3 - Cholesterol Flashcards Preview

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Flashcards in 3 - Cholesterol Deck (27):
1

What are the oxidative effects of LDLs?

Pro atherogenic:
Inhibits macrophage activity
Induce T cell activity
Toxic to endothelial cells
Enhance platelet aggregation

2

Give an example of a statin

Simvastatin
Pravastatin
Fluvastatin

3

Describe the effect of statins

Inhibit cholesterol synthesis in hepatocytes
Increase clearance of LDLs
Decrease production of LDLs

4

What are the secondary benefits of statins?

Anti-inflammatory
Plaque reduction
Increased endothelial function
Decreased thrombotic risk

5

What is the mechanism of action of statins?

Deceased serum LDLs and increased synthesis of LDL receptors, so more is taken up by receptors

6

What are the adverse effects of taking statins?

Increased transaminase levels -indicative of liver damage
Myopathy, potentially developing into rhabdomyalisis
GI upset

7

Name an example of a fibric acid derivative

Gemfibrozil
Fenofibrate

8

What type of molecule is a fibric acid derivative?

An ampipathic (hydrophobic and phillic) carboxylic acid

9

What is the mechanism of action for fibric acid derivates?

PPAR alpha agonist, increasing the production of lipoprotein lipase therefore decreasing triglyceride production

10

What are the effects of taking fibric acid derivatives?

Decreased triglyceride production
Increased fatty acid uptake and oxidation
Increased LDL particle size

11

What are the side effects of fibric acid derivatives?

GI upset
Abnormal liver function tests
Gall stones
Myositis (inflamed muscles)

12

What are the contraindications for fibric acid derivatives?

Gall bladder disease
Hepatic dysfunction
Renal dysfunction

13

What are the effects of nicotinic acid?

Decreased lipoprotein synthesis
Decreased VLDL
Increased HDL
Therefore reducing coronary events

14

What are the contraindications for nicotinic acid?

Peptic ulcer disease
Active liver disease or abnormal liver function tests

15

What are the side effects of nicotinic acid?

Hepatotoxicity
Headache
Itching
Activation of peptic ulcer
Hyperglycaemia
Decreased insulin sensitivity

16

What is the mechanism of action of Ezetimibe?

Selectively inhibits intestinal cholesterol absorption, so less intestinal delivery of cholesterol to liver

17

What are the effects of Ezetimibe?

Decreased intestinal delivery of cholesterol to liver
Increased expression of hepatic LDL receptors
Decreased cholesterol content of atherogenic particles

18

What are the side effects of Ezetimibe?

Headaches
Abdominal pain
Diarrhoea

19

Why is Ezetimibe generally well tolerated?

Circulates enterohepatically, delivering agent back to target site and limiting systemic exposure, producing fewer side effects

20

What target should be set for cholesterol levels?

2 mmol for LDL
4mmol total

21

What can statins be given in combination with?

Fibric acid derivatives
Nicotinic acid
Ezetimibe
Omega 3

22

What is the danger of giving fibric acid derivatives in combination with statins?

Increased risk of myopathy and rhabdomyolysis

23

Describe the mechanism of action of PCSK9 inhibitors

Inhibits PCSK9 from internalising LDL receptors, so more receptors are present so can remove more from the bloodstream

24

What type of molecule is a PCSK9 inhibitor?

A monoclonal antibody

25

Give an example of a PCSK9 inhibitor

Evolocumab

26

Which dietary factors have a positive effect of cholesterol levels?

Fish oils
Fibre
Vitamin C and E
Alcohol (HDL)

27

Which dietary factors have a negative effect on cholesterol levels?

Dietary cholesterol and fat
Alcohol (triglycerides)