CVS 5

Question 1

Cardiovsacular disease is associated with increased LDL and decrease HDL. TRUE OR FALSE?

Answer 1

TRUE

Question 2

Nmae the three types of Hyperlipidemia’s?

Answer 2

• Hypercholesteridemia
• Hypertriglyceridemia
• Mixed hyperlipidemia

Question 3

Lowering LDL/HDL decreases risks of athesclerosis. TRUE OR FALSE?

Answer 3

TRUE

Question 4

List the following in increasing protein and lipid ratio (LDL,HDL,VLDL,chylomicrons?

Answer 4

• Chylomicrons
• VLDL
• LDL
• HDL

Question 5

Hyperlipidemia can be caused by genetic compenets or by diet. TRUE OR FALSE?

Answer 5

TRUE

Question 6

How do you manage hyperlipidemia?

Answer 6

• stop smoking (reduces risks of coronary heart disease)
• diet and diabetes management
• lifestyle changes before pharmacological intervention

Question 7

What are the two types of pharmacological intervention iwith hyperlipidemia managemnt?

Answer 7

• Primary prevention - treatment before clinical eveidence of disease e.g if patient has had history of high cholesterol levels
• Secondary prevention - after clinical evidence of the disease - try to signficantly reduce risks of M.I

Question 8

statins inhibit the enzyme HMGCR. true or false?

Answer 8

TRUE

Question 9

how many carbons does HMGCoA have?

Answer 9

6 carbons

Question 10

Statins inhibit HMGCR enzyme. true or false?

Answer 10

true

Question 11

the cholesterol synthesis pathway is dependent upon the amount of cholesterol in a patients body. true or false?

Answer 11

true

Question 12

if cholesterol is high in a patients body the cholesterol synthesis pathway is turned off and vice versa through the SREBP transcription factor. true or false?

Answer 12

true

Question 13

what are statins indicated for?

Answer 13

• Stroke

- Coronary heart disease

Question 14

How do statins work?

Answer 14

• Inhibit cholesterol synthesis

Question 15

Name a statin that is a pro-drug and is metabolised by CYP3A4?

Answer 15

Simvastatin

Question 16

Name a statin with a half life of 14hr and is metabolised by CYP3A4?

Answer 16

• Atorvastatin

Question 17

What is the dominant site of action of statins?

Answer 17

The liver

Question 18

Which statin are not metabolised by CYps?

Answer 18

• Rosuvastatin

- Pravastatin

Question 19

What are some ADRs of statins?

Answer 19

• Generally well tolerated but patients are at risk of myopathy

Question 20

What are some interactions of statins?

Answer 20

• affects drugs affecting CYP P450 enzymes

Question 21

what are bile acid binding resins indicated for?

Answer 21

• For patients which statins on own is insufficient

Question 22

what is the mechanism of action for bile acid binding resins?

Answer 22

• Positively charged resin binds negatively charged bile
  ↓decreased re-absorbtionbile (enterohepaticrecirc.)→↑excretion–↑bile synthesis →↓liver cholesterol →↑LDL receptor expression → ↓plasma cholesterol

Question 23

bile acid binding resin is insoluble in water. true or flase?

Answer 23

true

Question 24

bile acid binding resin decreases LDL by 30% true or false?

Answer 24

true

Question 25

Bile acid binding resin also bind vitamin A,D AND K therefore supplements of these are neccesary. TRUE OR FALSE?

Answer 25

TRUE

Question 26

What are inhibitors of cholesterol absorption indicated for?

Answer 26

- Hypercholesteronmia | - Or with statin or if statin not good on own

Question 27

What is the mechanism of action of cholesterol absorption inhibitors?

Answer 27

- Inhibit transport of cholesterol across intestinal brush border

Question 28

Provide a drug name for cholesterol absoprtion inhibitors?

Answer 28

- Ezetimibe

Question 29

Cholestrol absorption inhibitors also reduce cholestrol in chylomicrons. TRUE OR FALASE?

Answer 29

TRUE

Question 30

Why do cholestrol absorption inhibitors have long half lives?

Answer 30

- because they undergo constant enterohepatic recirculation

Question 31

What are some interactions of cholestrol absoprtion inhibtors?

Answer 31

- They plasma concentration increases with fibrates

Question 32

How do fibrates work?

Answer 32

- activates the PPARa transcription factor - which decreases triglycerides - Lowering LDL

Question 33

What are fibrates indicated for?

Answer 33

- Hypercholesterimia | - Hypertriglyceridpedimia

Question 34

what are the cautins for fibrates?

Answer 34

- They cause myotoxicity especially in patients with renal disease

Question 35

Fibrates are excreted in urine as glucorinode conjugates. TRUE OR FALSE?

Answer 35

TRUE

Question 36

What are some ADRs of fibrates?

Answer 36

- Cause GI disturbances | - Myopathy

Question 37

How do PCSK9 inhibitors work?

Answer 37

- They increase expression of LDL-R | - which leads to an increase in the LDL clearance

Question 38

What is nicotinic acid indicated for?

Answer 38

- Hyperlipidemia | - Hyperglycemia

Question 39

How doe nicotinic acid work?

Answer 39

- Increase HDL by decreasing lipolysis in adipose tissue | - Leads to decrease in VLDL, LDL and triglycerides

Question 40

Give a drug name for nicotinic acid?

Answer 40

- Niacin

Question 41

What are some ADRs of nicotinic acid?

Answer 41

- Can lead to diabetes | - Hyperurecemia - decrease in uric acid secretion leading to gout

Question 42

Niacin increases risk of bleeding. TRUE OR FALSE?

Answer 42

TRUE

Question 43

Omega-3-fatty acid are known to decrease triglyceride synthesis. TRUE OR FALSE?

Answer 43

TRUE

Question 44

What are two fish oil types?

Answer 44

- EPA | - DHA

Question 45

what is necrosis?

Answer 45

- Cell death but with leakage

Question 46

How does an atherosclerosis plaque start to build up?

Answer 46

- LDL have a long half life and are full of cholesterol (means that they can stay for a long time) - They can bind to proteio glycans - LDL becomes oxidised - Get recognised by macropahses - Macrophageases ingest them - Forming - foam cells and causing necrosis - This grows further and starts to occlude the arteries