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Flashcards in CAD Deck (73):
1

Which molecules inactivate factor VII/tissue factor complex to protect the endothelium?

tissue factor pathway inhibitor (TFPI)

2

Which molecules inhibit platelet activation to protect the endothelium?

porstacyclin (PGI2) and EDRF-NO

3

Which molecule lyses fibrin clots?

tPA

4

What 3 factors recruit leukocytes to the vessel wall to create a foam cell?

1) chemoattractant nature of LDL
2) expression of cytokines (TNF, MCP) by injured endothelial cells
3) expression of cell adhesion molecules (VCAM-1, ICAM-1)

5

Explain how a foam cell is formed.

endothelial injury -> lipoproteins accumulate in subendothelial space -> oxidation and glycation occurs -> recruitment of monocytes to vessel wall, convert to macrophages with receptors for LDL -> LDL uptake = foam cell/fatty streak made

6

What cytokines are expressed by injured endothelial cells?

TNF, MCP

7

How do fibrous plaques get made, in simple terms, in vessels?

endothelial injury -> leads to foam cell/fatty streaks -> lead to fibrous plaques

8

T/F: When smooth muscles cells migrate to the adventitia and proliferate, thus creates a fibrous plaque.

false, they migrate to intima to do this

9

What site in the body has the highest frequency of atherosclerosis?

abdominal and iliac arteries, then proximal coronary arteries second

10

T/F: MCA atherosclerosis is more common than thoracic aorta atherosclerosis.

false

1) abdominal/iliac arteries
2) proximal coronary arteries
3) thoracic aorta, femoral, and popliteal arteries
4) internal carotid arteries
5) vertebral, basilar, and MCA arteries

11

At what percentage of lesion diameter is resting coronary flow impacted? What about max coronary flow?

resting flow: impacted at 80% lesion diameter

max flow: impacted at 50% lesion diameter

12

What are some signs/symptoms of CAD?

pressure, tightness, heaviness, crushing, feeling of doom, elephant on chest, levine's sign (clenched fist over sternum)

13

What can occur with CAD?

sudden cardiac death, unstable angina, MI

14

Which of the following is NOT an associated sign of CAD?
a) dyspnea
b) diaphoresis
c) feeling of pressure
d) nausea
e) cool/clammy skin
f) all are associated signs

C) feeling of pressure -> this is a primary symptom

15

Match each lipoprotein to their source:

a) Chylomicron 1) IDL
b) HDL 2) GI tract
c) LDL 3) Liver and GI tract
d) IDL 4) remnants of VLDL
e) VLDL 5) Liver

a) chylomicron = GI tract (2)
b) HDL = Liver and GI tract (3)
c) LDL = IDL (1)
d) IDL = remnants of VLDL (4)
e) VLDL = liver (5)


remember: liver -> VLDL -> IDL -> LDL

16

What molecule carries the most total cholesterol?

LDL

17

T/F: HDL consists largely of apo-protein B.

false, mostly apo-A

18

Which of these has the largest diameter? Which has the smallest?
a) IDL
b) LDL
c) HDL
d) VLDL
e) chylomicron

largest = chylomicron

smallest = HDL


HDL

19

T/F: LDL is made up of mostly apo-B-100

true:

LDL = 95% apo-B-100
HDL = 64% apo-A-1 and 20% apo-A-II

20

In which form, homozygous or heterozygous, does a gene defect cause the LDL level to be 6-8x the normal level, resulting in death in 20s from MI?

homozygous gene defect:
- causes lack of LDL receptors that makes LDL level 6-8x normal, resulting in death from MI

21

What occurs for people with the heterozygous form of the gene defect causing a lack of LDL receptors?

have 2-3x normal LDL, resulting in CHD symptoms in late 40s-50s

22

Which of the following is NOT a component of lipoproteins?
a) chylomicrons
b) triglyceride
c) phospholipid
d) apoprotein
e) cholesterol
f) all are components

A) chylomicrons are not components of lipoproteins

it's cholesterol, triglycerides, apoproteins, and phospholipids

23

T/F: Larger LDL particles with lower density carries more risk factors than smaller LDL particles with higher density.

false: smaller particles with high density carry more risk factors

24

T/F: Larger LDL particles with lower density carries more risk factors than smaller LDL particles with higher density.

false: smaller particles with high density carry more risk factors

25

T/F: The smaller the LDL size, the more likely diabetes develops.

true

26

What are desirable LDL and TC levels?

