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Pharm Exam 2 > 20 - Antihyperlipidemics > Flashcards

20 - Antihyperlipidemics Flashcards

1
Q

most dense =

A

HDL

the least dense would be a chylomicron

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2
Q

dietary triglycerides and cholesteryl esters

A

chylomicron

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3
Q

endogenous triglycerides and cholesteryl esters

A

VLDL

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4
Q

cholesteryl esters and endogenous triglycerides

A

IDL

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5
Q

apoprtns associated with chylomicron

A

B-48
C
E
A

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6
Q

apoprtns associated with VLDL

A

C
B-100
E

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7
Q

apoprtns associated with LDL

A

B-100

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8
Q

apoprtns associated with HDL

A 
A-I
A-II
C
E
D
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9
Q

3 roles of lipoprtns

A
  1. serve as cofactors for enzymes involved in lipoprtn metabolism
  2. serve as ligands for receptors
  3. structual stabillity of lipoprtns
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10
Q

Chylomicron metabolism

A
  1. nascent TAG rich chylomicrons with apoB48 leave the small intestine
  2. Apo C and Apo E added to chylomicron from HDL
  3. lipoprtn lipase degrades TAG in CM at adipose tissue
  4. Apoc C is returned to HDL
  5. CE rick CM remnant bind through apoE to receptors on liver where endocytosed
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11
Q

what activates lipoprtn lipase?

A

apo C

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12
Q

metabolism of hepatic origin lipoprtns

A
  1. liver secretes nascent TAG rich VLDLs with Apo B100
  2. Apo C and Apo E transferred to VLDL from HDL
  3. Liportn lipase activated by apoC degrades TAG in VLDL
  4. Apo C and Apo E returned to HDL (NOW AN IDL)
  5. LDL binds to specific receptors and are endocytosed
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13
Q

the only place where cholesterol can be eliminated

A

liver

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14
Q

___ of bile acids/salts are excreted in feces daily

A

5%

95% reabsorbed and returned to liver

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15
Q

accepts excess cholesterol from peripheral tissues

A

HDL

HDL is transported to the liver where it binds to SRB1 through ApoA and CE are selectively delivered to hepatocytes

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16
Q

what enzyme turns a nascent HDL into a CE full mature HDL

A

LCAT

lecithin:cholesterol acyltransferase

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17
Q

what apoprtn activates LCAT

A

apoA-I

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18
Q

which apoprtn is a cofactor for lipoprtn lipase

A

Apo C-II

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19
Q

Major goals of clinical management of dyslipidemia

A
  • prevent acute pancreatitis
    (severe hypertriglyceridemia)
  • preventionof cardiovascular disease (reduce LDL reduces CVD risk)
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20
Q

cause primary chylomicronemia

A

decreased lipoprtn lipase activity

21
Q

manifestation primary chylomicronemia

A

increased chylomicrons/VLDL

22
Q

cause familial hypertriglyceridemia

A

impaired removal of VLDL and or chylomicrons

23
Q

manifestation of familial hypertriglyceridemia

A

increased VLDL and chylomicrons

24
Q

cause familial combined hyperliproteinemia

A

increased VLDL production and high conversion of VLDL to LDL

25
Q

manifestation of familial hyperlipoproteinemia

A

increased VLDL and LDL

26
Q

cause familial dysbetalipoproteinemia

A

decreased cleareance of VLDL IDL and chylomicron remnant because of a dysfunction or absence of apoE

27
Q

manifestation of familial dybetalipoproteinemia

A

increased IDL and chylomicrons

28
Q

cause familal hypercholesterolemia

A

LDLR impairments, high fat diet, inactivity

29
Q

manifestation of familial hypercholesterolemia

A

increased LDL

30
Q

cause familal ligand-defective apoB

A

mutation in apoB100 resulting in impaired endocytosis of LDL

31
Q

manifestation of familal ligand-defective apoB

A

increased LDL

32
Q

present in 20% of individuals who get coronary heart disease under 60

A

familial combined hyperlipidemia – liver overproduces VLDL

33
Q

MOA gemfibrozil and fenofibrate

A

PPAR actiavtor

  • decreases plasma triglycerides
  • increases plasma HDL (increased reverse cholesterol transport)
  • increased oxidation of fatty acids
34
Q

MOA cholestyramine
colestipol
colaevelam

A

bidn to bile acids and bile salts in the intestine

35
Q

effects of bile acid-binding resins

A

decreased LDL but increased TAG

36
Q

drug of choice to lower cholesterol in children and women who are pregnant or lactating

A

bile acid sequestrants

37
Q

side effects of bile acid binding resins

A

bloating and constipation

38
Q

how does niacin reduce both triglycerides and cholesterol?

A
  • reduces hormone sensitive lipase to reduce FFA in plasma –> decreased VLDL and LDL
  • also increases plasma HDL levels
39
Q

which enzyme does niacin target to decrease FFA?

A

hormone sensitive lipase

40
Q

side effect of niacin is reduced by what

A

flushing and itching can be reduced by pretreatment with NSAID

41
Q

what statin is safest to combine with niacin?

A

fluvastatin

highest risk is lovastatin

42
Q

inhibitor of cholesterol absorption

A

ezetimibe

blocks uptake of dietary cholesterol and reabsorption of cholesterol excreted in bile

43
Q

what enyme does ezetimibe target?

A

niemann-pick C1 like prtn

44
Q

most potent statins

A

atorvastatin and rosuvastatin

least = fluvastatin

45
Q

statins aka

A

HMG CoA reducatase inhibitors

decreases CE in cell, causing uptake of LDL from the blood

46
Q

indications for statins

A

elevated LDL
CVD
elevated CVD risk

47
Q

which drug would be used for treatement of primary chylomicronemmia?

A

fibrates: gemfibrozil or fenofibrate

would also be used for familial dysbetaliprotenemia

48
Q

what drugs would be used to treat familial ligand-defective apoB

A

statins or ezetimibe

Pharm Exam 2 (12 decks)

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