Chapter 19: Cholesterol and Lipoprotein Synthesis Flashcards Preview

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Flashcards in Chapter 19: Cholesterol and Lipoprotein Synthesis Deck (21)
1

MOA of the "statins?" What is the result of administering?

Inhibit HMG-coA reductase (RL step in cholesterol synthesis)

Decrease in LDL, increase HDL, decrease triglycerides

2

What is the least potent statin?

Fluvastatin

3

What are the two most potent statins?

Atorvastatin & rosuvastatin

4

How does inhibiting cholesterol synthesis decrease LDL?

A decrease in cholesterol causes up regulation of LDL receptors (SREBP2) so they express more --> more uptake of cholesterol from the plasma

5

MOA of cholestyramine?

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

What are the first and second line treatments for lowering LDL? What are the effects (respectively) on triglycerides?

Statins
Bile acid absorption inhibitors (Cholestyramine, colesevelam, colestipol)

Stains decrease tryglycerides, but bile acid abs inhibitors INCREASE levels!

7

Ezetimibe MOA?

Decreases cholesterol transport form micelles into the enterocyte by inhibiting uptake through brush border protein NPC1L1

Modest LDL reduction

8

What should you use with ezetimibe? Why?

Use a statin to prevent compensatory cholesterol synthesis

9

What drugs increase ezetimibe levels?

cyclosporine & fibrates

10

Do not use ezetimibe in pts with ____??

active liver disease

persistently elevated liver fxn test (even when given w a statin)

11

How do fibrates work?

Agonists of PPAR alpha --> this will increase lipoprotein lipase --> increase FA uptake into cells and decrease plasma TGs

12

What are the fibrate drugs?

Gemfibrozil
Fenofibrate

13

Drug of choice for hypertriglyeridemia?

Fibrates

14

When combining a fibrate with a statin, what is there an increased risk of?

myopathy

15

Fibrates _____ warfarin levels?

increase

16

Niacin MOA?

Decreases hormone sensitive lipase in order to decrease FFAs going to the liver for TG synthesis

17

Niacin is the drug of choice for what?

Tx for low HDL

18

What is a side effect of niacin that occurs within the first few weeks of use? How can this be prevented?

Flushing

Pretreat with aspirin

19

Niacin does what to insulin sensitivity?

impairs

20

What omega-3-fatty-acids are used to tx hypertriglyceridemia?

Eicosapentaenoic acid
Docosehexanoic acid

21

How do omega 3 fatty acids lower TG levels?

regulate nuclear transcription factors (SREBP-1c and PPARalpha) to reduce TG synthesis