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MOD 2 > Lipid Metabolism and Drugs > Flashcards

Lipid Metabolism and Drugs Flashcards

1
Q

equation for total cholesterol

calculated LDL

A

TC: VLDL(TG/5) + LDL + HDL

calculated LDL = total cholesterol - HDL - TG/5

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2
Q

apoliporprotein B-100

A

structural protein for VLDL, IDL, LDL, LDL receptor ligand

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3
Q

apolipoprotein C-III

A

inhibitor of LPL

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4
Q

NPCILI “neimann pick C1 like 1 protein”

A

transporter of cholesterol into the epithelial cell of small intestine

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5
Q

insulin effects on:

  • LPL activity in adipose tissue and muscle tissue
  • hormone sensitive lipase
  • ApoB100
A
  • increased LPL activity in adipose tissue (LPL chews up chylomicrons into FFA to be stored)
  • decreased LPL activity in muscle
  • suppression of HSL (dont want to break down adipose tissue, you want to store it)
  • ApoB100 production inhbited
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6
Q

metabolic syndrome (related to insulin resistance) leads to these 3 things

A
  1. increased TG
  2. decreased HDL
  3. small dense LDL
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7
Q

in metabolic syndrome with some degrees of insuline resistance, expalin what happens to the following:

  • LPL
  • FFA
  • Adipose tissue
  • Liver TG
  • liver ApoB100
  • Chylomicron remnant
  • HSL
A
  • decreased LPL
  • decreased FFA
  • decreased adipose tissue
  • increased chylomicron remnant (more TG rich, this is what returns to the liver)
  • increased Liver TG
  • increased HSL (breaking down more of adipose tissue and increasing FFA sent to the liver)
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8
Q

CETP: cholesterol ester transport protein

A

takes TG from VLDL and LDL and gives it to HDL2 (HDL gives up a CE)

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9
Q

explain what happens to HDL in metabolic syndrome

A
  • build up of TG on VLDL, LDL, and IDL
  • takes TG, delivers it to the HDL, and now HDL is TG rich
  • HDL more readily metabolized by hepatic lipase, so levels rapidly decrease
  • ultimately: low HDL
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10
Q

Ezetimide

  • action
  • mechanism of action
  • side effects
A
  • decreases LDL
  • binds directly to NPC1L1 in the gut
  • blocks intestinal absorption of cholesterol–>decreased cholesterol delivery to liver –> decreases hepatic cholesterol –> increased LDLR –> decreased serum cholesterol
  • increased liver function tests, diarrhea
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11
Q

Phytosterols

  • action
  • mech of action
  • side effect
A
  • natural plant product
  • gets excreted from enterocytes, brings cholesterol with it
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12
Q

Cholestyramine, Colestipol, Colesevelam

  • action
  • mech of action
  • side effects
A
  • decreases LDL
  • cationic resins bind bile acids –> increase bile acid excretion –> decrease enterohepatic circulation –> liver needs to make more bild acids –> increased LDLR –> decreased serum cholesterol
  • increased TG (unclear reasons)
  • bloating, bad taste, colesterol gallstones (URQ pain), can’t absorb fat soluble vitamins
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13
Q

Statins

  • action
  • mech of action
  • side effects
A
  • greatly decreases LDL
    • competitive inhibitor of HMG-CoA reductase (rate limiting step in cholesterol synthesis) –> decreased hepativ cholesterol –> increase LDLR –> decreased serum cholesterol
  • decreases TG
    • ​increasaed LDLR (apopB100 and E) –> increased removal of IDL –> decreased production of VLDL due to reduced synthesis of cholesterol, a require component of VLDL
  • increased liver function tests, rhabdomyolysis
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14
Q

Gemfibrozil, Fenofibrate

  • action
  • mech of action
  • side effects
A

Fibrates

  • TG breakdown, decreases TG
    • decreases C-III (part of VLDL that inhibits LPL) –> upregulates LPL –> decreased TG
    • direct stimulation of LPL synthesis
    • activates PPAR-a (receptor that modulates carb and fat metabolism)
  • increases HDL
    • decreases TG rich VLDL, IDL, LDL –> decreases transfer of TG by CETP to HDL –> decreased HDL metabolism since not as TG-rich –> increased serum HDL
    • increases structural components of HDL (apoA1 and apoA11)
  • decreases LDL
    • increases LDL receptors
  • myositis, increased LFTs, cholesterol gallstones

-

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15
Q

Niacin

  • action
  • mech of action
  • side effects
A

Vitamin B3- used for patients with low HDL levels

  • decreases TG
    • inhibits HSL with decreased FFA –> liver
    • decreased FA –> decreased TG –> decreased VLDL production
    • increases LPL activity
  • decreased LDL
    • decreased VLDL production
  • increased HDL
    • decreased TG rich VLDL, IDL, and LDL, decrease TG transfer to HDL
  • flushing, hyperglycermia, hyperuricemia
    • blunt red face with aspirin
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16
Q

omega 3 FAs

  • action
  • mech of action
A
  • decrease TG
  • cause significant rise of LDL-used for only one reason: to decrease TG
    • not first line of therapy
  • inhibit hepatic TG synthesis
  • increased beta oxidation
  • increase degradation of apoB100 (so less VLDL)
  • increase LPL activity
17
Q

Therapy for Homozygous Familial Hypercholesterolemia + complications

A
  • Apo B 100 inhibitors (substrate for LDL)
    • decreases LDL
    • less VLDL is being released from liver since it also needs apoB100
    • complication: fatty liver since not removing VLDL
  • microsomal triglyceride transfer protein inhibitors (MTTP puts stuff together to make VLDL)
    • decrease hepatic formation of VLDL
    • decreases formation of chylomicrons in the intestine
18
Q

Two new potential drug therapy and mechanisms

A
  1. CETP inhibitors
    1. decrease transfer of CE from HDL to VLDL, LDL, and IDL
    2. increases HDL, decreases LDL
  2. PCSK9 inhibitors
    1. normally made in liver, binds and degrades LDL receptor
    2. inhibitors increase LDL receptors –> decrease in LDL cholesterol
19
Q

what is the core of chylomicrons and VLDL

A

TG

20
Q

2 main roles of Lipoprotein lipase (LPL)

A
  • hydrolyzes triglycerides
  • facilitates cholesterol transfer to HDL
21
Q

xanthomas

A
  • plaques of lipid-laden histiocytes
  • on eyelids or skin
  • sign of hyperlipidemia
22
Q

Type I hyperchylomicronemia

  • cause
  • inheritance
  • effect
  • complications
A
  • LPL dysfunction (or deficient in C-II)
  • increased TG and chylomicrons
  • autosomal recessive
  • pancreatitis, enlarged liver, xanthomas
23
Q

Type II Hypercholesterolemia

  • cause
  • inheritance
  • effect
  • complications
A
  • few or no LDL receptors
  • very high LDL
  • autosomal dominant
  • tendon xanthomas, corneal arcus
24
Q

list the drugs associated with the side effect:

-increased liver function tests

A
  • statins
  • ezetimide
  • fibrates
25
Q

list the drugs associated with the side effect:

cholesterol gallsones

A
  • fibrates
  • bile resins
26
Q

list the drugs associated with the side effect:

rhabdo/myositis

A
  • statins
  • fibrates
27
Q

list the drugs associated with the side effect:

bloating/diarrhea

A
  • ezetimide
  • bile resins

think ones involved with STOMACH and digestion

MOD 2 (13 decks)

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