Cholesterol + Drugs + IHD Flashcards
(148 cards)
0
Q
Lateral portion of left ventricle is supplied by which artery?
A
Circumflex
1
Q
Anterior rounded section of a transverse cut heart is supplied by which artery?
A
left anterior descending
2
Q
posterior descending artery supplies which segment of the heart?
A
posterior flattened area
3
Q
LAD territory in the heart is where?
A
anterior 2/3 of heart
4
Q
The circumflex artery supplies which heart segment?
A
Lateral
5
Q
When does the myocardial blood usually flow?
A
during diastole
6
Q
which heart area is most susceptible to ischaemia?
A
subendocardial muscle
7
Q
additional oxygen supply to meet demand must be met by:
A
an increase in blood flow
8
Q
What is Laplace’s relationship?
A
ventricular wall stress is proportional to pressure and radius
inversely proportional to wall thickness
9
Q
Define Ischaemic heart disease
A
group of conditions where heart demand is not being supplied
10
Q
Is stable angina acute or chronic?
A
chronic
11
Q
Is unstable angina acute or chronic?
A
acute
12
Q
What prevents stenosis in initial stages of atherosclerosis?
A
vessel remodelling to accomodate
13
Q
How much percentage narrowing of a vessel do you need to get symptoms?
A
70%
14
Q
If a vessel has atherosclerosis, what else is impaired in the endothelium?
A
vasodilators
15
Q
Why do you get pain in Acute myocardial ischaemia?
A
no ATP = anaerobic resp = acidosis = products = stim the pain nerves
16
Q
Key features of unstable angina?
A
pain at rest, increasing in frequency
17
Q
Key feature in stable angina?
A
pain only upon exertion
18
Q
Acute plaque event happens when what tears and exposes what?
A
Fibrous cap tears and exposes tissue factor = thrombus
19
Q
if a thrombus starts, it’s it all or none?
A
Nope. It’s dynamic so there will be fibrinolysis too but the clotting may overtake and occlude the artery leading to infarction
20
Q
Most common cause of Sudden Cardiac Death?
A
arrhythmic cardiac arrest d/t ventricular fibrillation/tachycardia = no blood pumped out = drop dead
21
Q
Can the heart beat at 400-500 beats per minute?
A
YES. in Ventricular fibrillation. mind blown
22
Q
What is a mechanical mechanism for sudden cardiac death?
A
haemopericardium = tamponade (ECG is present but no CO)
23
Q
Do you always get an infarction with arrhythmic sudden cardiac death?
A
Not necessarily.
24
How long does it take to get irreversible myocite injury?
20-40 minutes of severe ischaemia
25
How long for MI to go transmural? where does it start?
up to 24 hours
26
99% cause of regional transmural MI is?
thrombosis post acute plaque event
27
Subendocardium get damaged in two shapes:
regional
| circumferential (not common)
28
What would you look for in MI diagnosis on ECG?
ST elevation MI
| Non-ST elevation MI
29
How many days can you detect CK-MB and Troponins in the blood post MI?
CK-MB: 2-3 days
| troponins: about 6 days
30
You usually die from complications of MI, they are: 3 things:
ventricular fibrillation = sudden death
cardiac failure
acute pulmonary oedema
31
What can be ruptured in MIs? WHen do they usually occur?
papillary muscles
| free wall of LV
32
Will a ventricular aneurysm risk bursting? what's so dangerous about them?
Not likely to burst, but dilation increases risk of thrombus formation d/t decreased flow blood
33
3 other causes of ischaemic heart disease?
thromboemboli
vasculitis
aortic dissection
34
4 None-coronary artery ischaemic heart disease
LV hypertrophy
rapid tachycardias
hypoxemia
shock
35
two surgical treatments for ischaemic heart disease?
stents
| coronary bypass
36
How is cholesterol transported in blood as?
lipoproteins (the carriers)
37
What is a waxy steroid metabolite found in cell membranes?
cholesterol
38
Chole- means?
Bile
39
stereos means?
solid
40
What is the principle sterol synthesized by animals?
Cholesterol. duh.
41
If the body is too hot or cold, what happens to cholesterol in the cell membrane?
Hot: fluidity/permeability increases too much
Cold: not fluid/permeable enough
42
What is the key component in vitamin D, steroid hormones and bile acids?
cholesterol
43
Name the 3 critical intermediates in cholesterol synthesis
HMG-CoA
Isoprene
Squalene
44
4 types of lipoproteins involved in cholesterol transport?
chylomicrons
VLDL
LDL
HDL
45
How does HMG-CoA reductase affect arteriosclerosis?
If it's hyperactive due to genetics, then you'll get more LDL cholesterol in blood
46
What is the genetic disease for increased cholesterol ?
