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Flashcards in 42 Atherosclerosis Deck (32)
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1

Where does 25 % of cholesterol production occur?

liver

2

Acetyl Coa becomes HMG CoA and then what happens for it to become cholesterol?

HMG CoA reductase creates mevalonic acid -->[geranyl pyrophosphate-->farnesyl pyrophosphate---> cholesterol]

3

Where is triglycerides taken up? chylomicron?

1. lipoprotein lipase removes in extrahepatic tissues
2. chylomicron taken up by hepatocytes

4

What transfers HDL cholesterol to IDL in the plasma?

LCAT

5

VLDL is synthesized by the liver and lipoprotein lipase hydrolyzes the triglyceride core. How are these remnants converted to LDL?

hepatic lipase removes triglycerides

6

What happens to hepatic LDL?

converted to bile acids

7

What happens to non hepatic LDL?

used for production of hormones cell membranes or stored in esterified form

8

Where else can circulating LDL enter?

macrophages and others to form foam cells which contribute to atheromatous plaques

9

What is HDL formed from? what happens to it

1. phospholipids and apolipoproteins
2. procurement of surface components from trig depleted chylomicrons and VLDL remnants, acquires free cholesterol from tissue sites and other lipoproteins

10

What is the treatment of borderline high cholesterol?

dietary and lipoprotein analysis, with possible drug therapy if CHD or 2 other risk factors

[male, FH, premature CHD, cigarette smoking, hypertension, low HDL, diabetes, obesity]

11

What is the treatment for high cholesterol?

1. dietary if no CHD or less than 2 risk factors
2. dietary +drug if CHD or 2 or more risk factors

12

What is the treatment for very high cholesterol?

Dietary + drug even if no CHD or other risk factors.

13

What do omega-3-ftty acids activate?

PPARalpha- decreases triglycerides- may increase LDL

14

What are the 4 approaches to lowering lipid levels?

1. prevent intestinal absorption of cholesterol or bile acids
2. decrease cholesterol synthesis-->increase LDL receptors--> increase LDL uptake
3, inhibit VLDL secretion --> decrease LDL production
4. upregulate lipoprotein lipase--> decrease trigs

15

Bile acid sequestrates are what? How do they increase uptake of LDL? Do they increase hepatic production of VLDL?

1. large polymeric cationic exchange resins-insoluble in water
2. increase uptake of LDL from up regulation of LDL receptors
3. Yes

16

What bile sequestrates reduces hyperglycemia?

colesevalam- also has the less side effects and drug drug interactions.

17

What is niacins effect on bile production?

no effect

18

What can long term niacin treatment increase?

insulin resistnce

19

What CYP for lovastatin, simvastatin, atorvastatin? fluvastatin, rosuvastatin?

1. CYP3A4
2. CYP2C9

20

How are HMG CoA reductase inhibitors enhanced absorption?

food

21

All statins undergo glycosylation and interact with?

gemfibrozil

22

What does grape juice inhibit?

CYP3A4 [lovastatin, simvastatin, atorvastatin]

23

PPAR activates polymerase and leads to what 4 things?

1 insulin sensitization
2. anti-proliferative
3. Anti-fibrotic
4. anti-inflammatory

24

Fibric acids lowers VLDL and raises what?

HDL

25

What proteins do fibrin acids up regulate?

lipoprotein lipase, APO A-I, APO` A-II

26

When combining fibrin acids with status, what increased risk is there?

myopathy

27

Is ezetimibe a CYP450 substrate?

No

28

For high LDL cholesterol what classes do we use?

1.bile acid sequestrates
2. nicotinic acid or HMG inhibitor
can combine

29

For high LDL and trigs what do we use?

1. weight loss and alcohol restriction
2. niacin or gemfibrozil
3. bile sequestrates or HMG inhibitors
[combination of the above increases risk of toxicity]

30

For high trig what do we use?

weight loss
gemfibrozil or nicotinic acid