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302 > Case of crash Dieter > Flashcards

Case of crash Dieter Flashcards

1
Q

lipoproteins?

A

lipid with amphipathic molecules surrounding (phospholipids) and apoliproteins so can float around in plasma

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2
Q

Classes of Lipoprotein?

A

chylomicron
VLDL
IDL
LDL
HDL

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3
Q

A1/2 role?

A

transfer of cholesterol from periphery to liver

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4
Q

endogenous lipid cycle in fasting ?

A

liver produces VLDL, which is broken down by lipoprotein lipase into free fatty acids and glycerol so IDL. then free fatty acids stored into fat tissue and the IDL is back in liver to be disposed of or moved into LDL to peripheral tissues

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5
Q

endogenous lipid cycle in fasting ?

A

liver produces VLDL, which is broken down by lipoprotein lipase into free fatty acids and glycerol so IDL. then free fatty acids stored into fat tissue and the IDL is back in liver to be disposed of or moved into LDL to peripheral tissues

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6
Q

role of the liver in endogenous?

A

triglyceride synthesis
export as VLDL
take up particles when triglyceride removed
LDL delivers cholesterol to peripheral cells

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7
Q

cholestrol is produced from?

A

acetate converted by HMG- CoA reductase

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8
Q

statins inhibit?

A

HMG coA reductase

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9
Q

when free cholesterol is low in cell?

A

N-SREBP transcription factor is switched on and the LDL receptor gene codes for LDL receptor protein

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10
Q

endogenous pathway, HDL particles produced from liver, what do they do?

A

absorb cholesterol from cells in the vascular endothelium and recycle it back to liver as LDL

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11
Q

exogenous pathway?

A

from dietary lipids- chylomicron particle are absorbed and broken down by lipoprotein lipase into free fatty acids and glycerol which then stored in adipose tissue

the remaining chylomicron is transported to liver

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12
Q

cholesterol and fatty acid in the gut are?

A

absorbed into intestinal mucosa cells and the reesterified to cholestrol ester and triglyceride and packaged with phospholipids and lipoproteins. they are then secreted into lymphatic vessels as chylomicrons

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13
Q

what happens to glycerol?

A

it is processed in liver to form more triglycerides or converted to glucose

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14
Q

what happens to the chylomicron remenant?

A

taken up by LDL receptors in liver

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15
Q

hepatic lipase features?

A

no cofactor,
substrate is IDL, HDL and LDL
present in liver, adrenal and endocrine

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16
Q

lipoprotein lipase features?

A

cofactor- ApoCII
substrate- CM and VLDL
tissues- adipose and skeletal muscle
regulation in feeding fasting and exercise

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17
Q

normal serum lipid concentration?

A

should be less than 5mmol/L

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18
Q

upper limit of normality for fasting triglycerides?

A

1.7mmol/L

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19
Q

HDL levels

A

above 0.9 mmol/l in men and 1.2 mmol/l

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20
Q

FH?

A

autosomal dominant disorder of lipid metabolism, usually hetereogenous
occurs in 1 in 270 people, raised cholestrol specifically LDL cholestrol

tendon and skin xanthomata

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21
Q

pathognomic for hypercholesterolaemia?

A

corneal arcus before age of 40

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22
Q

mutations of FH found?

A

ApoB
PCSK9
LDLR

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23
Q

causes of hypertriglyceridaemia?

A

obesity, DM, excess alcohol, renal failure, gout, drug treatment, thiazides, beta blockersm retinoic acid derivatives, oestrogen therapy

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24
Q

causes of hypercholestrolemia?

A

hypothyroidism, nephrotic syndrome, high saturated fat diet, cholestatic liver disease, anorexia nervosa

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25
Q

obesity?

A

over 30

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26
Q

normal weight?

A

18.5-24.9

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27
Q

as obesity increases so does?

A

insulin resisitance

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28
Q

metabolic/ X syndrome?

A

reduced glucose tolerance, hyperinsulinaemia, hypertension, visceral obesity, homeostatic disorder, lipid disorder (high triglycerides, low HDL, normal or elevated LDL)

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29
Q

clinical identification metabolic syndrome

A

waist circumference:
men> 94cm
women> 80 cm

plus any 2 of

fasting triglycerides over 1.7
HDL men less than 1.03
women less than 1.29

blood pressure over 130/85
fasting glucose over 5.6

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30
Q

dying of cardiovascular disease in UK?

A

1: 3

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31
Q

Q Risk score?

A

age, cholestrerol, RA, renal, AF, sex, smoking status, FH, BMI, systolic blood pressure, left ventricular hypertrophy, T2DM

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32
Q

PCSK inhibitors?

A

block PCSK 9 protein which is responsible for degrading cholesterol receptors thus preventing removal of LDL from blood

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33
Q

Metabolic adaptation?

A

decreased energy expenditure, decreased satiety, improving metabolic efficiency, increased cues for energy intake

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34
Q

the only appetite inducing (orexigenic) hormone is?

A

ghrelin

35
Q

ghrelin acts on?

A

NPY and AgRP neurons

36
Q

what stimulates brain feeding?

A

accelerator neurons produce NPY

37
Q

What causes inhibition of eating?

A

melanocortin peptides (brake)

38
Q

acclerator and brake neurons work on?

A

arcuate nucleus

39
Q

NPY neurons also?

A

produce agouti related peptides which block neuronal melanocortical receptors

40
Q

ghrelin rises when?

A

stomach is empty, stimulates hunger neurons

41
Q

PYY?

A

released before nutrients arrive in lower small intestine and colon and then a bit more, decreases food intake by inhibiting gut motility

41
Q

PYY?

A

released before nutrients arrive in lower small intestine and colon and then a bit more, decreases food intake by inhibiting gut motility

42
Q

GLP1?

