Ch 49 Flashcards
Saturated fat are what for cholesterol production in liver
Substrates
Risk of CAD (coronary artery disease) is directly related to what
LDL cholesterol in blood
Hydroxymethylglutaryl CoEnzyme A (HMG CoA)catalyzes what synthesis
Cholesterol in the liver
Drugs that inhibit HMG CoA are most effective at what
Lowering LDL cholesterol
Give HMG CoA inhibitor most effective at night because
Cholesterol synthesis increases at night
I, A-11 delivers cholesterol to
Non hepatic cells
B-100 delivers cholesterol to
Hepatic cells
Very low density lipoproteins are
Triglycerides
LDLs account for 60-70% of cholesterol in the blood and deliver cholesterol to
Non hepatic tissue
HDLs protects CAD and accounts for 20-30% of all cholesterol in blood. Function is to deliver cholesterol from peripheral tissues to where
Back to the liver
What does HDLs promote
Removal of cholesterol
LDL initiates and fuels development of what
Atherosclerosis
What is the “end result” of atherosclerosis process
Atherosclerotic lesion (large lipid core and tough fibrous cap)
What’s a desirable number for total cholesterol and what’s high risk
Desirable is < 200 mg/dl
High risk is > 240 mg/dl
Desirable number for HDLS
> 35 mg/dl
Desirable number for LDL cholesterol
< 130 mg/dl
What are 3 ways to manage high LDL cholesterol(non drug measures)
Diet modification
Reduction of LDL cholesterol
Reduction of body weight
What are 5 drugs used to lower lipids
HMG CoA reluctase inhibitors Bile acid binding resins Nicotinic acid Fibric acid derivatives Estrogen
Lovastatin (mevacor) is a HMG CoA reluctase inhibitor improves HDLS and lowers all LDLs by doing what
Increasing LDL receptors in the hepatocytes
Lovastatin (mevacor) is dose dependent and has what 3 adverse effects
Headache
Rash
Hepatotoxicity (rare)
Cholestyramine (questran) is a bile acid binding resin increases LDL receptors in the liver and also
Forms a complex with bile acid preventing absorption of bile acid thereby accelerating excretion
Excretion of LDLs cholesterol demands more synthesis, bile acid is also formed from cholesterol so cholestyramine (questran) makes liver cells synthesize more and lowers
Circulating LDL cholesterol
Cholestyramine (questran) has 2 adverse effects
Constipation
Decreased absorption of fat soluble vitamins
Nicotinic acid decreases production if VLDLs and has 4 adverse effects
Skin(flushing and itching)
Gastrointestinal (nausea, vomiting, gastric upset)
Hepatotoxicity
Hyperglycemia
Gemfibrozil (lopid) is a fibric acid, the mechanism is unknown and it reduces VLDLs. What are the 4 adverse effects
Rashes
Gastrointestinal
Gallstones
Hepatotoxicity
Estrogen works in what ways on post menopausal women
Reduces LDLs by 15-25% and increases HDLs by 10-15%
