Flashcards in Chap 27 Smoking Deck (18):
List mechanism of adverse CV effects caused by smoking.
endothelial cell damage
increased PLT and leukocyte adhesion to endothelial cells
impaired NO bioavailability causing abnormal vasomotor tone
increased total and LDL cholesterol
increase PLT aggregation, fibrinogen, TF, blood viscosity
increased HR, BP, myocardial O2 demand
Name different smoking cessation therapies.
buproprion (atypical anti-D)
Varenicline (champix, nicotinic acetylcholine receptor partial agonist)
Which treatments are prove to work for smoking cessation?
all of them
What are clinical effects of DM?
Increases risk of CAD and those with CAD and DM have worse outcome
Clinically evident CAD earlier
Increased risk of PAD
Increase incidence and severity of limb ischemia
More distal arteries involved in PAD
Most common cause of non-traumatic extremity amputation
How does DM lead to athero?
DM leads to
Hyperglycemia, free fatty acids, insulin resistance
These then leade to oxidative stress, protein kinase C activation and RAGE activation
This leads to
increase vasoC (htn, SMC growth)
thrombosis (plt activation)
What are non-pharmocological methods used to reduce cholesterols levels.
What are pharmocological methods used to reduce cholesterols levels?
Bile acid sequestrants
omega-3 fatty acids
How do statins work? What are their SE?
HMC-CoA reductase inhibitors
inhibites HMG-CoA reductase which is an enzyme that produces mevalonate which is the next step in the production of cholesterol.
hepatic injury rare
How does niacin work? what is its side effects?
nicotinic acid/vit B13
binds to receptors and inhibit cAMP production which decrease fat breakdown in adipose tissue and free fatty acids available for TG and VLDL production
dyspepsia, liver toxicity
How does fibrate work? what is its side effects?
peroxisome proliferators receptor-alpha agonist
activates pathways that increase lipolysis and elimination of TG from plasma
myopathy, hepatotxicity, nephrotoxicity
How do bile acid sequestrates work? what is its side effects?
binds to components of bile in GI tract and prevent from entering hepatic circulation. Liver then sequesters cholesterol to make bile reducing circulating volumes.
constipation, diarrhea, flatulence
How does ezetimibe work? what is its side effects?
interferes with absorption of cholesterol from the GI tract
How does HTN lead to atherosclerosis?
cause endothelial dysfunction
which causes reduction in NO
this leads to decrease vasod, increased inflammation, increase coagulation
What are non pharm methods to reduce BP?
weight loss, sodium restrictin, aerobic activity
limiting alcohol intake 1-2 servings daily
What are recommendation for BP control?
130/80 if CKD or DM
What are recommendation for DM control?
HGB A1C <7%
What are recommendation for lipid control?
all PAD LDL <70