Font size
WorksheetsLipoproteins and Cholesterol Functions
Total questions: 165
Worksheet time: 2hrs 23mins
Cholesterol
What type of cholesterol is absorbed from the GI tract and consists of animal-based foods like meat, dairy, and eggs
(a)
Cholesterol
What type of cholesterol is naturally produced in the liver and is the primary source for circulating cholesterol in plasma
(a)
Lipid Transport
(a) are formed when lipids bind to proteins for transport
Lipoprotein functions
(a) have the highest lipid content and lowest protein content
Primary function: transports dietary fats from small intestines
Lipoprotein functions
(a) has a high lipid content and low protein content
Primary function: delivers TGs to tissues from liver
Lipoprotein functions
(a) has both a moderate lipid and protein content
Primary function: Transports cholesterol to tissues
Lipoprotein functions
(a) has a low lipid content and has the highest protein content
Primary function: reverse cholesterol transport back to liver
Lipid profile
Total cholesterol of (a) mg/dL indicated desirable levels
Lipid profile
LDL-C levels of (a) mg/dL indicate optimal levels
Lipid profile
HDL-C levels of (a) mg/dL indicate low levels
Lipid profile
Triglyceride levels of (a) mg/dL indicates normal levels
Lipid abnormalities are a primary risk factor for clinical...
(a)
Dyslipidemia etiology
Caused by inherited genetic abnormalities
(a)
Dyslipidemia etiology
Triggered by environmental including lifestyle, diet, medications, or underlying diseases
(a)
Hypercholesterolemia
Can occur independently or alongside genetic disorders (4D classification)
(a)
Medication etiology
Diuretics, Beta-blockers, Glucocorticoids can (a) both LDL-C and triglycerides
Patient group - LDL-C >190
Treatment:
(a)
Patient group - LDL-C >190
LDL-C goals:
(a)
Patient group - Diabetes (40-75 yrs)
Risk assessment:
(a)
Patient group - Diabetes (40-75 yrs)
Treatment:
(a)
Patient group - Diabetes (40-75 yrs)
LDL-C goals:
(a)
Patient group - >75 years
Risk assessment:
(a)
Patient group - >75 years
Treatment:
(a)
Patient group >75 years
LDL-C goals:
(a)
Patient group - 40-75 years
Risk assessment:
(a)
Patient group - 40-75 years
Treatment:
(a)
Patient group - 40-75 years
LDL-C goals:
(a)
Patient group - 40-75 years (WIthout T2DM)
LDL-C goal (<5% risk):
(a)
Patient group - 40-75 years (Without T2DM)
LDL-C goals (5% - 7.4% risk):
(a)
Patient group - 40-75 years (Without T2DM)
LDL-C goals (7.5% - 19.9% risk):
(a)
Patient group - 40-75 years (Without T2DM)
LDL-C goals (>20% risk):
(a)
Patient group - 40-75 years (With T2DM)
Treatment (ASCVD risk <7.5%):
(a)
Patient group - 40-75 years (With T2DM)
Treatment (ASCVD risk >7.5%):
(a)
Patient group - 40-75 years (With T2DM)
LDL-C goals (ASCVD risk <7.5%):
(a)
Patient group - 40-75 years (With T2DM)
LDL-C goals (ASCVD risk >7.5%):
(a)
Lipid parameters
Increasing soluble fiber intake and Phytosterol supplementation is used to...
(a)
Lipid parameters
Increasing physical activity and smoking cessation..
(a)
Lipid parameters
5-10% weight loss, increasing physical activity, abstain from alcohol, and reducing refined carbohydrates and sugars...
