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LIPIDS PHARMACOLOGY Flashcards

(61 cards)

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1
Q

Complexes for transporting lipids

A

Lipoproteins

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2
Q

Sources of lipids

A

Exogenous
Endogenous

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3
Q

Storage site for triglycerides

A

Adipocytes

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4
Q

Dietary TGs are packaged as….

A

Chylomicrons

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5
Q

Endogenous TGs are packaged into……….

A

VLDL

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6
Q

Transporter for GI uptake of TGs

A

Nieman-Pick C1 Like 1 (NPLC1L1)

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7
Q

Function of HMG-CoA reductase

A

Reduces HMG CoA to mevalonate

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8
Q

Lipoproteins in terms of increasing density

A

HDL
LDL
IDL
VLDL
Chylomicrons

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9
Q

Source of LDL

A

When VLDL becomes dense after action of Lipoprotein lipase

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10
Q

Function of HDL

A

Reverse cholesterol transport
From peripheral tissues to liver

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11
Q

Transporter and apoprotein of reverse cholesterol transport

A

ABCA1 transporter
apo A1

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12
Q

Classes of hyperlpidemia

A

Primary (inherited/genetic)
Secondary (acquired)

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13
Q

Examples of primary dyslipidaemias

A

Familial hypertriglyceridemia
Familial hypercholesterolemia
Familial combined hyperlipidemia
Familial hyperapobetalipoprotein

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14
Q

Familial hypercholesterolemia

A

LDL receptor defect
Apo B receptor defect
Reduced LDL clearance or uptake
High levels of LDLc
Normal TGs

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14
Q

Familial hypertriglyceridemia

A

Mutated LPL gene
Endogenous overproduction of VLDL
High TGs and low HDL

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15
Q

Familial hyperapobetalipoprotein (Broad beta disease)

A

Defects in ApoE gene
Reduced clearance of chylomicrons, IDL and beta VLDL
High total cholesterol and TGs

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16
Q

Familial combined hyperlipidemia

A

Most common type
No single gene defect responsible
High LDL and TGs

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17
Q

Disease conditions that can cause dyslipidemia

A

Type 2 DM
CKD
Hypothyroidism
Polycystic ovary disease

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18
Q

Role of thyroid hormones in lipids

A

TH stimulates both lipogenesis and lipolysis, although when TH levels are elevated, the net effect is fat loss

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19
Q

Therapeutic options for dyslipidemia

A

Bile acid resins
Ezetemibe
Statins
Fibrates
Nicotinic acid derivatives
Fish oil derivatives (EPA, DHA)
Orlistat
PCSK9 inhibitors

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20
Q

Bile acid binding resins

A

Cholestyramine
Colesevelam
Colestipol

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21
Q

Which enzyme is upregulated by bile acid binding resins

A

7 alpha hydroxylase

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22
Q

Function of 7 alpha hydroxylase

A

Biosynthesis of bile acids from cholesterol

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23
Q

Effects of bile acid binding resins on lipid profile

A

Reduce LDL
No effect on HDL
Increase TGs

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24
Side effects of bile acid sequestrants
Constipation Diarrhea Bloating Dyspepsia Reduced absorption of fat soluble vitamins Reduced absorption of some drugs (digoxin, warfarin)
25
Contraindication to bile acid binding resins
Biliary and bowel obstruction disorders
26
Ezetimibe mechanism
Inhibits cholesterol absorption by blocking NPC1L1 transporter
27
Effect of statins on lipid profile
Reduce LDL Reduce TGs Increase HDL
28
Use of statins with these lipid lowering agents increases risk of adverse effects
Fibrates Niacin
29
Most potent statins
Atorvastatin Rosuvastatin
30
Least potent statin
Fluvastatin`
31
Long acting statins
Pravastatin Rosuvastatin Atorvastatin
32
Short acting statins
Lovastatin Simvastatin
33
Which statins are not metabolised throug Cyp 450 pathway
Rosuvastatin Pravastatin
34
Adverse effects of statins
GI disturbances Increased liver enzymes Insomnia Rash Rhabdomyolysis Myositis
35
Examples of fibrates
Bezafibrate Fenofibrate Gemfibrozil Clofibrate
36
Effects of fibrates on lipid profile
Reduce VLDL Reduce TGs Reduce LDL Increase HDL
37
Mechanism of fibrates
Agonists at PPAR-alpha Increase transcription of genes for LPL, apoA1 and apoA5 Stimulate beta oxidation of fatty acids Inhibit NF-Kb
38
Clinical use of fibrates
Hypertriglyceridemia Mixed dyslipidemia Dysbetalipoproteinemia
39
Which agent is preferred in dysbetalipoproteinemia
Fibrates
40
Adverse effects of fibrates
GI symptoms Pruritis Rash Myositis Rhabdomyolysis AKI
41
How do statins and fibrates cause AKI
Myoglobin infiltration
42
How do fibrates cause cholelithiasis
Increasing secretion of cholesterol into bile acids
43
Contraindications of fibrates
Gallbladder disease Impaired renal function
44
Which fibrate has a better safety profile
Fenofibrate
45
Mechanism of nicotinic acid derivatives
Activates HM74A receptor Inhibit TG production and VLDL secretion Increase half life of apoA1
46
Effect of nicotinic acid derivaties on lipid profile
Reduce TGs Reduce LDL Increase HDL
47
Effect of activation of HM74A receptor
Inhibits lipolysis Reduces flux of FFAs to the liver
48
Examples of nicotinic acid derivatives
Niacin Acipimox
49
Adverse effect of nicotinic acid derivatives (NAD)
Cutaneous flushing Pruritis Palpitations GI distrubances Hyperuricemia Impaired insulin sensitivity Hepatotoxicity
50
Contraindication to nicotinic acid derivatives
Active peptic ulcer disease Caution in gout
51
How do nicotinic acid derivatives cause cutaneous flushing
Release of PGD2 AND PGE2 in the skin
52
How is cutaneous flushing due to nicotinic acid derivatives treated
Aspirin 30minutes before taking the nicotinic acid derivatives
53
Examples of omega-3 fatty acids
Eicosapentanoic acid EPA Docosahexanoic acid DHA
54
Effect of fish oils on lipid profile
Reduce TGs Some studies show increase in LDL but not conclusive
55
Mechanism of orlistat
Inhibits pancreatic and intestinal lipase activity
56
Mechanism of lomitapide
Inhibits microsomal triglyceride transfer protein (MTP) hinders producing lipoproteins that contain apo-B in the hepatocytes and the enterocytes and leads to a decrease in generating very-low-density lipoprotein (VLDL) and chylomicrons
57
Role of microsomal triglyceride transfer protein (MTP)
Transfers lipids (TGs, cholesteryl esters, and phosphatidylcholine) into apoB-containing lipoproteins such as very-low-density lipoprotein (VLDL) particles originating from the liver. Transfers lipids to chylomicrons originating from the intestine
58
Effect of lomitapide on lipid profile
Reduce LDL
59
Examples of PCSK9 inhibitors
Alirocumab Evolocumab
60
Role of PCSK9
Proprotein convertase subtilisin kexin 9 (PCSK9) is involved in LDL receptor regulation PCSK9 is a protease that degrades the LDL receptor, thereby regulating its expression

LIPIDS (3 decks)

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