HDLs?
- A.
Fibric Acids
- B.
Ezetimibe
- C.
Statins
- D.
Niacin
- E.
Bile acid-binding resins
Correct Answer
D. NiacinExplanation
Niacin is the drug of choice for lowering VLDL levels in patients at risk of pancreatitis and for mixed elevations of LDLs and VLDLs and low levels of HDLs. Niacin is a B vitamin that has been shown to decrease VLDL production in the liver, leading to lower levels in the blood. It also increases HDL levels, which helps to further improve the lipid profile. Niacin is often used in combination with other lipid-lowering medications for optimal results. Fibric acids, ezetimibe, statins, and bile acid-binding resins are also used to lower cholesterol levels but are not specifically indicated for these particular lipid abnormalities.Rate this question:
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- 22.
How can you avoid some of the adverse effects seen with Niacin (dyspepsia, skin flushing, itching)?
- A.
By taking an NSAID like Aspirin concurrently.
- B.
By taking the medication at night.
- C.
By taking the medication with food.
- D.
By taking the medication on an empty stomach.
- E.
The adverse effects cannot be avoided.
Correct Answer
A. By taking an NSAID like Aspirin concurrently.Explanation
Taking an NSAID like Aspirin concurrently with Niacin can help avoid some of the adverse effects such as dyspepsia, skin flushing, and itching. NSAIDs have anti-inflammatory properties that can counteract the flushing and itching caused by Niacin. However, it is important to note that this method may not completely eliminate all adverse effects and should be done under the guidance of a healthcare professional.Rate this question:
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- 23.
What conditions are worsened with Niacin (nicotinic acid)?
- A.
Gout
- B.
Cardiac atrial arrhythmias
- C.
Diabetes
- D.
Gallbladder disease
- E.
All of the above
Correct Answer
E. All of the aboveExplanation
Gout - see an increase in uric acid because it competes for excretion - Diabetes - glucose levels are affected - Gallbladder Disease - releases bile acids.Rate this question:
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- 24.
Giving Niacin in combination with statins causes an increased risk of what disease?
- A.
Gout.
- B.
MI.
- C.
Renal disease.
- D.
Myopathy (rhabdomyolysis).
- E.
Hepatic failure.
Correct Answer
D. Myopathy (rhabdomyolysis).Explanation
Rhabdomyolysis = degeneration of muscle cells - heart - eventually results in death.Rate this question:
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- 25.
What are the two drugs that are classified as fibric acid derivatives?
- A.
Niacin and Gemfibrozil.
- B.
Gemfibrozil and Fenofibrate.
- C.
Fenofibrate and Ezetimibie.
- D.
Simvastatin and Gemfibrozil.
Correct Answer
B. Gemfibrozil and Fenofibrate.Explanation
Gemfibrozil and Fenofibrate are classified as fibric acid derivatives. This classification is based on their chemical structure and mechanism of action. Fibric acid derivatives are commonly used to lower triglyceride levels and increase HDL cholesterol levels in patients with dyslipidemia. Niacin, Ezetimibe, and Simvastatin are not fibric acid derivatives, and they belong to different classes of drugs that are used for different purposes in the management of lipid disorders.Rate this question:
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- 26.
What do the fabric acid derivatives do?
- A.
Enhance oxidation of FA in liver and muscle.
- B.
Reduce rate of lipogenesis in the liver.
- C.
Increase synthesis of Apo AI and II for more HDL.
- D.
All of the above.
Correct Answer
D. All of the above.Explanation
The fabric acid derivatives have multiple effects on the body. They enhance the oxidation of fatty acids in the liver and muscle, which means that they help in breaking down fatty acids for energy production. They also reduce the rate of lipogenesis in the liver, which is the process of converting excess carbohydrates into fatty acids. Additionally, they increase the synthesis of Apo AI and II, which are proteins responsible for the production of high-density lipoproteins (HDL), also known as "good" cholesterol. Therefore, all of the options mentioned in the question are correct.Rate this question:
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- 27.
What is the principal indication for all fibrates?
- A.
Elevation of LDLs.
- B.
Reduction of HDLs.
- C.
Elevation of VLDLs.
- D.
High blood cholesterol levels.
- E.
High blood pressure.
Correct Answer
C. Elevation of VLDLs.Explanation
Fibrates are a class of medications primarily used to reduce elevated levels of triglycerides and increase levels of high-density lipoproteins (HDLs). They work by activating a specific receptor in the liver, which leads to increased breakdown of triglycerides and decreased production of very low-density lipoproteins (VLDLs). Therefore, the principal indication for fibrates is the elevation of VLDLs, not the elevation of LDLs or reduction of HDLs. High blood cholesterol levels and high blood pressure are not specifically targeted by fibrates.Rate this question:
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- 28.
