Pharm 35 Flashcards

A patient with high LDL is started on atorvastatin. Which enzyme is directly inhibited?

A) PCSK9

B) HMG-CoA reductase

C) PPAR-alpha

D) Intestinal cholesterol transporter

Which drug class includes atorvastatin, simvastatin, rosuvastatin, and pravastatin?

A) Fibrates

B) PCSK9 inhibitors

C) Bile acid sequestrants

D) Statins

Statins lower cholesterol by acting primarily in which organ?

A) Intestine

B) Kidney

C) Liver

D) Pancreas

HMG-CoA reductase normally helps the liver perform which process?

A) Break down triglycerides

B) Make cholesterol

C) Bind bile acids

D) Degrade LDL receptors

Blocking HMG-CoA reductase causes which direct effect?

A) More bile acid absorption

B) More VLDL secretion

C) More PCSK9 activity

D) Less liver cholesterol synthesis

After statins reduce liver cholesterol, the liver increases which surface proteins?

A) LDL receptors

B) ApoA-I proteins

C) PCSK9 proteins

D) Bile acid receptors

Increased hepatic LDL receptors cause which blood effect?

A) Less LDL clearance

B) More HDL breakdown

C) More LDL removal

D) More VLDL secretion

Statins are mainly used for which lipid abnormality?

A) High triglycerides

B) Low HDL only

C) High bile acids

D) High LDL

A patient is prescribed rosuvastatin to reduce plaque risk. Which clinical goal fits best?

A) Prevent atherosclerosis

B) Treat constipation

C) Increase VLDL secretion

D) Block vitamin absorption

Statins help prevent heart disease mainly by lowering which lipoprotein?

A) HDL

B) Albumin

C) Chylomicrons

D) LDL

Which adverse effect is associated with statins?

A) Constipation

B) Bloating

C) Myopathy

D) Tendon rupture

Which organ toxicity is associated with statins?

A) Liver dysfunction

B) Lung fibrosis

C) Kidney stones

D) Bone marrow failure

Fenofibrate and gemfibrozil belong to which class?

A) Statins

B) PCSK9 inhibitors

C) Bile acid sequestrants

D) Fibrates

Which name clue helps identify fenofibrate and gemfibrozil?

A) “fib” in name

B) “statin” suffix

C) “cumab” suffix

D) “three Cs” clue

Fibrates directly activate which receptor?

A) HMG-CoA reductase

B) PCSK9

C) PPAR-alpha

D) ApoA-I

Activating PPAR-alpha mainly increases breakdown of which lipid?

A) Triglycerides

B) LDL receptors

C) Bile acids

D) Intestinal cholesterol

Fibrates are mainly used to lower which lipid?

A) LDL

B) HDL

C) Bile acids

D) Triglycerides

Compared with LDL lowering, fibrates are mainly better for lowering what?

A) Cholesterol absorption

B) Triglycerides

C) PCSK9 activity

D) Bile acid binding

Fibrates can also cause a small increase in which lipoprotein?

A) LDL

B) VLDL

C) HDL

D) Chylomicrons

A patient with very high triglycerides is started on gemfibrozil. Which mechanism explains the benefit?

A) Blocks PCSK9

B) Activates PPAR-alpha

C) Binds bile acids

D) Blocks cholesterol absorption

Which adverse effect is associated with fibrates?

A) Cough

B) Tendon rupture

C) Bradycardia

D) Myopathy

Fibrates share which side effect with statins?

A) Constipation

B) Liver dysfunction

C) Decreased absorption

D) Visual changes

Colestipol, cholestyramine, and colesevelam belong to which class?

A) Statins

B) Bile acid sequestrants

C) Fibrates

D) Sterol absorption inhibitors

Which memory clue was given for bile acid sequestrants?

A) “floxacin” ending

B) “statin” suffix

C) “cumab” ending

D) The three Cs

Bile acid sequestrants work in which location?

A) Gut

B) Liver cytosol

C) Blood plasma

D) Kidney tubule

Bile acid sequestrants directly bind what?

A) LDL receptors

B) HMG-CoA reductase

C) Bile acids

D) ApoA-I

Bile acids are made from which molecule?

A) Triglycerides

B) Cholesterol

C) Glucose

D) Amino acids

If bile acids are trapped and excreted, what must the liver use more of?

A) Potassium

B) Glucose

C) Albumin

D) Cholesterol

Bile acid sequestrants lower LDL because the liver uses cholesterol to make what?

A) New bile acids

B) VLDL

C) ApoA-I

D) PCSK9

Which clinical effect results from bile acid sequestrants?

