CVS 5 Flashcards
Cardiovsacular disease is associated with increased LDL and decrease HDL. TRUE OR FALSE?
TRUE
Nmae the three types of Hyperlipidemia’s?
- Hypercholesteridemia
- Hypertriglyceridemia
- Mixed hyperlipidemia
Lowering LDL/HDL decreases risks of athesclerosis. TRUE OR FALSE?
TRUE
List the following in increasing protein and lipid ratio (LDL,HDL,VLDL,chylomicrons?
- Chylomicrons
- VLDL
- LDL
- HDL
Hyperlipidemia can be caused by genetic compenets or by diet. TRUE OR FALSE?
TRUE
How do you manage hyperlipidemia?
- stop smoking (reduces risks of coronary heart disease)
- diet and diabetes management
- lifestyle changes before pharmacological intervention
What are the two types of pharmacological intervention iwith hyperlipidemia managemnt?
- Primary prevention - treatment before clinical eveidence of disease e.g if patient has had history of high cholesterol levels
- Secondary prevention - after clinical evidence of the disease - try to signficantly reduce risks of M.I
statins inhibit the enzyme HMGCR. true or false?
TRUE
how many carbons does HMGCoA have?
6 carbons
Statins inhibit HMGCR enzyme. true or false?
true
the cholesterol synthesis pathway is dependent upon the amount of cholesterol in a patients body. true or false?
true
if cholesterol is high in a patients body the cholesterol synthesis pathway is turned off and vice versa through the SREBP transcription factor. true or false?
true
what are statins indicated for?
- Stroke
- Coronary heart disease
How do statins work?
- Inhibit cholesterol synthesis
Name a statin that is a pro-drug and is metabolised by CYP3A4?
Simvastatin
Name a statin with a half life of 14hr and is metabolised by CYP3A4?
- Atorvastatin
What is the dominant site of action of statins?
The liver
Which statin are not metabolised by CYps?
- Rosuvastatin
- Pravastatin
What are some ADRs of statins?
- Generally well tolerated but patients are at risk of myopathy
What are some interactions of statins?
- affects drugs affecting CYP P450 enzymes
what are bile acid binding resins indicated for?
- For patients which statins on own is insufficient
what is the mechanism of action for bile acid binding resins?
- Positively charged resin binds negatively charged bile
↓decreased re-absorbtionbile (enterohepaticrecirc.)→↑excretion–↑bile synthesis →↓liver cholesterol →↑LDL receptor expression → ↓plasma cholesterol
bile acid binding resin is insoluble in water. true or flase?
true
bile acid binding resin decreases LDL by 30% true or false?
true
Bile acid binding resin also bind vitamin A,D AND K therefore supplements of these are neccesary. TRUE OR FALSE?
TRUE
What are inhibitors of cholesterol absorption indicated for?
- Hypercholesteronmia
- Or with statin or if statin not good on own
What is the mechanism of action of cholesterol absorption inhibitors?
- Inhibit transport of cholesterol across intestinal brush border
Provide a drug name for cholesterol absoprtion inhibitors?
- Ezetimibe
Cholestrol absorption inhibitors also reduce cholestrol in chylomicrons. TRUE OR FALASE?
TRUE
Why do cholestrol absorption inhibitors have long half lives?
- because they undergo constant enterohepatic recirculation
What are some interactions of cholestrol absoprtion inhibtors?
- They plasma concentration increases with fibrates
How do fibrates work?
- activates the PPARa transcription factor
- which decreases triglycerides
- Lowering LDL
What are fibrates indicated for?
- Hypercholesterimia
- Hypertriglyceridpedimia
what are the cautins for fibrates?
- They cause myotoxicity especially in patients with renal disease
Fibrates are excreted in urine as glucorinode conjugates. TRUE OR FALSE?
TRUE
What are some ADRs of fibrates?
- Cause GI disturbances
- Myopathy
How do PCSK9 inhibitors work?
- They increase expression of LDL-R
- which leads to an increase in the LDL clearance
What is nicotinic acid indicated for?
- Hyperlipidemia
- Hyperglycemia
How doe nicotinic acid work?
- Increase HDL by decreasing lipolysis in adipose tissue
- Leads to decrease in VLDL, LDL and triglycerides
Give a drug name for nicotinic acid?
- Niacin
What are some ADRs of nicotinic acid?
- Can lead to diabetes
- Hyperurecemia - decrease in uric acid secretion leading to gout
Niacin increases risk of bleeding. TRUE OR FALSE?
TRUE
Omega-3-fatty acid are known to decrease triglyceride synthesis. TRUE OR FALSE?
TRUE
What are two fish oil types?
- EPA
- DHA
what is necrosis?
- Cell death but with leakage
How does an atherosclerosis plaque start to build up?
- LDL have a long half life and are full of cholesterol (means that they can stay for a long time)
- They can bind to proteio glycans
- LDL becomes oxidised
- Get recognised by macropahses
- Macrophageases ingest them
- Forming - foam cells and causing necrosis
- This grows further and starts to occlude the arteries
