hyperlipidaemia and lipid lowering drugs

Question 1

what is the two function of cholesterol

Answer 1

-give cell rigidity (becomes a problem is cell is too rigid)
-importance component in bile acids which allows recirculation of cholesterol

Question 2

how is excess cholesterol excreted

Answer 2

trapped in GIT then excreted via faeces

Question 3

what are lipoproteins

Answer 3

breaks off proteins combining cholesterol

Question 4

what is the difference between high density (HDL) and low density lipoproteins (LDL)

Answer 4

HDL = has more protiens, mops up cholesterol from various organs and walls of arteries (slows athersceolosis)
LDL = deposits cholesterol into tissues

Question 5

what is the cause of primary dyslipidaemia

Answer 5

combination of dietary and genetic factors - familial hypercholesteolaemia

Question 6

what is the cause of of secondary dsylipidaemia

Answer 6

consequence of other condition
-diabetes melitius
-alcoholism
-renal disease

Question 7

what is the non-pharmacological treatment

Answer 7

-cardioprotective diet
-weight loss
-physical activity (increases HDL)
-decrease alcohol consumption
-smoking cessation

Question 8

when would pharmacological treatment be used to treat dyslipidaemia

Answer 8

-only if there is a history/family history of CV disease
-many risk factors
-poor lipid profile

Question 9

how many types of hyperlipidaemia are there

Answer 9

I, IIa, IIb, III, IV, V

Question 10

what types of hyperlipidaemia is chylomicrons levels elevated

Answer 10

Type I and Type V

Question 11

What type of hyperlipideamia is beta very low density lipoproteins elevated

Answer 11

Type III

Question 12

What type of hyperlipideamia is LDL elevated

Answer 12

Type IIa, IIb

Question 13

what is the difference between Type IIa and Tyoe IIb hyperlipidaemia

Answer 13

In both LDL is elevated, in IIb VLDL is elevated also

Question 14

which two types of hyperlipideamia has high atherosclerosis

Answer 14

IIa and IIb

Question 15

which type of hyperlipidaemia has the highest levels of triglycerides

Answer 15

Type I - Chylomicrons elevated

Question 16

which type of hyperlipideamia can be treated with statins

Answer 16

type IIa, IIb, V

Question 17

which type of hyperlipideamia can be treated with fibrates

Answer 17

IIb,III,IV,V

Question 18

which type of hyperlipideamia can be treated with ezetimibe

Answer 18

IIa

Question 19

which type of hyperlipideamia can be treated with nicotinic acid

Answer 19

IIb

Question 20

which type of hyperlipideamia can be treated with niacin & fish oil

Answer 20

V

Question 21

which type of hyperlipideamia isn’t treated with parmaceutical

Answer 21

Type I

Question 22

which type of hyperlipideamia has the highest levels of cholesterol

Answer 22

IIa, IIb, III

Question 23

What is familial hypercholesterolaemia (FH) and how is it caused

Answer 23

The reduction in receptor mediator clearance of LDL
Due to mutation of LDLR, APOB or PCSK9 gene
autosomal co-dominant

Question 24

what is the risk of developing FH

Answer 24

1/250

Question 25

what is the lipid profile of FH

Answer 25

elevated LDL, Cholesterol , triglycerides

Question 26

what are the physical signs of FH

Answer 26

-Cholesterol deposits in the eyes (Xanthelasmas) -white, blue or grey crescent shape made of lipid (fatty) deposits that curves around the outer edge of the cornea -tendon xanthomas - slowly enlarging subcutaneous nodules usually found attahced to the Achilles tendon/tendon over knuckles -homozygous also have planal digital and natal cleft, cutanous xanthomas, Aortic stenosis

Question 27

what is Niacin an example of

Answer 27

Nicotinic acid

Question 28

what is the effect of Niacin

Answer 28

- liver = decrease VLDL synthesis + decrease VLDL & LDL levels - Adipose = decrease sensitive lipase activity, decreased Triglycerides levels - Decrease catabolic rate of HDL - increases HDL - Increase clearance of VLDL by activating lipoprotein lipase