A) HDL drops severely

B) LDL decreases

C) VLDL secretion increases

D) Triglycerides vanish

Which listed drug is a bile acid sequestrant?

A) Atorvastatin

B) Ezetimibe

C) Fenofibrate

D) Colestipol

Which listed drug is a bile acid sequestrant?

A) Cholestyramine

B) Rosuvastatin

C) Gemfibrozil

D) Evolocumab

Which listed drug is a bile acid sequestrant?

A) Alirocumab

B) Niacin

C) Colesevelam

D) Bempedoic acid

Which side effect is associated with bile acid sequestrants?

A) Myopathy

B) Hyperkalemia

C) Bronchoconstriction

D) Constipation

A patient on cholestyramine develops abdominal gas and fullness. Which adverse effect fits?

A) Liver dysfunction

B) Bloating

C) Tendon rupture

D) Neurotoxicity

Bile acid sequestrants can decrease absorption of what?

A) LDL receptors only

B) Liver cholesterol only

C) Other drugs and vitamins

D) Bone marrow cells only

Which side effect set best matches bile acid sequestrants?

A) Constipation, bloating, decreased absorption

B) Rash, fever, hyperkalemia

C) Myopathy, liver dysfunction

D) GI upset, neurotoxicity, tendon rupture

A patient taking colesevelam has reduced absorption of another medication. Which mechanism explains this?

A) PPAR-alpha activation

B) Gut binding effect

C) PCSK9 blockade

D) HMG-CoA reductase inhibition

Which lipid-lowering class works by making the body excrete bile acids in stool?

A) Fibrates

B) Statins

C) PCSK9 inhibitors

D) Bile acid sequestrants

Ezetimibe belongs to which drug category?

A) PCSK9 inhibitor

B) Sterol absorption inhibitor

C) Fibrate

D) Bile acid sequestrant

Ezetimibe acts primarily in which body site?

A) Liver

B) Kidney

C) Pancreas

D) Intestine

Ezetimibe directly blocks absorption of what?

A) Cholesterol

B) Triglycerides

C) Bile acids

D) ApoA-I

Ezetimibe lowers LDL by decreasing cholesterol entry from where?

A) Kidney

B) Muscle

C) Gut

D) Pancreas

A patient with high LDL is started on ezetimibe. Which mechanism best explains its effect?

A) Activates PPAR-alpha

B) Blocks cholesterol absorption

C) Blocks PCSK9

D) Binds bile acids

Less intestinal cholesterol absorption causes which blood effect?

A) HDL disappears

B) VLDL secretion increases

C) PCSK9 increases

D) LDL goes down

Which listed drug is a sterol absorption inhibitor?

A) Ezetimibe

B) Niacin

C) Fenofibrate

D) Evolocumab

Which pairing is correct?

A) Ezetimibe—PPAR-alpha activator

B) Ezetimibe—bile acid binder

C) Ezetimibe—intestinal cholesterol absorption blocker

D) Ezetimibe—PCSK9 blocker

Niacin decreases secretion of which lipoprotein from the liver?

A) HDL

B) LDL

C) Chylomicrons

D) VLDL

Less VLDL secretion eventually leads to less of which lipoprotein?

A) LDL

B) HDL

C) Albumin

D) ApoA-I

Niacin decreases breakdown of which apolipoprotein?

A) ApoB-100

B) ApoA-I

C) ApoC-II

D) ApoE

ApoA-I helps increase which lipoprotein?

A) LDL

B) VLDL

C) HDL

D) Chylomicrons

Niacin is best known in these notes for increasing which lipid?

A) LDL

B) VLDL

C) Bile acids

D) HDL

Which drug is described as the best for raising HDL?

A) Ezetimibe

B) Niacin

C) Fenofibrate

D) Cholestyramine

Niacin lowers LDL indirectly by decreasing which precursor lipoprotein?

A) HDL

B) Albumin

C) VLDL

D) LDL receptors

Evolocumab and alirocumab belong to which class?

A) Statins

B) PCSK9 inhibitors

C) Fibrates

D) Bile acid sequestrants

Which name clue helps identify evolocumab and alirocumab?

A) “statin” suffix

B) “fib” in name

C) “cumab” suffix

D) “three Cs” clue

PCSK9 inhibitors directly block which protein?

A) ApoA-I

B) PPAR-alpha

C) HMG-CoA reductase

D) PCSK9

PCSK9 normally breaks down which liver surface proteins?