Familial hypercholesterolaemia.
47
How many carbons in cholesterol ?
27
48
Which carbon is the OH on in cholesterol ?
3
49
describe cholesterol's relationship with water
it's amphiphilic. kinky.
50
Do plants make any cholesterol?
Nope. They have their own sterols
51
Where is VLDL cholesterol made?
liver
52
cholesterol in liver has 3 fates:
1. ester formation, stored as VLDL
2. bile (recycled usage)
3. membranes
53
how much percent is cholesterol in the animal cell membrane?
8%
54
Where does cholesterol fit in the cell membrane's Phospolipids?
In the cis-bond kink to decrease fluidity
55
What does cholesterol start off as?
Acetyl CoA
56
What has more energy? 1 ATP? or 1 NADPH?
NADPH yo.
57
Where in the cell is cholesterol made?
endoplasmic reticulum
58
What is ApoB-100?
protein that identifies LDL, attaches to receptor on liver
59
Lipoproteins have a phospholipid bilayer?
Naw. Monolayer!
60
HDL has what protein marker?
ApoA-I (HDL is good so it's number one!)
61
VLDL and LDL has what protein marker?
ApoB-100 (LDL is bad so it's b for bad)
62
what is the protein marker for chylomicrons and VLDL?
ApoC-II ( C for chylomicrons)
63
ApoC-II marks what?
Chylomicrons and VLDL
64
ApoA-I marks what?
HDL
65
Where do you find ApoC-II usually?
Outside of muscles to break down fat anuse it as energy
66
What's the cholesterol donor?
LDL
67
What's the cholesterol scavenger?
HDL
68
VLDL is created in liver, LDL is created?
In plasma from reminant chylomicrons
69
What and where does LCAT and ACAT enzymes come into play regarding cholesterol ?
LCAT - in plasma for HDL
| ACAT - liver for VLDL
70
What's in side LDL lipoprotein?
cholesterol ester, triacylglycerols, free cholesterol (no need to pay for them.)
71
HDL does what to macrophages?
prevents foam cell formation
72
What shape is Apo-AI
circular to make hydrophobic ring and round up cholesterol
73
How much percent does cardiovascular disease account for?
40%!
73
How much percent does cardiovascular disease account for?
40%!
74
3 kinds of dyslipidaemia are?
hypercholesterolaemia
hypertriglyceridaemia
mixed hyperlipidaemia
75
When are you considered high risk for hypercholesterolaemia?
>7.5mmol/L cholesterol
76
Is cholesterol important for hormones?
Yes. precursor to steroid hormones
77
Whats the first statin discovered called?
Mevastatin
78
What do all statins do?
inhibit HMG-CoA
| derease mevalonic acid
79
One dose of statin is great! TWO dose must double the effect right?
Nope.
80
What conditions to you use statins?
hypercholesterolaemia
| mixed hyperlipidaemia
81
How long does it take for effect of statins?
1-2 years or use
82
Grapefruit juice doesn't mix well with:
Statins
83
You need to be careful of these 3 things if you're taking statins cause they'll increase statin levels too much:
antibiotics
antifungals
fibrates
84
Common adverse effects of statins?
mild GI, headahce, insomnia, dizzy
85
When should you withhold statins? 3 scenarios:
infection
presurgery
post trauma
86
What drug binds bile acid to treat hypercholesterolaemia?
Resins like Cholestyramine
87
When should you give Resins if you have to give other drugs?
hours before or after resin
88
Whats Ezetimibe?
selective inhibition of cholesterol absorption in intestine via sterol transporter
89
does Ezetimibe affect bile acids, fat soluble vitamins, or cholesterol?
Cholesterol only, its like a cholesterol sniper.
90
Can you combine Ezitimibe?
Yes, like statins and other agents too
91
Which B-vitamin can you use to treat hypercholesterolaemia?
B3 - Niacin
92
What are some adverse effects of Niacin treatment for hypercholesterolaemia?
Flushing, vasodilation, hypotension, BUT tolerance develops
93
Would you use Niacin for hypercholesterolaemia alone?
Nope. Usually only in combos
94
What are fibrates used to treat?
Hypertriglyceridaemia
95
Gemfibrozil and fenofibrate are Hypertriglyceridaemia drugs, how do they work?
nuclear receptor agonistsm upregulate gene for lipoprotein lipase to lyse triglycerides in plasma
96
Are fibrates for Hypertriglyceridaemia first line?
Second line after dietary and lifestyle changes
97
Nausea, dry mouth, headache and rash are common side effects for which Hypertriglyceridaemia drug?
Fibrates
98
Can you treat Hypertriglyceridaemia with fish oils?
Yep.