LDL

27

What are considered very high LDL and TC levels?

LDL > 190
TC > 500

28

T/F: High serum cholesterol levels were positively correlated with CHD death rate.

true

29

Which of the following interventions proved the most effective at lowering LDL?
a) surgery
b) sequestrins
c) diet
d) statins

surgery, followed by statins

30

Which of the following is not true about elevated TG?
a) is associated with remnants of TG-rich lipoproteins like VLDL and IDL
b) is NOT an independent risk factor for CAD
c) acute pancreatitis and skin xanthomas can be seen in hypertriglyceridemia
d) commonly associated with overweight, obesity, and physical inactivity
e) all the above are true

B) elevated TG IS an independent risk factor (initially thought not to be, but has been discovered as so)

31

T/F: Increase your TG levels, you increase your risk for heart disease.

true

32

What are xanthomas associated with?

hypertriglyceridemia

33

What is a normal level of TG?

34

What is considered borderline high TG?

150-199 = borderline high

high = 200-449
v high = >500


35

T/F: raising HDL reduces your risk for CHD.

true

36

What values indicate high and low HDL?

high = 60
low = 40

37

What level of HDL is a risk factor for metabolic syndrome in women?

38

Which of the following isn't true about HDL:
a) HDL 60
e) all are true

C) HDL3 actually increases with drinking, so drink awayyyyyy the sorrows of this effing class

39

T/F: Even if LDL-C is low (yay), a decreasing or low HDL value is still an independent predictor of CHD risk.

true: no matter if LDL is low or not, if HDL is low, that's not good for you

40

A ratio for total-c / HDL- c that is over 4 indicates what?

baaaad ratio, too much total-c and not enough HDL-c; risk significantly higher
- ratio decreases as you increase HDL :)

41

Why is HDL so good, what does it do?

prevents peripheral accumulation of cholesterol
- minimizes LDL oxidation so macrophages don't get it
- decreases expression of adhesion molecules to reduce macrophage attraction

42

What are the 3 factors that recruit leukocytes? ...which then allow for increased uptake of LDL :(

- chemoattractant nature of LDL
- expression of cytokines by injured endothelial cells
- expression of cell adhesion molecules

43

Which of the following is NOT a way that HDL can act antiatherogenically?
a) antioxidant effects on LDL
b) inhibition of adhesion molecule expression
c) prostacyclin stabilization
d) allowing platelet activation
e) promotion of NO production
d) all are correct

D) HDL actually inhibits platelet activation

- does stuff that reduces macrophage activity (first two options) and also vasodilates/unclogs (last 3 options)

44

T/F: An inverse correlation between body weight and HDL-c is consistently observed in BOTH men and women.

true

45

For every 3 pounds of weight loss, how much is HDL increased?

1 mg/dL

46

What kind of exercise increases HDL in a dose-dependent manner?

aerobic

47

T/F: Regular exercise increases HDL level, and there's a clear dose-response relationship there.

true

48

After how long of smoking cessation does it take for HDL levels to return to normal?

