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Nursing Pharmacology > Module 12 > Flashcards

Module 12 Flashcards

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1
Q

Coronary heart disease occurs when coronary blood circulation fails to adequately supply the ______ with blood.

A

heart

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2
Q

Coronary heart disease is primarily caused by _________.

A

atherosclerosis

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3
Q

__________ occurs when plaque builds up on the walls of the arteries. This causes the _______ to narrow and results in decreased blood flow to the ______.

A

Atherosclerosis
artery
heart

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4
Q

The risk of developing CHD (coronary heart disease) is _________ related to the levels of __________ in the blood.

A

directly

cholesterol

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5
Q

Those with high blood __________ are at high risk of developing CHD.

A

cholesterol

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6
Q

In Canada, CV disease causes _____ of all deaths. This is _____ than any other illness.

A

1/3rd

more

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7
Q

Cholesterol is an important molecule that supports many physiological roles. Where is it found (primarily) and what is it a precursor of?

A

Found in cell membranes

Precursor of steroid hormones and bile salts

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8
Q

Where do humans obtain cholesterol from?

A

Exogenous (dietary) sources and through synthesis (endogenous) which primarily occurs in the liver

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9
Q

Approximately __% of the cholesterol in humans is acquired where? Where is the rest acquired from?

A

80% of cholesterol is synthesized by the liver, the remaining 20% is acquired from dietary sources

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10
Q

Where do most drugs targeting cholesterol act?

A

Since the liver produces 80% of cholesterol in the body, most drugs target the liver to decrease cholesterol synthesis

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11
Q

The basic structure of lipoproteins includes an outer ________ ____ made up of _________. This allows lipoproteins to be _______ in ________.

A

hydrophilic shell
phospholipids
soluble
plasma

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12
Q

What is the core of lipoproteins composed of?

A

The core is lipophilic, composed of triglycerides and cholesterol.

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13
Q

What is the primary function of lipoproteins

A

Transport cholesterol and triglycerides in the blood.

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14
Q

Why are lipoproteins required for transport of cholesterol and triglycerides?

A

Triglycerides and cholesterol are lipophilic and thus require a transporter (i.e. lipoproteins) to be soluble in the blood

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15
Q

All lipoproteins have __________ embedded in the phospholipid shell.

A

apolipoproteins

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16
Q

Apolipoproteins have three functions, what are they?

A

1 - Allow recognition by cells which may bind and ingest lipoproteins
2 - Activate enzymes that metabolize lipoproteins
3 - Increase the structural stability of lipoproteins

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17
Q

Lipoproteins that contain __________ __ transport cholesterol from non-hepatic tissue back to the liver whereas lipoproteins that contain _________ ____ transport cholesterol to non-hepatic tissue

A

Lipoproteins w/ apolipoprotein A-1 –> transport cholesterol from non-hepatic tissue, back to the liver

Lipoproteins w/ apolipoprotein B-100 –> transport cholesterol to non-hepatic tissue

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18
Q

Lipoproteins are named based on what quality?

What are the different names following this classification?

A

Their density
VLDL - very low density lipoprotein
LDL - low density lipoprotein
HDL - high density lipoprotein

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19
Q

Describe how the density of lipoproteins indicates the protein:lipid ratio.

A

Low density means there is relatively more lipid than protein in the lipoprotein.

High density indicates that there is more protein than lipid.

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20
Q

What is the function of VLDL?

A

Deliver triglycerides from the liver to adipose tissue and muscle.

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21
Q

VLDL:

They have a ________ rich core and account for almost all of the ________ content in the blood.

A

triglyceride

triglyceride

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22
Q

Almost all of the triglyceride content in the blood comes from what source?

A

VLDL

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23
Q

Describe the link between VLDL and atherosclerosis.

A

The link is controversial, as some studies indicate a link, and others do not. There is a suggestion that high VLDL levels contributes to atherosclerosis.

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24
Q

What apolipoprotein does VLDL contain? Where is the “cargo” deposited?

A

Contains apolipoprotein B-100 –> allows them to bind to cells and transfer their lipid (mostly triglyceride) to cells

25
Q

What is the whole purpose of VLDL in the body?

A

It transports triglycerides from the liver, to adipose tissue and muscle cells.
Apolipoprotein B-100 allows them to bind to non-hepatic cells.

26
Q

What is the purpose of LDL?

A

Deliver cholesterol to non-hepatic tissue

27
Q

LDL has a _______ rich core and accounts for ___-___ of ________ in the blood.

A

LDL has a CHOLESTEROL rich core and accounts for 60-70% of CHOLESTEROL in the blood

28
Q

Since LDL transports cholesterol from the liver to non-hepatic cells, what apolipoprotein does it contain?