(a)
Thickening or hardening of the arteries caused by a buildup of plaque in the inner lining
(a)
Complications of atherosclerosis
Chest pain from reduced blood flow to the heart muscle
(a)
Complications of atherosclerosis
Heart attack
(a)
Complications of atherosclerosis
Blockage to blood flow in brain
(a)
Complications of atherosclerosis
Plaque in arteries of the extremities, especially legs
(a)
Complications of atherosclerosis
Weakened/bulging area of the wall of the aorta, which may rupture or dissect
(a)
ASCVD risk enhancing factors
Waist circumference (inches)
(a)
ASCVD risk enhancing factors
Family history of premature ASCVD (first degree relative)
(a)
ASCVD risk enhancing factors
Primary hypercholesterolemia
(a)
ASCVD risk enhancing factors
Chronic kidney disease
(a)
ASCVD risk enhancing factors
History of (a)
ASCVD risk enhancing factors
Premature (a)
ASCVD risk enhancing factors
____ ____ ancestry
(a)
ASCVD risk enhancing factors
Chronic inflammatory conditions
(a)
ASCVD risk enhancing factors
Elevated triglycerides
(a)
ASCVD risk enhancing factors
Elevated blood pressure
(a)
ASCVD risk enhancing factors
Elevated blood glucose
(a)
CAC scoring
CAC = 0
(a)
CAC scoring
CAC 1-99
(a)
CAC scoring
CAC >100
(a)
Efficacy monitoring
Short-term evaluation leads to lipid panel reading in (a) after initiation
Efficacy monitoring
Long-term evaluation on lipid panel every (a)
SAMS
(a) statins MAY be better tolerated as they are less likely to be to be taken up into the muscles
SAMS
(a) statins are more distributed through the body and more often linked to SAMS
Thyroid
Hypothalamus produces...
(a)
Thyroid
Pituitary produces...
(a)
Thyroid
TSH forms...
(a)
Thyroid
Cold, stress, leptin, norepinephrine, and MSH promote
(a)
Thyroid
Inhibitors that block TRH release
(a)
Stimulus and release of TRH (Stage 1: Hypothalamus)
"Stimulators” activate the
(a)
Stimulus and Release of TRH (Stage I: Hypothalamus)
GPCRs are linked to Gs which activates
(a)
Stimulus and Release of TRH (Stage I: Hypothalamus)
cAMP activates ______ which activates _____
(a)
Stimulus and Release of TRH (Stage I: Hypothalamus)
CREB = cAMP response element-binding protein that binds to ____ receptors on DNA which activates the hypothalamus to make ____
(a)
TRH and TSH Production (Stages I-II)
TRH formed in hypothalamus is transported down the portal
system to the pituitary where it binds to (a) receptors
TRH and TSH Production (Stages I-II)
THR receptors are GPCR linked to ___ which
forms ___ and ___
(a)
TRH and TSH Production (Stages I-II)
DAG and IP3 stimulates (a) release
Thyrotropin (TSH) and GPCRs (Gs) – Stage II
TSH increases expression of Na+/I- iodine uptake pumps, TPO
genes, efflux pumps and stimulates (a) growth
Iodination
TPO catalyzes two DITs which combines to form
(a)
Iodination
TPO catalyzes an MIT and DIT to combine to form
(a)
Endocytosis and release
The (a) secretes T4/T3 hormone to maintain peripheral thyroid hormone levels
Substances that inhibit T4/T3 secretions (Name two)
(a)
Overview of T4/T3 Biosynthesis and Release
Storage of T4 and T3 in the ______ gland
Binding of T4/T3 by _______ ______
(a)
The body is producing normal quantities of substances to stimulate those receptors in the hypothalamus involved in TRH biosynthesis, but no TRH is being produced. Propose several possible explanations for these abnormalities.
Receptor, G-protein, cAMP not formed
Enzymes produce TSH that are functional
Drug could block steps in processes
TSH is produced but not functional
Creb not binding or not forming
The hypothalamus is producing normal quantities of TRH to stimulate pituitary TRH receptors, but no TSH is being secreted. Propose several possible explanations for these
abnormalities
Disease related such as infection, cancer, or even trauma
DAG and IP3 not formed
IP3 releases Ca++
Genetic defects
TRH can reach the pituitary
The thyroid gland is producing normal quantities of thyroid hormones, but peripheral tissues are not responding as they normally do to thyroid hormone stimulation. Propose several possible explanations for these abnormalities.
Receptor has low affinity (MCAT binding to THR)
Genetic abnormality (DNA)
Protein synthesis compromised (mutation)
Functional MCAT
The hypothalamus, pituitary and thyroid gland are all functioning normally, but plasma T4 levels are well below normal. Propose several possible explanations for these abnormalities
MCAT hyper activity
Patient may be hyperthyroid
Phenytoin excreted at an abnormally high rate
Patient may be hypothyroid
A patient on lithium therapy has lower than normal plasma thyroid hormone levels, signs and symptoms of hypothyroidism and has developed a goiter. Why are plasma thyroid hormone levels low and why has the patient developed a goiter?
Lithium competition with Na/K pump and indirectly blocks the Na/I pump
Lithium can block the release of T4/T3
T4/T3 plasma levels are low so the HP increase TRH and TSH
TSH over stimulates the thyroid gland
Lithium blocks the release of TSH
The hypothalamus is under-producing TRH and the pituitary gland is under-producing TSH (lower than normal levels of both TRH and TSH). However, plasma levels of T4 are normal (not high!). Propose several possible explanations for these abnormalities.
