Lipoprotein

Front 1

what are ther major risk factors for coronary artery disease?

Back 1

45+ man, 55+woman, family hx, DM, hypertension, smoking, abdominal obesity,lowl HDL (<40),high LDL

Front 2

w/ CAD, what should be done to further evaluate plasma lipoproteins? (already have glc and cholesterol)

Back 2

LDL panel after 10 hr fast

Front 3

why identify risk factors for CAD?

Back 3

1. reversible 2. determine LDL goal

Front 4

LDL gaol for pts w/ known CAD or equivalent risk (DM, atherosclerotic diseases)

Back 4

<100 mg/dl, maybe even 70

Front 5

increased risk fo MI sudden death in 10 years in pts w/ known CAD or equivalent risk (DM, atherosclerotic diseases)

Back 5

20%

Front 6

LDL goal for pts w/ 2 or more CAD risk factors?

Back 6

<130mg/dl

Front 7

increased risk of MI or sudden death in 10 yrs in pts 2 or more CAD risk factors?

Back 7

10-20%

Front 8

LDL gaoal for pts w/ no or 1 risk factor for CAD?

Back 8

<160mg/dl

Front 9

risk of MI or death w/ in 10 years for pts w/ no or 1 risk factor for CAD?

Back 9

<10%

Front 10

in an LDL panel?

Back 10

total cholesterol, triglycerides, HDL

Front 11

how to calculated LDL?

Back 11

total cholesterol-hdl-triglycerides/5

Front 12

why is fasting important w/ LDL panel?

Back 12

need to get rid of chylomicroms, which invalidates calculation in VLDL

Front 13

role of LDL cholesterol

Back 13

forward cholesterol transport (from liver to other cells)--> cholesterol is part of membranes, precursors for steroid hormones

Front 14

why are elvetaed levels of ldl cholesterol

Back 14

treatable risk factor for CAD (become foam cells when taken up by macrophages scavenger receptors in arterial walls)

Front 15

role of hdl cholesterol

Back 15

reverse cholesterol transport (removes cholesterol from tissues/arteries)--> returns to liver and excretes as bile acid

Front 16

why are low levels of hdl important

Back 16

indicate increased coronary risk

Front 17

what is the major apoprotein in ldl

Back 17

apob-100

Front 18

what is the major apoprotein in hdl

Back 18

apoa-1

Front 19

genetic hyperlipoproteinemias?

Back 19

familail combined hyperlipidemia (elevated VLDL/LDL, sometimes low HDL)

Front 20

threshold cholesterol level for familail hypercholesterolemia?

Back 20

300-400mg/dl

Front 21

pathogenesis of familial combined hyperlipidemia?

Back 21

production of apob-100 increased

Front 22

effect of reducing cholesterol in someone who already has CAD

Back 22

reduces risk of death or another MI, doesn't cahnge size of plaques/degree of stenosis, just makes them less likely to rupture

Front 23

drugs to lower LDL-cholesterol (first priority in treatment)

Back 23

HMGCo-A reductase inhibitors, bile acid sequestrants, niacin, cholesterol absorption inhibitors

Front 24

mechanism of HMGCoA reductase inhibitors?

Back 24

block RLS in choolesterol synthesis--> fall in cholesterol levels--> upregulate hepatic LDL receptors--> increased clearance of LDLfrom plasma + increased VLDL uptake

Front 25

side fxs statins?

Back 25

rare-myopathy, elevated transaminase, toxicity when given w/drugs that inhibit cyp3a4

Front 26

first line drugs for lowering LDL cholesterol?

Back 26

statins-HMGCoA-reductase inhibitors

Front 27

mechanism of bile acid sequestrants

Back 27

bile bile acids intestine + increase their fecal sequestrion--> more cholesterol oxidized to bile acids--> lower intracellular cholesterol levles--> upregulates LDL receptors--> increased LDLclearance

Front 28

side fx of bile acid sequestrants?

