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Retired NBME 22 Answers

nbme22/Block 4/Question#35 (reveal difficulty score)
Nicotinic acid acts at which of the following ...
Pathway labeled โ€˜Cโ€™ ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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 +17  upvote downvote
submitted by โˆ—btl_nyc(72)
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A: cholestryramine and other bile acid resins prevent the reuptake of bile acids from the gut.

B: Statins inhibit HMG-CoA reductase, preventing the liver from making mevalonic acid, a precursor to cholesterol.

C: Niacin (nicotinic acid) reduces hepatic VLDL synthesis and also inhibits lipolysis in adipose tissue by inhibiting hormone sensitive lipase.

D&E: Fibrates upregulate lipoprotein lipase (LPL), increasing triglyceride clearance (VLDL and chylomicrons are full of triglycerides) and also activate peroxisome proliferator-activated receptor- alpha (PPAR-alpha) to induce HDL synthesis.

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icrieeverytiem  My dumbass thought nicotinic acid=something to do with smoking smh +2
chaosawaits  @icrieeverytiem me toooo +
kani  me 3 +



 +13  upvote downvote
submitted by โˆ—mattnatomy(46)
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Answer = C. (Decreased hepatic VLDL synthesis)

Nicotinic acid = Niacin. Niacin works by:

  1. Inhibiting lipolysis (hormone sensitive lipase) in adipose tissue)

  2. Reducing hepatic VLDL synthesis

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johnthurtjr  Well color me surprised. I was completely thrown off here. +34
miriamp3  @almondbreeze go to the cardiovascular pharmacology you will see a draw of lipid lowering agents and you will find niacin en two places ++one on the adipose tissue and the second one in the liver by the vldl production. in the text in the same page is also mention it FA 2018 pg 313. +
djeffs1  I still don't quite see how C corresponds to those 2 processes... +

The only place where FA2019 talks about - pg. 67, on Hartnup dz: pellagra-like symptoms. Treat with high- protein diet and nicotinic acid.

well, great



 +3  upvote downvote
submitted by โˆ—btl_nyc(72)
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A: cholestryramine and other bile acid resins prevent the reuptake of bile acids from the gut. B: Statins inhibit HMG-CoA reductase, preventing the liver from making mevalonic acid, a precursor to cholesterol. C: Niacin (nicotinic acid) reduces hepatic VLDL synthesis and also inhibits lipolysis in adipose tissue by inhibiting hormone sensitive lipase. D&E: Fibrates upregulate lipoprotein lipase (LPL), increasing triglyceride clearance (VLDL and chylomicrons are full of triglycerides) and also activate peroxisome proliferator-activated receptor- alpha (PPAR-alpha) to induce HDL synthesis.

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 +1  upvote downvote
submitted by โˆ—gh889(154)
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Could someone please explain which drugs (if any) are at D and E?

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usmleuser007  1) label D (VLDL -->ILD --> LDL) = anything that increased LPL = Fibrates which use PPAR-alpha (Rx) are good at reducing [VLDL]; therefore, less VLDL means more ILD. 2) VLDL --> fatty acid oxidation = using fats (TAGs) for energy production Here PPAR-gamma plays a role= which are Thiazolidinediones (also called glitazones) are a class of medicines that may be used for the treatment of type 2 diabetes. They are also good at reducing serum TAGs Note VLDL are very rich in TAGs +2



 +0  upvote downvote
submitted by โˆ—usmleuser007(464)
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1) label D (VLDL -->ILD --> LDL) = anything that increased LPL = Fibrates which use PPAR-alpha (Rx) are good at reducing [VLDL]; therefore, less VLDL means more ILD.

2) VLDL --> fatty acid oxidation = using fats (TAGs) for energy production Here PPAR-gamma plays a role= which are Thiazolidinediones (also called glitazones) are a class of medicines that may be used for the treatment of type 2 diabetes. They are also good at reducing serum TAGs

Note VLDL are very rich in TAGs

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 +0  upvote downvote
submitted by โˆ—psaucy(2)
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I miss so many questions on NBME exams not knowing the common names for things lol fuck me

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psaucy  only knowing the common names* +



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