30-60 days

49

What does CETP do?

distributes cholesterol and TG btwn lipoproteins
- bad guy

50

Inhibition of CETP by what drug can lead to an increase in HDL and decrease in LDL/VLDL?

torcetrapib

51

What does HDL do?

carries cholesterol to the liver

52

What did inhibiting CETP by JTT-705 do in cholesterol fed rabbits?

decreased aortic atherosclerosis

53

What two things can inhibit CETP?

torcetrapib and JTT-705

54

T/F: A significant favorable effect was found for CETP inhibitor in atherroma volume. (when taken with a statin)

false, no significant effect found and actually BP slightly increased

- these people took statins + CETP to see if that would help increase HDL even more

55

Which of the following is NOT true about smoking?
a) #1 cause of preventable death in US
b) responsible for 80-90% of COPD death
c) responsible for 90% lung cancer death
d) 2 or more packs a day leads to 4x coronary events vs non smokers
e) over one half of total death in US is due to smoking

E) only 1/3 of total death in US is due to smoking

STILL HUGE

56

How many deaths are attributed to smoking each year?

443,000

with lung cancer being the most common dx, then ischemic heart disease, then COPD

57

What does nicotine do to the nervous system?

- stimulates SNS with increasing epi/norepi
- increases BP and vasoconstriction of peripheral vessels

58

Which of the following is NOT true about the pathophysiological effects of smoking?
a) 5x increase in HbCO vs nonsmokers (losing Hb)
b) carbon monoxide binds to Hb, myoglobin, and cytochrome oxidase
c) shift of HbO2 dissociation curve to the R
d) compensatory response of increased Hb
e) increase in platelet aggregation

C) the dissociation curve shifts to the LEFT


all else is true: smoking helps clots form

59

What is "hard CHD"?

MI + CHD death

60

What are the 3 risk categories for smokers?

high risk: from established CHD/CHD equivalents
mod high risk: multiple risk factors (2 or more)
Low risk: 0-1 risk factors

61

Which diet therapy is more stringent for those trying to lower TLC: primary or secondary prevention with diet?

secondary prevention is more stringent: only

62

What are HMG=CoA reductase inhibitors? What do they do?

statins
- they inhibit activity of HMG-CoA reductase to decrease cholesterol synthesis
- results in decreased LDL in circulation

63

Which of the following is NOT a lipid risk factor?
a) increased LDL
b) increased small, dense LDL
c) increase in apo A
d) decreased HDL
e) increased Lp (A)
f) reduction in apo A-1
g) all are lipid risk factors

C) increase in apo B, not apo A, is a lipid risk factor

- apo A is HDL, so if apo A increased that would actually be good
- reducing apo-A is bad, less HDL

64

What drugs decrease recirculation of bile salts via enterohepatic circulation?

bile acid sequestrants

65

What drugs inhibit the activity of HMG-CoA reductase to reduce the synthesis of cholesterol in the blood?

statins

66

What drugs reduce intrahepatic cholesterol, which causes an increased expression of LDL receptors, thus causing a decrease in circulating LDL?

bile acid sequestrants
- Cholestyramine (LoCholest, Questran, Prevalite)
- Colestipol (Colestid)

67

What water soluble B complex vitamin inhibits lipolysis in adipose tissue, thus decreasing synth of VLDL and lowers LDL/TG but increases HDL?

nicotinic acid (niacin)
- reduction in hepatic synthesis of Apo-B proteins

68

Which of the following is NOT true with exercise?
a) lipoprotein lipase activity decreases with exercise
b) LCAT enzyme activity increases with exercise
c) LCAT esterifies free cholesterol to HDL2, helping in transport to the liver
d) lipoprotein lipase activity promotes breakdown of TG, VLDL, and chylomicrons

A) -> lipoprotein lipase activity INCREASES, b/c lipoprotein lipase is a good guy and breaks down TG and chylomicrons

69

A score of what on the Fagerstrom test for nicotine dependence indicates a high degree of dependence?

7 or greater on fagerstrom test = high nicotine dependence

70

What is important to consider when minimizing nicotine withdrawal?

gradual nicotine tapering

71

What options are there for nicotine receptor agonist drugs?

- nicotine patch
- polacrilex (nicorette)
- nasal spray

72

What's the biggest nicotine withdrawal symptom most face?

anxiety, closely followed by irritability/anger

73

T/F: Over 3/4ths of people quitting experience weight gain

true, actually 90% do
- women more than men, appears from calorie intake