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Digestion > Section 4B > Flashcards

Section 4B Flashcards

1
Q

What occurs to chylomicrons once they enter the lymphatic circulation?

A

They are transported upward through the thoracic duct and emptied into the venous circulation at the jugular and subclavian veins

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2
Q

When does lipemia usually occur?

A

Within an hour after eating a fatty meal. Plasma usually becomes clear within a few hours since chylomicrons have a short half life (<60 min.)

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3
Q

What enzyme is present in capillary endothelium that hydrolyzes the TGs of chylomicrons into fatty acids & glycerol so they can be transported to adipose tissue and liver?

A

Lipoprotein lipase

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4
Q

What are the 5 classes of lipoproteins?

A 
Chylomicrons
Very low density lipoproteins (VLDL)
Intermediate density lipoproteins (IDL)
Low density lipoproteins (LDL)
High density lipoproteins (HDL)
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5
Q

Chylomicrons are synthesized by what?

A

The enterocytes of the small intestine

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6
Q

Where are the other 4 classes of lipoproteins other than chylomicrons synthesized?

A

By liver hepatocytes

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7
Q

The naming of lipoproteins is based on the results of what?

A

Ultracentrifugation by which the lipoproteins are separated according to their density

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8
Q

VLDL contains what?

A

High TGs/ moderate cholesterol & phospholipids

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9
Q

IDL contains what?

A

Moderate TGs, cholesterol & phospholipids

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10
Q

LDL contains what?

A

Low TGs/ high cholesterol & phospholipids

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11
Q

HDL contains what?

A

Low TGs, cholesterol & phospholipids

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12
Q

What are the only two lipoproteins routinely monitored?

A

LDL-C & HDL-C

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13
Q

What is the role of LDLs?

A

Transport cholesterol and other lipids from the liver to the peripheral tissues, making them available for membrane or steroid hormone synthesis

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14
Q

Function of HDLs

A

to transport excess cholesterol from peripheral tissues to the liver, where it is broken down and becomes part of the bile

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15
Q

what is the most effective drugs currently in use for treating elevated LDL-C?

A

Statins

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16
Q

Name the 7 statin drugs in the USA market

A
  1. Atorvastatin (Lipitor)
  2. Fluvastatin (Lescol)
  3. Lovastatin (Altoprev, Mevacor)
  4. Pravastatin (Pravachol)
  5. Simvastatin (Zocor)
  6. Rosuvastatin (Crestor)
  7. Pitavastatin (Livalo)
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17
Q

What is the general term for any muscle disease?

A

Myopathy

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18
Q

What is myalgia?

A

Refers to muscle pain or weakness without increased creatine kinase

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19
Q

What is Myositis?

A

The same as myalgia but includes elevated Creatine Kinase

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20
Q

What is Rhabdomyloysis?

A

Muscle symptoms, very high creatine kinase

Increased serum creatinine, often with dark urine and myoglobinuria

21
Q

What degree of statins (How many?) have been associated with myopathy?

A

All statins

22
Q

Approximately how many patients taking statin reports muscle complaints

A

1 in 10 patients

23
Q

What are the 7 risk factors for statin myopathy?

A
  1. Elderly
  2. Small size
  3. High statin dose
  4. Liver or renal disease
  5. Diabetes
  6. Uncontrolled hypothyroidism
  7. Interacting medications
24
Q

What was the first lipid-lowering agent that was associated with a reduction in total mortality?

A

Niacin (Nicotinic Acid, Vitamin B3)

25
Q

What are the 3 basic preparations of Niacin?

A
  1. Immediate (regular) release (IR); crystalline niacin
  2. Sustained/extended release (SR & ER)
  3. No-flush (Inositol hexaniacinate; niacinadmide)
26
Q

What are the two niacin drugs that are IR?

A

Niacor (Prescription)

Generic (OTC)

27
Q

What are the two SR & ER niacin drugs?

A

Niaspan (Prescription (ER))

Slo-Niacin (OTC (SR))

28
Q

What is the efficacy of No-flush niacin?

A

They are worthless! Do not affect lipid levels. They do not contain nicotinic acid, which is the active ingredient

29
Q

How does Niacin work? (Its MOA)

A

Reduces the production of VLDL which leads to a secondary reduction in LDL. Niacin is the MOST POTENT agent for raising HDL levels.

30
Q

What is the main adverse effect of niacin?

A

Intolerance to niacin is common! Only 50-60% of patients may be able to take full doses

  • Tingling
  • Flushing
  • Sensation of warmth in face or upper body
31
Q

How to blunt the niacin adverse effects?

A

Taking ASA or other NSAID (ibuprofen) 30-45 minutes prior to each niacin dose blunts this prostaglandin-mediated effect.

32
Q

What are sometimes considered the safest hypolipidemic drugs and why?

A

Resins because they are not absorbed from the intestine

33
Q

name 3 available resins

A

Colestipol (Colestid)
Cholestyramine (Questran, Questran light)
Colesevelam (Welchol)

34
Q

What is the MOA of Resins?

A

They bind bile acids in the intestinal lumen

35
Q

The MOA of Resins leads to what two things?

A

Decreased emulsification of dietary fat
Prevention of bile acid reabsorption, this causes liver to increase its production of bile acids, using hepatic cholesterol to do so.

36
Q

How do Resins affect LDL and HDL levels?

A

Plasma LDL levels can be reduced by 30%

Resins have little effect on HDL and TGs in blood

37
Q

What are 6 common adverse effects related to Resins and the GI system?

A
  1. Constipation
  2. Bloating/ abdominal distention/ pain
  3. flatulence
  4. Nausea
  5. Vomiting
  6. Dyspepsia
38
Q

What extra supplementation may relieve adverse effects of resins?

A

Fiber supplement which may relieve constipation and bloating

39
Q

Resins bind what other durgs that interfere with their absorption?

A
  1. Fat soluble vitamins
  2. Folate
  3. Thiazides
  4. Tetracyclines
  5. Warfarin
  6. Propanolol
  7. Penicillin
40
Q

How do you avoid resin interaction with other drugs?

A

Take resin a few hours after taking medications that it may interfere with

41
Q

All H2O absorption in the small intestine is what?

A

Passive and secondary to solute movement

42
Q

Where does calcium absorption occur?

A

Duodenum and Jejunum and is regulated by vitamin D3

43
Q

How are fat-soluble vitamins (A,D,E&K) absorbed?

A

Similar to fat

44
Q

Most water-soluble vitamins are absorbed how?

A

by simple diffusion

45
Q

Vitamin B12 requires what for normal absorption?

A

IF

46
Q

What cells absorbe IF-Vitamin B12 complexes across the brush border?

A

Ileal cells

47
Q

What causes vitamin B12 deficiency?

A

Atrophy of the gastric mucosa results in a deficiency of IF and acid secretion

48
Q

How long does it take chyme to move through the entire small intestine via peristalsis?

A

3-5 hours

49
Q

Sympathetic nerves generally do what to small intestine?

A

Inhibit activity while PNS generally excites muscular activity

Digestion (15 decks)

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