Deiodinase problem (T4 levels are normal but not T3)
Possible autonomous nodules
T4 levels are unstable while T3 levels are stable
T4 is turning off hypothalamus
The liver is producing significantly higher than normal levels of thyroxine binding globulin, but plasma free (unbound) thyroid hormone levels are normal and hypothalamus, pituitary and thyroid gland function is normal. What would cause thyroxine binding globulin levels to rise and how could plasma free T4 levels be normal?
Maybe a patient is on high dose estrogen and the liver produces more binding proteins
Measuring TH hormone level in blood
HPT system can correct for some variation in plasma proteins
Androgens tend to raise binding globulin levels
Hypothyroid causes
Many disease that directly target the thyroid is known as
(a)
Hypothyroid Causes
Diseases that directly target the hypothalamus and pituitary are known as
(a)
Hypothyroid causes
Issues related directly to the T4/T3 diffusion in target tissue is known as
(a)
What is a cause of peripheral hypothyroidism
(a)
Biochemical defects
Chronic autoimmune thyroiditis (Hashimoto's disease) is
(a)
Subclinical hypothyroidism outcomes
More than 10 mIU/liter of thyrotropin leads to a stronger risk of
Congestive heart failure
Stroke
Coronary heart disease
Cognitive decline
Foods such as cauliflower, cabbage, bok choy, broccoli, brussel sprouts can inhibit
(a)
Medications that can induce or worsen thyroid disorders - HOW?
Parkinson’s Disease patient on carbidopa/levodopa
(a)
Medications that can induce or worsen thyroid disorders - HOW?
Patient with schizophrenia treated with risperidone
(a)
Medications that can induce or worsen thyroid disorders - HOW?
Patient with bipolar disease treated with lithium?
(a)
Medications that can induce or worsen thyroid disorders – HOW?
Patient with cardiovascular disease treated with amiodarone
(a)
Medications that can induce or worsen thyroid disorders – HOW?
Patient with cardiovascular disease treated with propranolol?
(a)
Medications that can induce or worsen thyroid disorders – HOW?
Seizure patient on phenytoin (CYP inducer)
(a)
Hypothyroid major signs and symptoms
Cardiovascular:
Hypertension
Hypotension
Bradycardia
Tachycardia
Hypothyroidism major signs and symptoms
Dermatologic:
Cool, dry skin
Coarse hair
Brittle nails
Nail overgrowth
Warm, clammy skin
Small changes in T4/T3 levels produce _______ changes in ___ levels
(a)
Interpretation of TFTs and Site of Pathology
High T4/T3 + low TSH targets
(a)
Interpretation of TFTs and Site of Pathology
High T4/T3 + High TSH targets
(a)
Interpretation of TFTs and Site of Pathology
Low T4/T3 + Low TSH targets
(a)
Interpretation of TFTs and Site of Pathology
Low T4/T3 + High TSH targets
(a)
Hypothyroid Problem #1
Low TRH
Low TSH
Low T4
Low T3
What is happening?
TRH is produced and secreted, the pituitary cells are stimulated to produce TSH. TSH production means the thyroid gland cannot be activated to synthesize and release T4/T3.
TRH is not being produced and secreted, the pituitary cells cannot be stimulated to produce TSH. No TSH production means the thyroid gland cannot be activated to synthesize and release T4/T3.
TRH is not being produced and secreted, the pituitary cells can be stimulated to produce TSH. TSH production means the thyroid gland cannot be activated to synthesize and release T4/T3.
Hypothyroid Problem #2
High TRH
Low TSH
Low T4
Low T3
What is happening?
Low levels to T3 lead to no negative feedback so the hypothalamus continues to produce TRH
The hypothalamus is producing excessive amount of TRH
The hypothalamus is producing an excessive amount of TSH
T4 negative feedback causes hypothalamus to produce TRH
Hypothyroid Problem #3
High TRH
High TSH
Low T4
Low T3
What is happening?
Both hypothalamus and pituitary are over producing hormones
Thyroid gland is dysfunction and not responding to TSH
Thyroid gland is producing enough T4/T3 to send negative feedback to promote TRH secretion
Low levels of T3 means no negative feedback
Hypothyroid Problem #4
Normal TRH
Normal TSH
High T4
Low T3
What is happening?
