Hyperlipidaemia and therapeutic approaches

Question 1

Hyperlipidaemia

Answer 1

high LDL cholesterols

Question 2

Dyslipidaemia

Answer 2

High levels of HDL-cholesterol

Question 3

Chylomicrons

Answer 3

Transport TGs/cholesterol from intestine via lymph to blood

Question 4

VLDL

Answer 4

High TG content, lipoprotein lipase converts VLDL Tis to FFA

Question 5

LDL

Answer 5

high cholesterol content

Question 6

Hypercholesterolemia

Answer 6

Elevated LDL-c

Question 7

Lipid functions

Answer 7

Energy storage
Intracellular signalling
Base for steroid hormone synthesis 
vit D synthesis 
Insulation

Question 8

Triglycerides

Answer 8

Glycerol backbone with 3x FFAs

Excess calories converted to Tis and transpired to fat cells for storage

Question 9

Cholesterol

Answer 9

Steroid alcohol found in animal tissues
Mainly synthesised in liver
precursor of steroids, bile acids and vit D
Maintains cell membranes

Question 10

Lipoproteins

Answer 10

Bind lipids and facilitate transport in water

Cell surface receptors are different for different apolipoproteins

Question 11

Function of low cholesterol lipoproteins

Answer 11

Deliver endogenous TAG to peripheral tissues

Question 12

Optimal levels of LDL-c

Answer 12

<1.8mmol/L

Question 13

Optimal levels of cholesterol

Answer 13

<4.4mmol/L

Question 14

Optimal levels of triglycerides

Answer 14

<1.1mol/L

Question 15

Causes of primary dyslipidaemias

Answer 15

• Genetic mutations
• Familial hypercholesterolemia most common
• Typically presents in children

Question 16

Causes of secondary dyslipidaemias

Answer 16

• Diet
• Obesity
• Diabetes
• Hypothyroidism
• Alcohol
• CKD
• Drugs

Question 17

Management of dyslipidaemias

Answer 17

• Lifestyle - reduce total and saturated fat intake, weight loss, exercise
• Statins: HMG-COA reductase inhibitors
• Secondary pt first-line treatment is lifestyle changes
• Plant sterols (stop body absorbing cholesterol) lower LDL-C and increase HDL-C

Question 18

Statins MOA

Answer 18

HMG-coA reductase inhibitors (important in cholesterol synthesis)

Question 19

Side effects of statins

Answer 19

Kidney problems
Muscle degeneration and ache
Paraesthesia

Question 20

PCSK9

Answer 20

Proprotein convertase subtilise/kexin type 9
Binds LDL for degeneration in lysosomes
Determines LDL-c concentration
This needs to be inhibited to allow LDL to be taken up from blood

Question 21

Ezetimibe

Answer 21

Impairs intestinal uptake of dietary and bile conjugated cholesterol
Used as add on to statins

Question 22

Side effects ezetimibe

Answer 22

Fatty stools

Question 23

Statin target organ

Answer 23

Liver

Question 24

Statin MOA

Answer 24

Inhibit HMG COA - involved in cholesterol synthesis

This causes liver cells to make more LDL receptors = increased clearance of LDL from blood stream

Question 25

Side effects statins

Answer 25

Muscular side effects and GI disturbances

Question 26

Ezetimibe target organ

Answer 26

GI tract

Question 27

MOA ezetimibe

Answer 27

Selective cholesterol absorption inhibitor - inhibits cholesterol at brush border at small intestine Increases LDL cholesterol uptake into cells = decreased blood levels

Question 28

Ezetimibe side effects

Answer 28

Fatigue, diarrhoea, abdo pain

Question 29

Colestyramine target organ

Answer 29

GI tract

Question 30

Colestyramine MOA

Answer 30

Binding bile acids, reducing reabsorption which reduces conversion of cholesterol into bile acids

Question 31

Colestyramine side effects

Answer 31

Intestinal obstruction and acidosis

Question 32

Fibrates MOA

Answer 32

Activate PPAR to break down triglycerides

Question 33

Fibrates side effects

Answer 33

Myositis-like syndrome if renal function impaired

Question 34

Nicotinic acid MOA

Answer 34

Reduces production of TGs and VLDL which are converted to LDL in blood

Question 35

Side effects nicotinic acid

Answer 35

vasodilatation - skin flushing

Question 36

methylcellulose MOA

Answer 36

Attracts water into colon = softer and bulkier stool | Swelling ins Atomach = reducing hunger