Back 28

constipation, flatulence, abdominal cramping, drug interference

Front 29

mechanism of niacin?

Back 29

decreases LDL & TG, increases LDL by activating receptor that inhibits lipolysis and realease of FFA--> decreased hepatic VLDL production--> decreased LDL production

Front 30

side fx of niacin>

Back 30

flushin, hepatitis, insulin resistance (hyperglucemia)

Front 31

mechanism of action of ezetimibe?

Back 31

inhibits cholesterol transport, blocking GI absorption of cholesterol

Front 32

side fx of ezetimibe?

Back 32

diarrhea, muscle aches

Front 33

secondary (acquired) causes of hypercholesterolemia?

Back 33

hypothyroidism, nephrotic syndrom, obstructive jaundice

Front 34

secondary (acquired) causes of hypertiglycerlemia

Back 34

hypothyroidism, nephrotic syndrome, DM, renal failure, alcohol abuse, oral estrogen therapy

Front 35

defect in familail hypercholesteroemia?

Back 35

deficient fxning ldl recepotrs: liver can't remove ldl --> low intracellular cholesterol--> increased hepatic cholesterol synthesis--> foam cells/atherosclerosis

Front 36

levels of LDL in homozygotes of familail hypercholesterolemia? Heterozygotes?

Back 36

homo- astronomic!, hetero- 1/2 receptors, 2x the cholesterol)

Front 37

why do people w/ deficient fxning ldl receptors avoid atherosclerosis (familail hypercholesterolemia)>

Back 37

SRA recpeots, not LDL receptors, are used to take cholesterol into arteries

Front 38

what causes thick achilles' tendon in familail hypercholestrolemia?

Back 38

tendon xatnomas- lipid filled macrophages in tendon (specific)

Front 39

what is the corenal ring in familail hypercholesterolemia?

Back 39

arcus conrea- accumulation of lipids (not specific)

Front 40

how can you tell when chylomicrons are elevated?

Back 40

plasma triglyceride >1000, (often elevated VLDL)

Front 41

where do chylomicrons originate

Back 41

synthesized by intestine from dietary fat

Front 42

what is the major apoprotien of chylomicons?

Back 42

apob-48

Front 43

how are chylomicrons removed from plasma

Back 43

lipoprotein lipase metabolism them by breakind down TGs in their core

Front 44

what factors can elevate chylomicrons?

Back 44

children- genetic deficiency of LPL or apo CII; adults- familail hyperlipidemia, familial hypertriglyceridemia, familial dysbetalipoproteinemia + diabetes, alcoholic, oral estrogens

Front 45

difference between familail combined hyperlipidemia and familail hypertriglyceremia

Back 45

in familial hyper TG- only VLDL and triglycerides (not cholesterol) are elevated= no increased risk of CAD

Front 46

what is dysbetalipoproteinemia?

Back 46

polymorphism of APO2= remant of VLDL can't be removed; TGs and cholesterol elevated

Front 47

diabetes and lipoproteins?

Back 47

poorly controled diabetes--> increased VLDL production and decreased LPL (clears chylomicorns) activity

Front 48

cause of abdnominal pain in chyomicronemia?

Back 48

pancreatitis

Front 49

consequences of chylomicronemia?

Back 49

pancreatitis, eruptive xantomas, lipemia retinalis, hepatosplenomagaly, dyspnea, neurologic dysfxn

Front 50

mechanism of fibric acid derivatives?

Back 50

treat hypertiglyceridemia- decreased hepaic VLDL secretion and lower plasma VLDL, activate PAPR (peroxisomes)

Front 51

when to use fibric acid derivative?

Back 51

only have elevated triglycerides

Front 52

side fx fibric acid derivatives?

Back 52

GI, hepaptitis, gall stones, myopathy

Front 53

role of fish oil?

Back 53

omega-3 fatty acids: inhibit TG synthesis, decrease vLDL production