T4 is not being converted to T3 in peripheral tissues
T3 is not sending negative feedback
T3 can be treated with cytomel
Hypothalamus and pituitary are not working
Raphe Nucleus is the site where (a) is synthesized
Locus coeruleus is the site where (a) is synthesized
Substantia nigra is the site where (a) is synthesized
VTA is the site where (a) is synthesized
GPCR signaling
Gs _______ adenylyl cyclase and also _______ cAMP activity
(a)
GPCR signaling
Gi ______ adenylyl cyclase and _______ cAMP activity
(a)
GPCR signaling
Gq ______ Ca++ and ______ activity
(a)
________ quickly increases BDNF whereas __________ take longer to work
(a)
= Activity of the natural ligand (10 cAMP)
(a)
60% of natural ligand activity, blocks 40% of activity (6 cAMP)
(a)
Blocks natural ligand activity but no basal activity (2 cAMP)
(a)
Block natural ligand and basal activity (0 cAMP)
(a)
Pharmacologic action defined as "inverse agonism" can only exist at a receptor that exhibits..
inhibitory activity upon natural ligand binding
Constitutive activity in the absence of natural ligand binding
Gs-mediated GPCR signaling upon natural ligand bonding
An influx of positively charged ions upon natural ligand binding
Selective Serotonin Reuptake inhibitors (SSRIs) _______ synaptic levels of ________
(a)
Name the drugs (core concept only) that increase synaptic levels of serotonin
Sertraline (Zoloft)
Fluoxetine (Prozac)
Venlafaxine (Effexor)
Paroxetine (Paxil)
Amitriptyline (Elavil)
Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) _______ synaptic levels of ______ and _______
(a)
What might have caused an individual to have elevated blood pressure when on MAO?
Activation of MAO lead to too little monoamine causing hypotensive crisis
Non-adherence with blood pressure medication
Too much serotonin in the blood stream causing serotonin syndrome
Inactivation of MAO enzyme caused to much monoamine leading to elevated blood pressure
What is the mechanism of action for the blood pressure elevation? MAO
Norepinephrine cannot be broken down because of enzyme inhibition and causes elevated blood pressure
Serotonin cannot be broken down because of enzyme inhibition and causes elevated blood pressure
Dopamine cannot be broken down because of enzyme inhibition and causes blood pressure elevation
Acetylcholine cannot be broken down because of enzyme inhibitions and causes blood pressure elevation
What adverse effect do you suspect is the cause of this patients dry mouth, blurred vision, constipation, and urinary retention?
Antidopaminergic activity
Antiserotonergic activity
Anticholinergic activity
Antinoradrenegic activity
What antidepressant class causes the greatest risk of anticholinergic activity?
Serotonin antagonists and reuptake inhibitors (SARIs)
Monoamine oxidase inhibitors (MAOls)
Norepinephrine dopamine reuptake inhibitors (NDRIs)
Tricylic antidepressants
Serotonin norepinephrine reuptake inhibitors
Antidepressant associated arrhythmias are associated with blocking which of the following?
Acetylcholine receptors
Alpha adrenergic receptors
Voltage gated sodium channels
Noradrenergic receptors
Can any of the patients medications cause an increase in blood pressure? If so, which one(s)?
None of these medications increase blood pressure
Angiotensin-converting enzyme inhibitors increase blood pressure
Serotonin norepinephrine reuptake inhibitors increase blood pressure
Both of this patients medications can potentially increase blood pressure
What is the mechanism of action of this patients increase in blood pressure?
Increase in 5HT
Decrease in 5HT
Increase in NE
Decrease in NE
Why would this patient be looking for a medication to help with sleep?
Diuretic is keeping him up because he has to go to the bathroom
Depression causes insomnia
NDRI induced activation
Because he is not sleeping well
Is an NaSSA a good choice for this patient? Why?
No, it will cause weight loss
Yes, it will cause weight gain
No, it will cause insomnia
Yes, it will help with sleep
Why would this patient have difficulty with sleeping?
Depression causes insomnia
SSRIs cause insomnia
SSRIs cause insomnia
SSRIs cause sedation
Why did the clinician add a serotonin antagonist and reuptake inhibitor?
SARI causes activation
SSRI causes activation
Depression causes activation
SSRI causes sedation
What is the mechanism of action of this patients sexual dysfunction?
Its just natural because he is over age 20
Anticholinergic activity
5HT2C antagonism
Sigma 1 receptor activity
Nitric oxide synthetase (NOS) inhibition
AB is a 20 year old male who is having his first episode of depression. He is started on an SSRI today. How long should he take the SSRI?