Which drug can be displaced by the fibrates, causing increased levels of the drug in the blood?
- A.
Aspirin
- B.
Tetracycline
- C.
Warfarin
- D.
Ezetimibe.
- E.
Vicodin.
Correct Answer
C. WarfarinExplanation
Fibrates are known to displace warfarin, leading to increased levels of warfarin in the blood. Warfarin is an anticoagulant medication used to prevent blood clots. When fibrates displace warfarin, it means that fibrates compete with warfarin for binding sites on proteins in the blood, resulting in less warfarin being able to bind to these proteins. This leads to an increase in the free, unbound fraction of warfarin in the blood, which can potentially increase its anticoagulant effects and risk of bleeding.Rate this question:
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- 29.
How do the Bile Acid-Binding Resins (Cholestyramine, Colestipol, and Colesevelam) function?
- A.
By binding LDLs and removing them from circulation.
- B.
By increasing HDLs.
- C.
By attacking the plaque directly.
- D.
By cationic exchange.
- E.
By anionic exchange.
Correct Answer
D. By cationic exchange.Explanation
Chloride ion is released from the cationic quaternary ammonium binding site in exchange for bile acids. They form an insoluble complex with bile acids present in the intestine, preventing the reabsorption of bile acids.Rate this question:
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- 30.
Does the binding of bile acids by bile acid-binding resins cause an increase in plasma LDL levels or a decrease?
- A.
Increase.
- B.
Decrease.
Correct Answer
B. Decrease.Explanation
Increased excretion of bile acids creates a demand for more cholesterol to make more bile in the liver. More LDL receptors are made to endocytose more LDLs increasing the amount of cholesterol in the liver and decreasing plasma LDL levels.Rate this question:
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- 31.
What type of individual would not benefit as much from the bile acid-binding resins?
- A.
Hemophiliacs.
- B.
Patients suffering from gout.
- C.
Patients genetically deficient in LDL receptors.
- D.
Patients with a fever.
- E.
Patients in renal failure.
Correct Answer
C. Patients genetically deficient in LDL receptors.Explanation
Combination therapy would be required.Rate this question:
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- 32.
If a patient is at risk for pancreatitis, which drugs would you want to avoid?
- A.
Fibric acid derivatives
- B.
Bile Acid-Binding Resins
- C.
Niacin
- D.
Statins
- E.
Ezetimibe
Correct Answer
B. Bile Acid-Binding ResinsExplanation
If a patient has high VLDLs (high triglycerides), don't start with these drugs because they also turn on the synthesis of triglycerides initially (due to liver compensation) - might be enough to push the patient into pancreatitis.Rate this question:
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- 33.
Which are the most effective antihyperlipidemics with few side effects?
- A.
Niacin
- B.
FIbric Acids
- C.
Bile acid-binding resins
- D.
Ezetimibe
- E.
Statins
Correct Answer
E. StatinsExplanation
Statins are considered the most effective antihyperlipidemics with few side effects. They work by inhibiting an enzyme involved in cholesterol synthesis, thereby reducing the levels of LDL cholesterol in the blood. Statins have been extensively studied and have shown significant benefits in reducing the risk of cardiovascular events. They are generally well-tolerated, with only a small percentage of users experiencing side effects such as muscle pain or liver abnormalities. Other antihyperlipidemics, such as niacin, fibrates, bile acid-binding resins, and ezetimibe, may also be effective but may have more side effects or be less potent in lowering LDL cholesterol levels.Rate this question:
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- 34.
Which drugs are competitive inhibitors of hepatic HMG CoA reductase, the rate-limiting enzyme in cholesterol biosynthesis?
- A.
Statins
- B.
Ezetimibe
- C.
Fibric Acids
- D.
Bile acid-binding resins
- E.
Niacin
Correct Answer
A. StatinsExplanation
Statins are competitive inhibitors of hepatic HMG CoA reductase, the rate-limiting enzyme in cholesterol biosynthesis. They work by blocking the action of this enzyme, which reduces the production of cholesterol in the liver. This leads to a decrease in the amount of cholesterol in the bloodstream, helping to lower LDL (bad) cholesterol levels. Statins are commonly prescribed to patients with high cholesterol to reduce their risk of cardiovascular diseases. Ezetimibe, fibric acids, bile acid-binding resins, and niacin are not competitive inhibitors of hepatic HMG CoA reductase.Rate this question:
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- 35.
What are the benefits from statin usage?
- A.
With less cholesterol synthesized, the amount of cholesterol in the liver is reduced.
- B.
Serum cholesterol level is reduced due to the fact that more LDL receptors are synthesized and more LDL is removed from the blood.
- C.
