Drugs effecting atherosclerosis

Question 1

what is the central core of lipoproteins composed of

Answer 1

HYDROPHOBIC

triglycerides or cholesterol esters

Question 2

what is the coat of the lipoprotein composed of

Answer 2

hydrophilic coat of polar substances 
- phopholipids 
- free cholesterol
- associated proteins 
apoproteins or apolipoproteins

Question 3

what are the four main variations of lipoproteins

Answer 3

core lipids
apoproteins
size
density

Question 4

what are the five main classes of lipoproteins

Answer 4

HDL 
IDL
LDL
VLDL
chylomicrons

Question 5

what acts as a transport molecules for TG and cholesterol esters

Answer 5

chylomicrons

Question 6

what are the three outcomes when chylomicrons enter the liver

Answer 6

cholesterol is stored
cholesterol is oxidised to bile acids
released to VLDL which transport cholesterol and newly synthesised triglycerides to tissues

Question 7

what happens to the TGs on VLDL

Answer 7

they are removed leaving an LDL with a high cholesterol which is taken up by cells pr liver

Question 8

what is the role of HDL

Answer 8

absorbs cholesterol from cell breakdown and transfer it to VLDL and LDL

Question 9

what is a risk factor for atheromatous disease

Answer 9

increase in plasma cholesterol associated with increase in LDL
THIS IS CALLED HYPERLIPIDAEMIA

Question 10

What is stenosis

Answer 10

narrowing

Question 11

what is an ideal level of cholesterol

Answer 11

less than 5 mmol/l

Question 12

mildly high cholesterol

Answer 12

5 to 6.4 mmol/l

Question 13

high cholesterol

Answer 13

6.5 to 7.8 mmol/l

Question 14

very high cholesterol

Answer 14

above 7.8 mmol/l

Question 15

how do lipid lowering drugs act and what are the alternatives

Answer 15

either by reducing production of lipoproteins or increasing their removal from the blood as the aim is to reduce plasma cholesterol

• lifestyle modification (diet and excercise)
• drug therapy should be secondary

Question 16

where is cholesterol derived from

Answer 16

• de nova synthesis in liver
• uptake from circulating LDL’s
• Uptake of chylomicron remnants

Question 17

PCSK9 (enzyme that mediates degradation of LDL receptors on the surface of liver cells) inhibitors

Answer 17

alirocumab and evolcumab

inhibiting the enzyme increases the amount of LDL bound and cleared by the liver

Question 18

side effects of stratins

Answer 18

myositis 
angio-oedema 
GI disturbances 
insomnia 
rash

Question 19

side effects of fibres

Answer 19

myositis

Gi disturbances

Question 20

side effects of colestyramine, ezetimibe

Answer 20

GI symptoms

Question 21

side effects of nicotinic acid

Answer 21

flushing
palpitations
GI disturbances

Question 22

what are the clinical uses of statins

Answer 22

• primary prevention of arterial disease in patent with high serum cholesterol
• secondary prevention of myocardial infarction and stroke in those who have atherosclerotic diseases
• atorvastatin lowers serum cholesterol in familial hypercholesterolaemia

Question 23

what makes up the mevalonate pathway

Answer 23

cholesterol synthesis and protein prenylation

Question 24

what is protein preylation

Answer 24

addition of lipid tails to small GTPase signalling molecules
ensures they are localised correctly

Question 25

clinical uses of fibrates

Answer 25

mixed dyslipidaemia (raised serum triglyceride as well as cholesterol)
in patients with low HDL and high risk of atheromatous disease (type 2 diabetes) 
combined with other lipid lowering drugs in patients with severe treatment resistant dyslipidaemia