A

Apolipoprotein B-100

29
Q

Describe the link between LDL cholesterol and atherosclerosis.

A

There is a clear link between LDL cholesterol and development of atherosclerosis.
The higher the blood LDL level, the greater the risk of developing CHD

30
Q

How does reducing LDL levels in the blood affect atherosclerosis development?

A

Reducing LDL levels halts or even reverses atherosclerosis and has been proven to decrease death from CHD

31
Q

LDL cholesterol is often referred to as what?

A

Bad cholesterol

32
Q

What is the role of HDL in the body?

A

HDL’s deliver cholesterol from non-hepatic tissue back to the liver.
Thus, HDL promotes cholesterol removal from the blood

33
Q

What is the main core lipid of HDL?

A

Cholesterol

34
Q

HDL accounts for __-

__% of total blood cholesterol.

A

20-30%

35
Q

Describe the link between HDL and CHD.

A

Elevated HDL decreases the risk of CHD

36
Q

What apolipoprotein does HDL contain?

A

HDL particles may contain multiple apolipoproteins including A-I, A-II and A-IV

37
Q

Which apolipoprotein from HDL particles mediates their beneficial effects.

A

A-1 –> allows delivery of cholesterol from non-hepatic cells to the liver

38
Q

HDL protects against ________ and is thus also called what?

A

Atherosclerosis

Good cholesterol

39
Q

The initiation of atherosclerosis begins with what?

A

Damage to the endothelium

40
Q

There are many factors that may damage the endothelium, what are they?

A

HTN, smoking, elevated blood lipids, hemodynamic factors, immune reactions

41
Q

After damage to the endothelium occurs, what accumulates in the sub-endothelial space?

A

LDL cholesterol

42
Q

What occurs to LDL cholesterol that accumulates in the sub-endothelial space?

A

It may become oxidized

43
Q

What does oxidation of LDL cholesterol lead to?

A

Oxidation of LDL cholesterol causes recruitment of monocytes to the sub-endothelial space

44
Q

Recruitment of monocytes by oxidized LDL particles leads to what?

A

Conversion of monocytes to macrophages, which ingest oxidized LDL cholesterol. The cells then become larger and vacuolated = foam cells

45
Q

As foam cells accumulate, a _____ _______ appears.

A

fatty streak

46
Q

The formation of a fatty streak is followed by what processes?

A

Platelet adhesion, smooth muscle migration, and collagen synthesis

47
Q

What is the end result of LDL accumulation in the sub-endothelial space?

A

Atherosclerotic lesion characterized by a lipid core and tough fibrous plaque

48
Q

Although LDL cholesterol plays a critical role in the development of atherosclerosis, it is important to note that atherosclerosis is primarily an __________ process.

A

inflammatory

49
Q

Cholesterol screening is recommended for who?

A

All males over 40, and all females over 50, or females that are post-menopausal

50
Q

Cholesterol screening is also recommended for people with these conditions/characteristics.

A

Have diabetes
Have heart disease or a (prominent) family history of heart disease
Have HTN
Have central obesity
Smoke or has recently stopped smoking
Have inflammatory (i.e. arthritis/lupus) or renal disease

51
Q

_________ ______ assessment is used by HCPs to estimate the risk a patient has of developming CV disease.

A

CV risk assessment

52
Q

What is the most commonly used form of CV risk assessment?

A

Framingham Risk Score

53
Q

What are the different components used in the FRS to calculate a risk score?

A

Gender, age, total blood cholesterol, smoking status, HDL cholesterol and systolic BP

54
Q

The risk score from the FRS represents the patient’s ___ year risk of developing CHD.
Patients with a risk score above __% are considered high risk, between __-___% are considered moderate risk, and below __% are considered low risk.

A

10 year risk
20%+ - high risk
10-19% - moderate risk
<10% - low risk

55
Q

It has been shown that the Framingham score tends to ________ the risk in what groups?

A

underestimate risk in youth, women and pts with metabolic syndrome

56
Q

Why would we treat low risk (FRS identified) patients?

A

Because it doesn’t take into account LDL cholesterol levels in the blood

57
Q

Combination of medical disorders that cause increased risk of CHD and type II diabetes

A

metabolic syndrome

58
Q

Metabolic syndrome is diagnosed when patients have three or more of these factors.

A 
1 - Central obesity
2 - Elevated triglycerides
3 - Low HDL cholesterol
4 - Hyperglycemia
5 - HTN
59
Q

Estimates suggest that __ in ____ Canadians have metabolic syndrome.
Treatment of metabolic syndrome is directed at decreasing the risk for ____ and ________

A

1 in 4

CHD and type II diabetes

Nursing Pharmacology (30 decks)

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