Chapter 19: Cholesterol and Lipoprotein Synthesis Flashcards Preview

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Flashcards in Chapter 19: Cholesterol and Lipoprotein Synthesis Deck (21)
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1
Q
MOA of the "statins?" What is the result of administering?
A
Inhibit HMG-coA reductase (RL step in cholesterol synthesis)

Decrease in LDL, increase HDL, decrease triglycerides
2
Q
What is the least potent statin?
A
Fluvastatin
3
Q
What are the two most potent statins?
A
Atorvastatin & rosuvastatin
4
Q
How does inhibiting cholesterol synthesis decrease LDL?
A
A decrease in cholesterol causes up regulation of LDL receptors (SREBP2) so they express more --> more uptake of cholesterol from the plasma
5
Q
MOA of cholestyramine?
A
Inhibits bile acid absorption - this prevents enterohepatic circulation of the bile acids --> causes more bile salts to be made --> cholesterol is then excreted more

LDL decreases
HDL increase
6
Q
What are the first and second line treatments for lowering LDL? What are the effects (respectively) on triglycerides?
A
Statins
Bile acid absorption inhibitors (Cholestyramine, colesevelam, colestipol)

Stains decrease tryglycerides, but bile acid abs inhibitors INCREASE levels!
7
Q
Ezetimibe MOA?
A
Decreases cholesterol transport form micelles into the enterocyte by inhibiting uptake through brush border protein NPC1L1

Modest LDL reduction
8
Q
What should you use with ezetimibe? Why?
A
Use a statin to prevent compensatory cholesterol synthesis
9
Q
What drugs increase ezetimibe levels?
A
cyclosporine & fibrates
10
Q
Do not use ezetimibe in pts with ____??
A
active liver disease

persistently elevated liver fxn test (even when given w a statin)
11
Q
How do fibrates work?
A
Agonists of PPAR alpha --> this will increase lipoprotein lipase --> increase FA uptake into cells and decrease plasma TGs
12
Q
What are the fibrate drugs?
A
Gemfibrozil
Fenofibrate
13
Q
Drug of choice for hypertriglyeridemia?
A
Fibrates
14
Q
When combining a fibrate with a statin, what is there an increased risk of?
A
myopathy
15
Q
Fibrates _____ warfarin levels?
A
increase
16
Q
Niacin MOA?
A
Decreases hormone sensitive lipase in order to decrease FFAs going to the liver for TG synthesis
17
Q
Niacin is the drug of choice for what?
A
Tx for low HDL
18
Q
What is a side effect of niacin that occurs within the first few weeks of use? How can this be prevented?
A
Flushing

Pretreat with aspirin
19
Q
Niacin does what to insulin sensitivity?
A
impairs
20
Q
What omega-3-fatty-acids are used to tx hypertriglyceridemia?
A
Eicosapentaenoic acid
Docosehexanoic acid
21
Q
How do omega 3 fatty acids lower TG levels?
A
regulate nuclear transcription factors (SREBP-1c and PPARalpha) to reduce TG synthesis