VLDL and IDL might also be removed because their ApoE component is recognized by LDL receptors.
- D.
Reduction of inflammation by an unknown mechanism.
- E.
All of the above.
Correct Answer
D. Reduction of inflammation by an unknown mechanism.Explanation
These drugs do not work as well for those with LDL receptor deficits and combination therapy may be required.Rate this question:
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- 36.
Which statins are inactive lactone prodrugs that must be hydrolyzed to the active beta-hydroxyl derivatives?
- A.
Atovastatin and Fluvastatin
- B.
Lovastatin and Simvastatin
- C.
Pravastatin and Simvastatin
- D.
Fluvastatin and Pravastatin
- E.
Rosuvastatin and Simvastatin
Correct Answer
B. Lovastatin and SimvastatinExplanation
Atorvastatin, pravastatin, and fluvastatin are active drugs.Rate this question:
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- 37.
Which statins increase HDLs but less so than niacin?
- A.
Rosuvastatin and simvastatin
- B.
Simvastatin and fluvastatin
- C.
Rosuvastatin and lovastatin
- D.
Pravastatin and lovastatin
Correct Answer
A. Rosuvastatin and simvastatinExplanation
Rosuvastatin and simvastatin are statins that increase HDL (high-density lipoprotein) levels, but not as much as niacin. HDL is often referred to as "good" cholesterol because it helps remove LDL (low-density lipoprotein) cholesterol from the arteries. Niacin is a B vitamin that is known to significantly increase HDL levels. Therefore, while rosuvastatin and simvastatin can improve HDL levels, they are not as effective as niacin in doing so.Rate this question:
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- 38.
Which statins have a high first pass extraction by the liver?
- A.
Rosuvastatin and fluvastatin
- B.
Simvastatin and rosuvastatin
- C.
Lovastatin and simvastatin
- D.
Atorvastatin and fluvastatin
Correct Answer
C. Lovastatin and simvastatinExplanation
Lovastatin and simvastatin have a high first pass extraction by the liver. First pass extraction refers to the metabolism of a drug by the liver before it enters the systemic circulation. In the case of lovastatin and simvastatin, they undergo extensive metabolism in the liver, which reduces their bioavailability. This means that a significant portion of the drugs is metabolized by the liver before it reaches the systemic circulation, resulting in a lower concentration of the active drug in the body.Rate this question:
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- 39.
The drugs azole-antifungal, erythromicin, clarithromycin, cyclosporine, calcium channel blockers (verapamil and diltiazem), ritonavir or grapefruit juice - which all inhibit cytochrome P450 enzymes - CYP3A4 can all inhibit the metabolism of which statins?
- A.
Simvastatin and rosuvastatin
- B.
Lovastatin, rosuvastatin, and atorvastatin
- C.
Atovastatin, simvastatin, and lovastatin
- D.
Rosuvastatin, lovastatin, and simvastatin
Correct Answer
C. Atovastatin, simvastatin, and lovastatinExplanation
The drugs listed in the question are known to inhibit the cytochrome P450 enzyme CYP3A4. This enzyme is responsible for metabolizing statins, which are medications used to lower cholesterol levels. Therefore, when these drugs inhibit CYP3A4, they can interfere with the metabolism of statins, leading to higher levels of statins in the body. Among the given options, the correct answer is "Atovastatin, simvastatin, and lovastatin" because these three statins are metabolized by CYP3A4 and can be affected by the listed drugs.Rate this question:
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- 40.
Which drug accelerates the metabolism of statins?
- A.
Erythromycin
- B.
Cyclosporine
- C.
Rifampin
- D.
Vitamin K
- E.
Warfarin
Correct Answer
C. RifampinExplanation
Rifampin is a drug that accelerates the metabolism of statins. It is an antibiotic commonly used to treat tuberculosis and other bacterial infections. Rifampin works by inducing liver enzymes that are responsible for breaking down drugs, including statins. This increased metabolism can lead to lower levels of statins in the body, reducing their effectiveness. Therefore, it is important to monitor statin levels and adjust the dosage accordingly when rifampin is co-administered.Rate this question:
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- 41.
Which statin is metabolized by CYP2C9 and has fewer drug interactions?
- A.
Atorvastatin
- B.
Lovastatin
- C.
Pravastatin
- D.
Fluvastatin
- E.
Simvastatin
Correct Answer
D. FluvastatinExplanation
Fluvastatin is the correct answer because it is metabolized by CYP2C9, which is an important enzyme in drug metabolism. This means that the effectiveness and side effects of fluvastatin may be influenced by other drugs that interact with CYP2C9. Compared to other statins, fluvastatin has fewer drug interactions, making it a safer option for patients who are taking other medications that may interact with statins.Rate this question:
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- 42.