4 to 6 weeks
A minimum of one year
Indefinitely
Until symptoms are better and then stop
What is the goal of treating depression?
Response
Relapse
Recurrence
Remission
A 46-year-old female complains of sedation, weight gain, lack of energy, lack of focus, and anxiety. These are her only symptoms and she has had them for about 8 weeks. Does she have depression? Why or why not?
Yes, because she has 5-symptoms
Yes, because she has had symptoms for 8 weeks
No because she needs to have more than 5-symptoms
No because she does not have depressed mood or anhedonia
AB is now having a second episode of depression and his doctor initiates an SNRI antidepressant today. How long should you use the antidepressant and why?
4 to 6 weeks
Minimum treatment is 12 months
Indefinitely
4 to 9 months
AB is now having a third episode of depression. He is initiated on an NRDI. How long do you recommend that he take this drug?
Why?
4 to 6 weeks
A minimum of 12 months
Indefinitely
4 to 9 months
The primary hypothesis for depression is the monoamine hypothesis. Why is this theory flawed?
Monoamines rise immediately but depression is not treated for a minimum of 4 to 6 weeks
The monoamine hypothesis is not flawed
The primary hypothesis is not the monoamine hypothesis
Monoamines take 4 to 6 weeks to rise correlating with treatment of depression
A PHQ-9 score of 25 is associated with:
Mild depression
Moderate depression
Moderately severe depression
Severe depression
Which of the following medications can cause symptoms of depression?
Isotretinoin
Oral contraceptives
Beta blockers
Benzodiazepines
How long does it take for antidepressants to treat depressive symptoms?
4-6 days
1-2 weeks
2-4 weeks
4-6 weeks
What kind of information is placed in the subjective portion of a SOAP? What kind of information is placed in the objective portion of a SOAP?
Social history, Rating scales scores
Rating scale scores, medications
History of present illness, family history
Laboratory values, vital signs
Suicidal thinking is a potential adverse effect that must be managed for which of the antidepressants?
None of the antidepressants
TCAS
MAOIs
All of the antidepressants
SSRIS
Serotonin norepinephrine reuptake inhibitors (SNRIs) are the most dangerous class of antidepressants in overdose.
True
False
Which rating scale is clinician rated?
Patient health questionaire-9
Beck Depression Inventory
Hamilton Depression Scale
Zung Depression Scale
Which is a risk factor for developing depression?
Being male
Being in your 30's (i.e. 30 -40 years old)
Having a job making decent money
Being divorced
What drugs do not cause this adverse effect (decreased libido/inability to maintain an erection)?
MAOI
NDRI
SARI
NaSSa
SNRI
Which of the drug classes that we discussed this week decrease libido?
SSRI
SNRI
TCA
NDRI
Which antidepressants initially make anxiety worse in the first week of use, but treat anxiety with long term use?
SSRIs
SNRIs
NDRIs
MAOIs
Which of the following drug classes has an antidepressant that can lead to hypertension?
Serotonin reuptake inhibitors
Serotonin norepinephrine reuptake inhibitors
Serotonin antagonists and reuptake inhibitors
Serotonin modulators
Which PHQ-9 score is associated with severe depression?
20-27
15-19
10-14
5-9
Which PHQ-9 score is associated with a moderate depression
20-27
15-19
10-14
5-9
Which of the following effects is caused by antagonism of muscarinic (acetylcholine) receptors?
Anxiety, nausea, headache
Dry mouth, constipation, urinary retention
Hypertension, orthostatic hypotension, QTinterval prolongation
Sedation, sexual dysfunction, weight gain
An increase in norepinephrine in the synaptic cleft leads to which of the following adverse effects?
Postural hypotension
Hypertension
Arrhythmia
QT prolongation
Which of the following drugs block reuptake of norepinephrine and dopamine?
Mirtazapine (Remeron)
Bupropion (Wellbutrin)
Tricyclic antidepressants
Citalopram (Celexa)
Tricyclic antidepressants (TCA's) and Specific Serotonin Norepinephrine Reuptake Inhibitors (SNRI's) cause which mutual adverse effects when taken in overdose?
Prolongation of the QTc interval
Central nervous system depression
Seizures
Hypertension
It takes 5 months to see which of the following with the use of antidepressants?
Response
Recurrence
Remission
Recovery
Which of the following medications are associated with a risk of developing depression?
Isotretinoin
Benzodiazepines
Beta blockers
Oral contraceptives
