Cardio: Statins Flashcards

1
Q

Cholesterol is packaged into chylomicrons as _____________.

A

cholesteryl ester (like the cholesterol gold bars being packaged in CH-ESTs before being loaded onto the hot air balloon)

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2
Q

What is on the outside of chylomicrons?

A

Triglycerides (think of the hot air balloon with the TRI-pronged pitchforks sticking out)Also, keep in mind that chylomicrons have more triglycerides than cholesterol (just like how the hot air balloon is mostly pitchfork-wielding passengers and not so many chests)

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3
Q

___________ are on the surface of chylomicrons.

A

Apolipropoteins

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4
Q

Prior to being resorbed by the liver, chylomicrons deliver ________________.

A

triglycerides to peripheral tissues in the form of free fatty acids (just like the pitchfork-wielding passengers deboarding at the LipoProtein Lighthouse –LPL –above the muscle-clams on the beach)

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5
Q

Remnant lipoprotein is taken up by the liver by ________________.

A

apolipoprotein E-mediated endocytosis (think of the hot air balloon landing on the LoaD –L dock)

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6
Q

After being absorbed into hepatocytes, cholesterol from remnant lipoprotein can take one of two fates: ________________.

A

it can be secreted into bile acid (and then pooped out) or it can be packaged into circulating lipoproteins

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7
Q

Describe the composition of VLDL.

A

Mostly triglyceride (just like the airship VLDL mostly filled with pitchfork-wielding passengers) with apolipoprotein B100 (like the B-shaped anchor)

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8
Q

What is IDL?

A

Intermediate-density lipoprotein

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9
Q

LDLs are formed by ______________.

A

the continual loss of triglycerides from VLDL (think of the little LDL ship with only CHESTs on it)

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10
Q

What is the basic function of LDL?

A

It delivers cholesterol to the body (such as to the adrenals for steroid synthesis).

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11
Q

How do cells regulate their cholesterol levels?

A

When low on cholesterol, they express more apolipoprotein B100 receptors, leading to endocytosis of LDL. When cholesterol is abundant in cells, they express fewer B100 receptors, leading to less endocytosis.

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12
Q

How is LCAT depicted in this sketch?

A

As the diver moving free cholesterol bars (cholesterol) to the chests on the HDL submarine (cholesteryl ester)

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13
Q

HDL helps get cholesterol back to the liver (where it can be excreted as bile) by two mechanisms: ______________.

A

directly – by absorbing cholesterol as cholesteryl ester via LCAT – and indirectly –by using CETP to package cholesterol onto LDL(Think of the submarines directly taking chests back and adding chests onto the platforms beneath the LDL boat.)

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14
Q

Statins work in a one-two mechanism: _______________.

A

they decrease the synthesis of cholesterol by inhibiting HMG co-a reductase which then stimulates the liver to reel in more circulating LDL(Think of the Steampunk Statin pirate disrupting the gold-bar smelting and the other pirate making the sailors pull in more LDL by the B100 anchor.)

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15
Q

Remember, statins are the only lipid-lowering drug shown to ____________.

A

prevent CV mortality

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16
Q

It is standard practice to prescribe statins even in a patient with normal lipid levels if ___________.

A

they’ve had an MI, have diabetes, or have signs of peripheral vascular disease(Think of the pirate playing the banjo with broken strings, the pirate eating candy, and the clogged pipe.)

17
Q

Remember an important contraindication for statins is _____________.

A

pregnancy (the teratogen tarantula on the submarine)

18
Q

Statin-induced myopathy usually presents as ____________.

A

proximal bilateral muscle soreness

19
Q

Remember to check for drug interactions with ____________.

A

CYP450-affecting drugs (because all statins except one are metabolized by CYP450) (Think of the CYP license plate on the tank.)

20
Q

True or false: statins are idiosyncratic hepatotoxins.

A

False, but they can lead to a usually asymptomatic elevation in LFTs.