99
What do you do if you have severe Hypertriglyceridaemia?
polytherapy: diet, fibrates, fish oils, statins, niacin, orlistat
100
What does decreased Q10 symptoms?
cardiac and skeletal muscle pain and complications
101
What's the good thing that statins block out?
Q10 production
102
how do statins work?
competitive inhibitors of HMG-CoA reductase
103
how do you get elevated circulatory LDL in terms of a genetic reason?
Failure of LDL receptors to take LDL from circulation
104
What is a xanthoma?
cholesterol deposits = yellow under skin
105
Familial Hypercholesterolemia is suspected if? 2 things.
family history of early MI
| >15mM choesterol
106
How do you treat Familial Hypercholesterolemia?
statins
107
What is mutated in Familial Hypercholesterolemia?
LDL receptor gene
108
In Familial Hypercholesterolemia, is it dominant or recessive?
Dominant
108
If you have Familial Hypercholesterolemia, what age can you get an MI?
mid twenties
108
Whats so important about the end product cholesteryl ester droplet after the cell takes in the LDL?
If provides feedback inhibition of HMG-CoA reductase
108
In Familial Hypercholesterolemia, what mechanism is messed up in the cholesterol production circuit?
HMG-CoA reductase is not inhibited and it just has a field day and over produces cholesterol
109
" Bro, I feel like my breast is being strangled."
"Dude, you have angina pectoris, go to the hospital."
110
What is variant angina?
coronary vasospasm at rest
| unknown mediator
111
Any coronary reserve with angina?
Nope. All used up.
112
General drugs classes to affect:
Preload
Afterload
Mycardium
Preload: Nitrates
Afterload: Ca2+ blockers
Myocardium: B-adrenoceptor/Ca2+ blockers (Ivabradine)
113
How does nitrates decrease preload?
relaxes veins
114
how does nitrate decrease afterload?
relax large arteries
115
What's the short acting nitrate given for acute symptoms of angina?
GTN (glyceryl trinitrate)
116
How do you administer GTN?
sublingually or transdermally
117
What's finicky about GTN? 3 things:
light sensitive
needs to be in glass vial
1st pass metabolism
118
What's the longer acting nitrate given for angina? how is it administered?
isosorbide dinitrate orally
119
do you only take nitrates reactively?
You can take them proactively too.
120
Why would you get reflex tachycardia with nitrate use alone? what can you do about it?
Baroreflex activates due to decrease in BP. So combine with B-blockers or Ca2+ blockers
121
Nitrate and viagra is bad why?
Viagra is a phosphdiesterase inhibitor, breaks down cAMP and you'll get over cGMP production and could be fatal.
122
"I love GTN, I use it ALL the time Doc, that cool?"
"Bro, you're gonna develop tolerance, your tissues are thiol depleted, here's some N-acetyl cysteine, and take off the patch at night dummy."
123
What kind of channels do Ca2+ blockers block?
L-type channels
124
What drugs to block Ca2+ into heart?
verapamil
| diltiazem
125
What's nifedipine and felodipine used for?
block Ca2+ entry into vessels
126
What's verapamil
| diltiazem used to do?
block Ca2+ into heart
127
Drugs to block Ca2+ entry into vessels?
nifedipine and felodipine
128
Should you combine verapamil and nifedipine in severe angina?
NO WAY. never combine two cardio depressive agents. You can combine it with a B-blocker instead Dr. House.
129
How are Ca2+ blocker normally used? Reactively? or?
Prophylactically
130
What type of Beta adrenoceptors are blocked?
Beta-1 adrenoceptors
131
Two areas of the heart the beta blockers effect:
Nodes
| myocardium
132
Would you choose beta blockers or Ca2+ blockers for first line prophylaxis?
beta blockers
133
What is the selective beta-1 blocker?
atenolol
134
What's a non-selective beta blocker?
propranolol
135
"I'm on nitrates, Ca2+, and B-blockers Doc, my heart disease is a-ok right?"
"Actually those drugs aren't disease modifying, your risks of MI and mortality is exactly the same, you'll just be more comfortable before you drop dead."
136
Why is ivabradine so great?
'pure' heart rate reduction
137
selective inhibition of inward Na-K current in sinus node is done by which drug?
ivabradine
138
does ivabradine affect contractility, conduction, BP?
Nope. Just heart rate.
139
Why give ivabradine if it 'only' decreases heart rate?
It preserves endothelium-mediated vasodilation to there is improved exercise tolerance
140
What drug give you brightness in your visual field due to retinal effects?
ivabradine
141
Does ivabradine work if your HR is >70bpm?
Yes! only if it's <70 bpm!
142
What is drug is contraindicated in variant angina?
B-adrenoceptor antagonists cause it may worsen the vasospasm
143
How would you treat unstable angina?
Nitrate, Ca2+/B-blocker, and also aspirin
