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Chem Path > Chem Path: Brief lipid update > Flashcards

Chem Path: Brief lipid update Flashcards

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1
Q

What is the cholesterol distribution in fasting plasma

A

13% VLDL
70% LDL
17% HDL

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2
Q

What are mixed micelles?

A

They are the major component of bile acids

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3
Q

Which enzyme facilitates transport of mixed micelles from the small intestine to the lymphatics/liver?

A

NPC1L1

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4
Q

Which enzymes facilitate movement of cholesterol from lymphatics back to the small intestine

A

ABC G5 and G8

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5
Q

What does cholesterol downregulate in the liver

A

HMG CoA reductase

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6
Q

Where do bile acids get absorbed

A

Terminal ileum

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7
Q

What are the 2 fates of cholesterol in the liver?

A

They can get hydroxylased into bile acids

They get turned into esters by ACAT

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8
Q

What happens to cholesterol esters in the liver

A

Get attached to VLDL by MTP and apoB TG

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9
Q

What is the difference between HDL and LDL

A

HDL brings cholesterol from peripheral cells to the liver, while LDL does the opposite

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10
Q

How does HDL collect cholesterol from the cells

A

Via ABC A1

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11
Q

What happens to VLDL

A

It is the precursor to LDL

It also get converted to HDL vis CETP and cholesterol esters and HDL gets turned into VLDL via CETP and triglycerides

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12
Q

What is the triglyceride distribution in fasting plasma

A

55% VLDL
29% LDL
11% HDL
Transient increase in chylomicrons after eating

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13
Q

How are triglycerides processed and transported in the capillaries

A

Fatty foods are broken down into FAs, which are further broken down into triglycerides, which are transported as chylomicrons

Chylomicrons are then broken down into FFAs by lipoprotein lipase

FFAs are taken up by liver and adipose tissue

Liver resynthesises FFA into triglycerides and exports them as VLDL

VLDL will also be broken down into FFAs by lipoprotein lipase

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14
Q

What are the 4 types of primary hypercholesterolaemia and what gene mutations are they usually associated with

A

Familial - LDLR, ApoB or PCSK9 - autosomal recessive

Polygenic - NPC1L1, HMG Co reductase

Familial hyper A lipoproteinaemia - Increase in HDL, CETP defic

Phytosterolaemia - ABC G5 and G8, - absorb plant sterols freely so increased risk of atherosclerosis

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15
Q

For FH, is hetero or homo more common?

A

Heterozygous

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16
Q

What are some signs of heterozygous FH

A

Corneal arcus
Xantholasma
Tendon xanthoma

17
Q

What happens in PCSK 9 mutation?

A

PCSK 9. degrades LDLR. Mutations can either increase rate of degradation of LDLR to reduce rate of degradation

18
Q

What are the 3 types of hypertriglyceridaemia

A

1 - Lipoprotein lipase or ApoC 2 def
4 - increased triglyceride production
5 - ApoA 5 def

19
Q

What would you be able to see in type 1 hyperlipidaemia

A

Eruptive xanthoma

20
Q

How can you differentiate between types 1 4 and 5 hyperlipidaemias?

A

Fridge test - chylomicrons at the top for types 1 and 5, VLDL a the top for type 4

21
Q

There is a clearance problem in which type of hyperlipidaemia?

A

Type 1

22
Q

What are the 3 types of primary mixed hyperlipidaemia

A

Familial combined hyperlipidaemia - some have high cholesterol some have high triglycerides

Familial hepatic lipase deficiency

Familial dys beta lipoproteinaemia

23
Q

what is Familial dys beta lipoproteinaemia ApeE 4/4 associated with

A

Alzheimer’s

24
Q

What is the classical sign of Familial dys beta lipoproteinaemia

A

Yellow palmar crease and eruptive xanthomas

25
Q

When would you get secondary hyperlipidaemia

A

Nephrotic syndrome, pregnancy,

26
Q

What other reasons can cause high triglycerides

A 
Exogenous sex hormones 
diabetes
gout
obesity 
progressive partial lipodystrophy 
chronic renal failure 
alcohol
27
Q

What other reasons can cause high cholesterol

A

Nephrotic syndrome

Obstructive liver disease

28
Q

What are the 4 types of hypolipidaemia

A

AB lipoproteinaemia - Autosomal recessive - MTP deficiency - Very low LDL and VLDL

HypoB lipoprotienaemia - Autosomal dominant - ApoB

Tangier disease. - HDL deficiency - ABC A1 mutation

Hypo alpha lipoproteinaemia - ApoA1 mutation

29
Q

What do statins do

A

Lower LDL greatly
Mild increase in HDL
Mild decrease in TG

30
Q

How does nicotinic acid work

A

Decrease in LDL

Great increase in HDL

31
Q

How do fibrates work

A

Decrease TG

32
Q

What does exetimibe do?

A

Reduces LDL

33
Q

What are 3 medications in the pipeline now

A

MTP inhibitor
Anti PCSK9 - reduces LDL
Anti sense apoB oligonucleotide - reduces LDL

34
Q

What is orlistat

A

Prevents fat abosrption

35
Q

What are the 3 surgical interventions for obesity

A

Gastric banding
Roux en Y gastric bypass
Biliopancreatic diversion

Chem Path (22 decks)

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