A

secreted by EEC- l cells and certain neurons in the nucleus of the solitary tract in the brainstem.

in response to food consumption

glucose dependent insulinotropic peptide (GIP) is co secreted

enhances insulin secretion

43
Q

leptin is secreted by?

A

white adipose tissue

44
Q

leptin interacts with?

A

mesolimbic dopamine system (motivation/reward)

nucleus of solitary tract (satiety)

45
Q

what happens in low energy diet?

A

increased hunger/desire

reduction in PYY, cholecystokinin, insulin leptin and amylin

ghrelin, GIP and pancreatic polypeptide increased?

46
Q

how does exercise affect food?

A

increase in PYY levels so less appetite and ghrelin

47
Q

in people with obesity?

A

intestinal enteroendocrine cell responsiveness is reduces

blunted ghrelin reduction post meal

reduced baseline and meal stimulated levels of anorectic peptides NT, GLP1 and PYY

leptin resistance

48
Q

drugs associated with?

A

antipsychotics: lithium, risperidone, quetiapine, apiprazole, olanzapine, valproic acid

antidepressant: citalopram, duloxetine, venlafaxine

sleep inducing agents: zopiclone, trazadone, zolpidem

neuropathic- pregabalin/ gabapentin

steroids

insuline

49
Q

anti- obesity agents?

A

CNS stimulants: phentermine, benzaphetamine, lorcaserin

antidepressant/ dopamine reuptake inhibitor, opiod antagonist- naloxone, bupropion

orlistat GLP1 RA
metformin amylin agonists SGLT2 inhibitors

50
Q

weight loss surgery requirements?

A

BMI over 40
between 35 and 39.9 with severe obesity related comorbidity
between 30 and 34.9 and poorly controlled diabetes

51
Q

weight loss surgery requirements?

A

BMI over 40
between 35 and 39.9 with severe obesity related comorbidity
between 30 and 34.9 and poorly controlled diabetes

52
Q

hind gut hypothesis?

A

glycaemic improvement is due to accelerated nutrient delivery to distal intestines

GLP1 main contributor

53
Q

likert scales?

A

unipolar (neutral/nothing to one extreme)

or bipolar (negative extreme to positive extreme)

54
Q

statistical test choice?

A

difference or correlation/association
independent vs repeated
parametric (meets normal distribution)
vs non parametric

55
Q

when comparing groups what test do you use?

A

2 groups- t test
more than 2 groups - ANOVA

compare the means

56
Q

when testing association in a categorical or binary data then you use?

A

chi-square test

57
Q

sertraline can cause?

A

low sodium/ GI bleeds

58
Q

prochlorperazine can cause?

A

parkinsonism

59
Q

why do you avoid giving ldopa at meal times?

A

it completes with meals

60
Q

how to give bisphosphonates?

A

take on empty stomach, sitting up 30 mins before food

61
Q

changes in elderly that will affect drug distribution?

A

decreased muscle mass
increased body fat
decreased serum albumin

62
Q

why does low muscle mass affect drug distribution?

A

less volume of distribution for drugs that distribute into muscles, therefore greater plasma concentration e.g digoxin

63
Q

digoxin toxicity?

A

bradycardia, junctional tachycardia, heart block, delirium confusion dizziness, anorexia, abdominal pain, green yellow vision double vision, photophobia

64
Q

why is increased body fat bad?

A

increased volume of distribution of fat soluble drugs, therefore increased t1/2

e.g diazepam

65
Q

side effects of benzodiazepines?

A

drowsiness, confusion, ataxia and dependency

66
Q

treatment reversa for benzodiazepine?

A

iv flumazenil 200mcg

67
Q

why is serum albumin important?

A

decreased albumin 12-25%- can reduce drug binding capacity and therefore more free drugi.e phenytoin/warfarin

albumin could be further depressed by heart failure, renal disease, RA, hepatic cirrhosis and some malignancies

68
Q

phenytoin toxicity?

A

CHANNT
coarse facies
hepatitis
ataxia
nystagmus
nausea vomiting
tremor

69
Q

what can cause bleeding?

A

warfarin has a small volume of distribution, 99% bound
asprin can replace, and a 1-2% displacement can double warfarin or triple concentration of free

70
Q

adverse effects of antiplatelets (aspirin)?

A

renal failure
fluid retention
peptic ulcer disease
bleeding tendency

71
Q

how quick does GFR decline?

A

1% per year from age of 40

72
Q

which drugs may be increased due to renal function reduction?

A

morphine, lithium

73
Q

early toxicity lithium 1.5 mmol/L?

A

agitation, tremor, twitching

74
Q

late toxicity lithium> 2 mmol/l?

A

fits, arrhythmia, renal failure

75
Q

morphine undergoes?

A

phase 2 metabolism by conjugation, renal impariemnt leads to build up of metabolite

76
Q

morphine toxicity?

A

DR CHAN

drowsiness
respiratory depression
constipation
hypotension
and
nausea vomiting

77
Q

treatment for morphine?

A

iv naloxone 400 mcg

78
Q

what pharmacodynamic effect on heart of elderly person?

A

reduced and delayed bronchodilatory response to b agonist
decreased calcium channel block effect on PR interval

79
Q

prescribing cascade?

A

medicines are being prescribed to treat side effects of other medicine

80
Q

side effects of ACE i i.e ramipril?

A

dry cough
hypotension
potassium increase
renal failure

81
Q

calcium channel blockers side effects e.g amlodipine?

A

hypotension
negatively inotropic
fluid retention, facial swelling, ankle swelling

82
Q

diuretics side effects?

A

hypotension
hypokalaemia
hyponatraemia
confusion
dehydration

302 (24 decks)

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