Which statins are not (significantly) metabolized by the cytochrome system and would not be affected by inducers or inhibitors of the cytochrome P450 system?
- A.
Fluvastatin and simvastatin
- B.
Pravastatin and rosuvastatin
- C.
Rosuvastatin and atorvastatin
- D.
Lovastatin and pravastatin
Correct Answer
B. Pravastatin and rosuvastatinExplanation
Pravastatin and rosuvastatin are not significantly metabolized by the cytochrome P450 system. This means that they are not affected by drugs or substances that induce or inhibit the activity of this system. As a result, their metabolism and effectiveness are not altered by the presence of other medications, reducing the risk of drug interactions.Rate this question:
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- 43.
Which statin reaches higher plasma levels in Asian patients and should possibly be given in lower doses to these patients?
- A.
Atorvastatin
- B.
Lovastatin
- C.
Pravastatin
- D.
Fluvastatin
- E.
Simvastatin
- F.
Rosuvastatin
Correct Answer
F. RosuvastatinExplanation
Rosuvastatin reaches higher plasma levels in Asian patients compared to other statins. Therefore, it should be given in lower doses to these patients to avoid potential adverse effects or toxicity.Rate this question:
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- 44.
Why are most statin drugs given at night?
- A.
To decrease stomach upset.
- B.
Because cholesterol synthesis increases at night.
- C.
To increase absorption.
- D.
Because food intake decreases absorption.
Correct Answer
B. Because cholesterol synthesis increases at night.Explanation
Most statin drugs are given at night because cholesterol synthesis increases during this time. Cholesterol is mainly synthesized in the liver, and its production is influenced by the circadian rhythm. The body produces more cholesterol at night, so taking statin drugs during this time helps to inhibit the production of cholesterol effectively. By targeting the peak period of cholesterol synthesis, statins can effectively lower cholesterol levels in the body and reduce the risk of cardiovascular diseases.Rate this question:
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- 45.
Which statins have longer half-lives and so can be given at any time of day?
- A.
Fluvastatin and rosuvastatin
- B.
Simvastatin and atorvastatin
- C.
Pravstatin and Lovastatin
- D.
Rosuvastatin and atorvastatin
- E.
Fluvastatin and simvastatin
Correct Answer
D. Rosuvastatin and atorvastatinExplanation
Rosuvastatin and atorvastatin have longer half-lives compared to other statins, which means they stay in the body for a longer duration. This allows them to be given at any time of the day since their effects are sustained throughout the day. Other statins, such as simvastatin and fluvastatin, have shorter half-lives and need to be taken at specific times to maintain their effectiveness. Pravastatin and lovastatin also have shorter half-lives and therefore need to be taken at specific times.Rate this question:
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- 46.
Statins plus what other drug may lower the risk of colon cancer and osteoporosis?
- A.
Aspirin
- B.
Warfarin
- C.
Heparin
- D.
Ezetimibe
- E.
Niacin
Correct Answer
A. AspirinExplanation
Statins increase bone growth - added benefit.Rate this question:
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- 47.
Myopathy is a possible adverse effect for all statins, but which statin plus gemfibrozil or niacin especially increases this risk?
- A.
Atorvastatin
- B.
Lovastatin
- C.
Pravastatin
- D.
Fluvastatin
- E.
Simvastatin
Correct Answer
B. LovastatinExplanation
Lovastatin, when combined with gemfibrozil or niacin, especially increases the risk of myopathy. This adverse effect is possible for all statins, but lovastatin has a higher risk when used in combination with gemfibrozil or niacin.Rate this question:
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- 48.
Are statins ok to give during pregnancy?
- A.
Yes
- B.
No
Correct Answer
B. NoExplanation
Statins have been shown to be teratogenic in rodents.Rate this question:
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- 49.
Which statins would you want to give a really compromised patient?
- A.
Fluvastatin and Lovastatin
- B.
Pravastatin and Rosuvastatin
- C.
Atorvastatin and Fluvastatin
- D.
Rosuvastatin and Atorvastatin
- E.
Simvastatin and Pravstatin
Correct Answer
C. Atorvastatin and FluvastatinExplanation
Atorvastatin has only 2% renal excretion and Fluvastatin has less than 6%.Rate this question:
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- 50.
Which statins could cause vivid dreams or fuzzy thinking?
- A.
Atorvastatin and Pravastatin
- B.
Simvastatin and Fluvastatin
- C.
Simvastatin and Lovastatin
- D.
Rosuvastatin and Atorvastatin
- E.
Fluvastatin and Pravastatin
Correct Answer
C. Simvastatin and LovastatinExplanation
Lovastatin and Simvastatin are able to penetrate the CNS. The other statins are not.Rate this question:
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