Clinical aspects of lipids Flashcards

1
Q

What are the 2 key lipids we should know?

A

Triacylglyceride
Cholesterol

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2
Q

What is Tendon Xanthoma?

A

Lipid deposits found along the Achilles tendon

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3
Q

What is Xanthelasma?

A

Lipid deposits around the eyes

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4
Q

What is Corneal arcus?

A

A white/grey ring around the iris/cornea

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5
Q

What is arcus senilis?

A

The term given to corneal arcus in the elderly

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6
Q

What are some common symptoms of familial hypercholesterolaemia?

A

Tendon Xanthoma
Xanthelasma
Corneal arcus
Milky serum of blood

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7
Q

What is measured for in a cholesterol test?

A

Total cholesterol
HDL - cholesterol
Triglycerides
Total:HDL-C ratio
LDL cholesterol

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8
Q

How do statins mainly work?

A

Statins are HMG CoA reductase inhibitors
This increases expression of LDL receptors on its surface, meaning that it can take up and break down more LDL-C

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9
Q

What are the functions of cholesterol?

A

Lower cholesterol
Reduce smooth muscle migration
Reduce foam cell formation
Reduce T-cell activation
Reduce adhesion and platelet aggregation
Reduce adherence and entry of leukocytes

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10
Q

What are some examples of statins?

A

Simvastatin
Atorvastatin
Rosuvastatin
Fluvastatin
Pravastatin

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11
Q

What are some examples of PCSK-9 inhibitors (Proprotein Convertase Subtilisin/Kexin type 9)?

A

Alirocumab
Evolocumab

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12
Q

What is an example of a fibrate?

A

Bezofibrate

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13
Q

What is an advantage of a fibrate?

A

They decrease triglycerides by a much larger amount than other drugs

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14
Q

What are the uses of ezetimibe?

A

It is prescribed in those who can’t take statins, although they aren’t very useful

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15
Q

What are the advantages of simvastatin?

A

It has a reasonably high efficacy and is backed by a large amount of evidence

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16
Q

What are the advantages of atorvastatin?

A

It has a higher efficacy than simvastatin and is backed by a large amount of evidence

17
Q

What are the advantages of fluvastatin?

A

It has a very high patient safety level and is used in those who can’t tolerate statins

18
Q

What are the advantages of rosuvastatin?

A

It has the highest efficacy, some evidence and is metabolised in a different way to most other drugs, so has fewer drug interactions

19
Q

What are the advantages of pravastatin?

A

There is good evidence and is metabolised in a different way to most other drugs, so has fewer drug interactions

20
Q

What dose of rosuvastatin is equal to 80mg of simvastatin?

A

10mg

21
Q

What enzyme metabolises atorvastatin, simvastatin and lovastatin?

A

Cytochrome P450 3A4

22
Q

How can ketoconazole, erythromycin, diltiazem and the furanocoumarins found in grapefruits affect statins?

A

These are all metabolised by Cytochrome P450 3A4 and cause permanent inactivation of the enzyme. This slows metabolism of statins and so increases blood plasma levels of them

23
Q

What is the risk of increased blood plasma levels of statins?

A

This increases the risk of rhabdomyolysis

24
Q

How can phenytoin, barbiturates, carbamazepine and rifampicin affect statins?

A

They are all powerful inducers of the Cytochrome P450 3A4 and so increase metabolism of statins, thus decreasing blood plasma levels of them

25
Q

Is the familial hypercholesterolaemia mutation autosomal recessive or dominant?

A

Dominant

26
Q

How does hypertriglyceridaemia cause acute pancreatitis?

A

Chylomicrons are very large and can obstruct capillaries in the pancreas, leading to localised ischaemia and acidaemia
This local damage causes the release of pancreatic lipases which reacts with triglycerides
The degeneration of triglycerides to free fatty acids can lead to cytotoxic injury, resulting in further local injury and inflammation