Chap 27 Smoking

Question 1

List mechanism of adverse CV effects caused by smoking.

Answer 1

endothelial cell damage

increased PLT and leukocyte adhesion to endothelial cells

impaired NO bioavailability causing abnormal vasomotor tone

increased endothelin-1

increased total and LDL cholesterol

incresed triglycerides

decreased HDL

Insulin resistance

increase PLT aggregation, fibrinogen, TF, blood viscosity

increased HR, BP, myocardial O2 demand

Question 2

Name different smoking cessation therapies.

Answer 2

Gum

lozenge

inhalation

nasal spray

transdermal patch

buproprion (atypical anti-D)

Varenicline (champix, nicotinic acetylcholine receptor partial agonist)

Question 3

Which treatments are prove to work for smoking cessation?

Answer 3

all of them

Question 4

What are clinical effects of DM?

Answer 4

Increases risk of CAD and those with CAD and DM have worse outcome
Clinically evident CAD earlier
Increased risk of PAD
Increase incidence and severity of limb ischemia
More distal arteries involved in PAD
Most common cause of non-traumatic extremity amputation

Question 5

How does DM lead to athero?

Answer 5

DM leads to
Hyperglycemia, free fatty acids, insulin resistance
These then leade to oxidative stress, protein kinase C activation and RAGE activation
This leads to
increase vasoC (htn, SMC growth)
inflammation
thrombosis (plt activation)

Question 6

What are non-pharmocological methods used to reduce cholesterols levels.

Answer 6

Dietary changes

exercise

Question 7

What are pharmocological methods used to reduce cholesterols levels?

Answer 7

statins
niacin
Fibrate
Bile acid sequestrants
Ezetimibe
omega-3 fatty acids

Question 8

How do statins work? What are their SE?

Answer 8

HMC-CoA reductase inhibitors
inhibites HMG-CoA reductase which is an enzyme that produces mevalonate which is the next step in the production of cholesterol.

hepatic injury rare
myopathy

Question 9

How does niacin work? what is its side effects?

Answer 9

nicotinic acid/vit B13
binds to receptors and inhibit cAMP production which decrease fat breakdown in adipose tissue and free fatty acids available for TG and VLDL production

flushing, itchyness
dyspepsia, liver toxicity
cardiac arrythmias

Question 10

How does fibrate work? what is its side effects?

Answer 10

peroxisome proliferators receptor-alpha agonist

activates pathways that increase lipolysis and elimination of TG from plasma

H/A, anusea
Myalgia
diarrhea
myopathy, hepatotxicity, nephrotoxicity

Question 11

How do bile acid sequestrates work? what is its side effects?

Answer 11

resin
binds to components of bile in GI tract and prevent from entering hepatic circulation. Liver then sequesters cholesterol to make bile reducing circulating volumes.

constipation, diarrhea, flatulence

Question 12

How does ezetimibe work? what is its side effects?

Answer 12

interferes with absorption of cholesterol from the GI tract

Question 13

How does HTN lead to atherosclerosis?

Answer 13

cause endothelial dysfunction
which causes reduction in NO
this leads to decrease vasod, increased inflammation, increase coagulation

Question 14

What are non pharm methods to reduce BP?

Answer 14

weight loss, sodium restrictin, aerobic activity

limiting alcohol intake 1-2 servings daily

Question 15

What are recommendation for BP control?

Answer 15

140/90

130/80 if CKD or DM

Question 16

What are recommendation for DM control?

Answer 16

HGB A1C <7%

Question 17

What are recommendation for lipid control?

Answer 17

all PAD LDL <70

Question 18

Name chemicals found in a cigarette.

Answer 18

acetone
ammonia
arsenic
carbon monoxide
formaldehyde
lead
tar
toluene