Question 29

what are the indications for niacin

Answer 29

Hypercholesterolaemia Hypertriglycidemia with low level of HDL

Question 30

what are the adverse effect of the nicotinic acid

Answer 30

Cutaneous flushing -Pruirtus & palpiattion -dose dependant nausea + abdominal discomfort - moderate incraese of liver enzymes to severe hepatoxicity -hyperuricemia in 20% of patients

Question 31

what decreases the adverse effects of Niacin

Answer 31

pretreatment with aspirin + NSAIDs

Question 32

how does ezetimibe work ?

Answer 32

-Inhibits intestinal absorption of cholesterol by interfering with Neimann-Pick C1-Like 1 (NPC1L1) transport protein -Decreases LDL and VLDL

Question 33

hows does Colestipol/Cholestyramine work and how is it administered

Answer 33

-Binds bile acid (BA) in gut, prevents reabsorption, diverting hepatic cholesterol to BA synthesis, upregulates LDL receptors -increasing LDL removal from the blood -orally as they stay in the GIT

Question 34

what are the adverse effects of Ezetimibe

Answer 34

diarrohoea, abdominal pain, headache (mild), rash, angioedema

Question 35

what are the adverse effects of Colestipol/Cholestyramine

Answer 35

constipation, bloating, malabsorption of Vitamin K/folic acid/ascorbic acid - disrupts absorption of digitalis, thiazides, warfarin and iron

Question 36

what are Colestipol/Cholestyramine's clinical uses

Answer 36

-primary hypercholesterolemia, when statins are contraindicated -pruitus associated with bilarily obstruction -bile acid diarrhoea

Question 37

who cant take ezetimibe

Answer 37

breastfeeding mothers

Question 38

which other lipid lowering drug is used with ezetimibe to treat hyperlipideamia

Answer 38

statins

Question 39

ezetimbe is metabolised into an active metabolites - true or false

Answer 39

true

Question 40

what is an example of a fibrate and what is the mechanism of action

Answer 40

Fenofibrate -agonist at peroxisome proliferator-activated receptor (PPAR-a) nuclear receptor that regulate lipid metabolism

Question 41

how does fibrates effects lipid metabolism

Answer 41

-increase synthesis of lipoprotein lipase by adipose tissue -stimulates fatty acid oxidation in liver -increase expression of apoA-1 & apoA5 -increase hepatic LDL uptake =Marked reduction circulating VLDL and TG Modest reduction in LDL

Question 42

what are the adverse effects of fibrates

Answer 42

Common = Rash, GI disturbance Rhabdomyolysis = smooth muscle degradation which causes renal failure by effecting glomerulus filtering Clofibrate may cause gall stones

Question 43

what are the clinical uses of fibrates

Answer 43

hypertriglyceridemia mixed hyperlipidaemia

Question 44

what types of patient cant take fibrates

Answer 44

-Allergies -Diabetes -people with Gall bladder, liver and kidneys conditions

Question 45

give an example of statins

Answer 45

atorvastatin (long acting), lovastatin (short acting)

Question 46

what is the mechanism of action for statins

Answer 46

-decrease synthesis of cholesterol (HMG CoA Reductase inhibitors) -increase uptake of LDL (secondary) by increases LDL receptor synthesis which incraeses clearance of LDL by the liver

Question 47

what is the cellular effect of statins

Answer 47

Endothelial function improves Improved vascularisation of ischaemic tissue Atherosclerotic plaque stabilisation Reduces vascular inflammatory response Reduced platelet activation Enhanced fibrinolysis Antithrombotic

Question 48

what are the adverse effects of statins

Answer 48

normally well tolerated may have muscle pain, GI disturbance, insomnia, rash Rarely myositis and angiodema

Question 49

when is statins not suitable

Answer 49

it patients have severe liver disease

Question 50

when are statins used (3)

Answer 50

-primary hyperlipidaemia -secondary hypercholesteroleamia -secondary prevention of MI and Stroke