A) LDL receptors

B) HDL proteins

C) Bile acid receptors

D) Sodium channels

Blocking PCSK9 allows LDL receptors to do what?

A) Break down faster

B) Stay alive longer

C) Leave the liver

D) Stop binding LDL

When LDL receptors stay alive longer, the liver does what?

A) Releases more LDL into blood

B) Stops clearing LDL

C) Pulls more LDL from blood

D) Makes more VLDL

PCSK9 inhibitors cause which lipid effect?

A) HDL disappears

B) Triglycerides always rise

C) VLDL secretion increases

D) LDL drops a lot

Which listed drug is a PCSK9 inhibitor?

A) Evolocumab

B) Fenofibrate

C) Ezetimibe

D) Colestipol

Which listed drug is a PCSK9 inhibitor?

A) Simvastatin

B) Alirocumab

C) Gemfibrozil

D) Niacin

Bempedoic acid acts primarily by inhibiting what?

A) Cholesterol biosynthesis

B) Bile acid absorption

C) ApoA-I breakdown

D) PCSK9 degradation

Bempedoic acid inhibits cholesterol biosynthesis in which organ?

A) Intestine

B) Liver

C) Kidney

D) Muscle

Bempedoic acid causes the liver to make less what?

A) HDL

B) ApoA-I

C) Cholesterol

D) Bile acid binders

After bempedoic acid decreases liver cholesterol, the liver increases what?

A) VLDL secretion

B) PCSK9 breakdown

C) Triglyceride storage

D) LDL receptors

Bempedoic acid lowers blood LDL by causing which effect?

A) More LDL pulled from blood

B) Less bile acid excretion

C) More VLDL secretion

D) More cholesterol absorption

Which drug inhibits cholesterol biosynthesis in the liver?

A) Cholestyramine

B) Bempedoic acid

C) Gemfibrozil

D) Niacin

Which class mainly lowers LDL by increasing hepatic LDL receptors after blocking liver cholesterol synthesis?

A) Fibrates

B) Bile acid sequestrants

C) Niacin

D) Statins

Which class mainly lowers LDL by preventing the degrading of LDL receptors?

A) PCSK9 inhibitors

B) Bile acid sequestrants

C) Fibrates

D) Sterol absorption inhibitors

Which class lowers LDL by blocking intestinal cholesterol absorption?

A) Fibrate

B) Sterol absorption inhibitor

C) Beta blocker

D) Sulfonamide

Which class lowers LDL by binding bile acids in the gut?

A) Statins

B) Fibrates

C) Bile acid sequestrants

D) PCSK9 inhibitors

Which class mainly lowers triglycerides through PPAR-alpha activation?

A) PCSK9 inhibitors

B) Statins

C) Sterol inhibitors

D) Fibrates

Which drug is most associated with raising HDL in these notes?

A) Niacin

B) Ezetimibe

C) Atorvastatin

D) Colestipol

Which lipid-lowering agents share myopathy and liver dysfunction as listed side effects?

A) Niacin and ezetimibe

B) Statins and fibrates

C) PCSK9 inhibitors and sequestrants

D) Bempedoic acid and niacin

Which drug lowers LDL by blocking intestinal absorption rather than liver synthesis?

A) Rosuvastatin

B) Ezetimibe

C) Pravastatin

D) Bempedoic acid

Which drug lowers LDL by blocking receptor degradation rather than cholesterol synthesis?

A) Simvastatin

B) Cholestyramine

C) Alirocumab

D) Niacin

Testing confirms a diagnosis of homozygous familial hypercholesterolemia. Which of the following interventions will be least effective in this patient?
(A) Atorvastatin
(B) Ezetimibe
(C) Lomitapide
(D) Mipomersen
(E) Niacin

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

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

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

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

Consumption of alcohol is associated with which of the following changes in serum lipid concentrations?
(A) Decreased chylomicrons
(B) Decreased HDL cholesterol
(C) Decreased VLDL cholesterol
(D) Increased LDL cholesterol
(E) Increased triglyceride

If the patient has a history of gout, which of the following
drugs is most likely to exacerbate this condition?
(A) Colestipol
(B) Ezetimibe
(C) Gemfibrozil
(D) Niacin
(E) Simvastatin

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

Which of the following is the most accurate
description of ezetimibe’s mechanism of an action?
(A) Decreased lipid synthesis in adipose tissue
(B) Decreased secretion of VLDL by the liver
(C) Decreased gastrointestinal absorption of cholesterol
(D) Increased endocytosis of HDL by the liver
(E) Increased lipid hydrolysis by lipoprotein lipase