Al-Mehdi: Drugs affecting metabolism

Question 1

essential component of cell membranes and functions as a precursor to fat-soluble vitamins and steroid hormones

Answer 1

cholesterol

Question 2

cholesterol sources in adults

Answer 2

bile acids
diet
sloughed intestinal cells
synthesis

Question 3

composed of 3 fatty acids attached to glycerol molecule

Answer 3

triglycerides

Question 4

require apolipoproteins for transport

Answer 4

TG and cholesterol

Question 5

TG: 10,650
TC: 1102

Answer 5

eruptive xanthoma (sever hypertriglyceridemia)

Question 6

TG: 6,000
TC: 760
untreated DM

Answer 6

eruptive xanthoma (severe hypertriglyceridemia)

Question 7

long chain fatty acids brought into intestine through _____

Answer 7

CD36

Question 8

cholesterol brought into intestine through _____

Answer 8

NPC1L1

Question 9

bile salts brought into terminal ileum and back to hepatocyte through what

Answer 9

ASBT

Question 10

chylomicron apo proteins

Answer 10

ApoB48

Question 11

chylomicron remnant apoproteins

Answer 11

ApoB48 and ApoE

Question 12

VLDL apo proteins

Answer 12

ApoB100

Question 13

___ and ___ (Gs) activate hormone sensitive lipase (HSL) to breakdown TG in adipocyte

Answer 13

beta3, Glucagon

Question 14

TG in hepatocyte is made into VLDL through what

Answer 14

MTTP

Question 15

made mostly of cholesterol

Answer 15

LDL

Question 16

made of cholesterol and TG (mostly TGs)

Answer 16

VLDL and chylomicrons

Question 17

non-atherogenic lipoproteins

Answer 17

HDL and chylomicron

Question 18

ATP Citrate Lyase inhibitor
(prevents availability of acetyl-CoA in cytoplasm); inhibits FA and cholesterol synthesis

Answer 18

BEMPEDOIC ACID

Question 19

block HMG-CoA reductase
ultimately lead to hepatocytes upregulating LDL receptors to bring in LDL from blood

Answer 19

-STATINS

Question 20

PCSK9 inhibitors (LDL receptors not being degraded)

Answer 20

INCLISIRAN
EVOLOCUMAB

Question 21

binds and prevents recycling of bile salts back to hepatocytes (prevents recycling of major cholesterol source)

Answer 21

CHOLESTYRAMINE

Question 22

blocks NPC1L1
(prevents cholesterol uptake)

Answer 22

EZETIMIBE

Question 23

blocks MTTP
(microsomal triglyceride transfer protein in the liver)

Answer 23

LOMITAPIDE

Question 24

(targets apoB mRNA in the liver and reduces synthesis of apoB100 protein)

Answer 24

MIPOMERSEN

Question 25

fat from fish that reduces triglyceride synthesis and increases fatty acid metabolism (decreases liver secretion of VLDL)

Answer 25

omega-3-acid ethyl ester

Question 26

binds Gi receptor on adipocyte and blocks HSL from breaking down TG (prevents reveres cholesterol transport)

Answer 26

NIACIN

Question 27

blocks ANGPTL3 that allows LPL to function (reduce hypertriglyceridemia)

Answer 27

EVINACUMAB

Question 28

blocks ApoCIII and allows LPL to function (reduce hypertriglyceridemia)

Answer 28

VOLANSORCEN

Question 29

PPARa agonists (increase FA metabolism; decrease liver secretion of VLDL, increased HDL and LPL)

Answer 29

fibrates (FENOFIBRATE and GEMFIBROZIL)

Question 30

1st line drug to use for hypercholesterolemia

Answer 30

-STATINS

Question 31

SE of this drug is rhabdomyolysis and myoglobinuria

Answer 31

-STATINS

Question 32

CI in pregnancy

Answer 32

-STATINS

Question 33

2nd line add on to Rx hypercholesterolemia

Answer 33

EZETIMIBE (inhibits NPC1L1)

Question 34

SE of this drug is diarrhea

Answer 34

EZETIMIBE

Question 35

3rd line add on to treat hypercholesterolemia

Answer 35

PCSK9 inhibitors (EVOLOCUMAB and INCLISIRAN)

Question 36

3rd or 4th line drug to treat hypercholesterolemia

Answer 36

bile acid sequestrants (CHOLESTYRAMINE and COLESEVELAM)

Question 37

these 2 drugs increases LDL receptors increases VLDL (bad) reduces HbA1c

Answer 37

CHOLESTYRAMINE COLESEVELAM

Question 38

1st line drug to treat hypertriglyceridemia

Answer 38

moderate/high intensity statins (Atorvastatin and Rosuvastatin)

Question 39

1st-2nd line to treat hypertriglyceridemia

Answer 39

omega-3-acid ethyl ester

Question 40

used for patients with TG>500 SE myositis and cholelithiasis Rx hypertriglyceridemia

Answer 40

fibrates (FENOFIBRATE and GEMFIBROZIL)

Question 41

LDL-C > 190 mg/dL

Answer 41

hypercholesterolemia

Question 42

TG>500 mg/dL

Answer 42

severe hypertriglyceridemia

Question 43

what to do if all the medicine fails to reduce TG or cholesterol levels

Answer 43

remove LDL from patients plasma (LDL Apheresis)

Question 44

process that happens in intestinal epithelial cells that converts Apo gene into ApoB100 and ApoB48 (not nonsense mutation b/c it is meant to happen)

Answer 44

RNA Editing