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32 Cards in this Set
- Front
- Back
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The important dietary ____ include fatty acids, triglycerides, and cholesterol. These substances are necessary for the formation of cell membranes, nerve tissue, and plasma lipoproteins.
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lipids
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Excess dietary lipids are stored as fat in ___ tissue, where they serve as a reserve form of energy.
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adipose
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Cholesterol is stored in the gallbladder as a component of ____ _____.
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bile acids
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With a balanced nutritional diet, the body absorbs ____ of its daily cholesterol from the diet and produces two-thirds through cellular synthesis in the liver and intestines.
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one-third
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Cholesterol is an important substrate for the body because it is the fundamental building block of steroid hormones (adrenal corticosteroids). 3-Hydroxyl-3- methylglutaryl coenzyme A (HMG-CoA) is acted upon by the enzyme HMG-CoA reductase to produce _____ acid. After a series of reactions in the liver, this becomes cholesterol.
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mevalonic
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The critical step that regulates cholesterol synthesis is ______.(This is important because it is a site of drug action.)
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MHG-CoA reductase
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_______, produced in the liver and intestines, transport lipids such as cholesterol and triglycerides to areas of utilization or storage.
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lipoproteins
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_____ lipoprotein delivers cholesterol to cells for further cell-specific synthesis.
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low-density
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_____ produced by the intestines transport dietary cholesterol and triglycerides. During the breakdown of this, triglycerides are hydrolyzed by the enzyme lipoprotein lipase. The remnants of this exchange cholesterol that can be converted to bile acids, excreted in the bile directly, or stored. These remnants also suppress internal cholesterol synthesis and down regulate the LDL receptors.
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chylomicrons
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although lipids are essential for cell structure and function, unusually high LDL levels in the plasma have been correlated with several disease such as diabetes mellitus, lupus erythmatosus, lipodystrophies, hypothroidism, and premature ______.
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atherosclerosis
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Cholesterol, carried by ____, has been implicated in the formation of atherosclerotic plaque.
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LDL
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Atherosclerosis usually manefest itself clinically as coronary artery disease (CAD), stroke, or hypertension, each of which contributes to ____-.
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Coronary heart Diseae (CHD)
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Risk factors associated with the development of ? are:
age (men over age 45; women over age 55); history of smoking, hypertension, premature menopause, obesity, antihypertension medication; hormone imbalance (diabetes mellitus, hypothyroidism); weight (> 30% overweight); and lipoprotein status (low HDL, high LDL) |
CHD
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On the other hand, cholesterol transported by ___ appears to be "protective". Individuals with high ___ cholesterol levels are thought to be less prone to CHD because of the rapid clearance of cholesterol and triglyceride-rich lipoproteins from the circulation. When it is available, it can exhange its cholesterol for tryglyceride through the action of lipid transfer proteins.
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HDL
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___ levels can be elevated through vigorous exercise, a diet that includes fish and/or diet supplementation with omega-3-polyunsaturated fatty acids (fish oils), and moderate alcohol consumption. Factors that decrease HDL include smoking, obesity, liver damage, uremia, and starvation.
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HDL
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Bile salts are syntesized from cholesterol and released into the duodenum as a part of bile. The main function of bile salts is to break down fats ingested in the diet into absorbable forms. The bile salts are recycled by intestinal absorption and storage within the _______.
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gall bladder
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_____ (Questran) is an ion exchange resin that combines with the bile salts and cholesterol in the intestinal tract. this insoluble binding prevents the absorption of the bile salts and cholesterol. the result is an increased elimination of bile salts, cholesterol, and other fats in the feces. Low density lipoprotein and cholesterol levels decrease during treatment.
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Cholestyramine
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The action of ____ (Colestid) is similar to that of cholestyramine. It interferes with the absorption of bile acids and cholesterol from the intestinal tract.
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colestipol
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_____, 4-6g per dose, is mixed with fruit juice and taken twice a day before meals. 1 hour before or 4 hours after.
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Cholestyramine
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This class causes gi disturbances, constipation, HA, dizziness, drowsiness, and anxiety, nausea, vomitting, flatulence, intestinal obstruction.
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Bile acid sequesterants
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Lovastatin (Mevacor) was the first in the class of drugs that inhibit the enzyme HMG-CoA reductase. This inhibition reduces the circulating LCL that transports cholesterol. By reducin the plasma levels of LDL, lthe levels of cholesterol in the plasma are reduced. At the same time, plasma levels of ____ cholesterol are increased in the circulation.
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HDL
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This drugs class should not be taken with grapefruit juice because drug interaction inhibits enzyme that metabolizes these drugs.
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Statins
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Lovastatin and simvastatin have been used successfully in combination with ______ to lower cholesterol. Combo therapy dramatically reduces cholesterol and LDL cholesterol to levels that cannot be attained by either the bile salt sequesterant or enzyme inhibitor alone.
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cholestyramine
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This class of drugs can elevate liver enzymes, the serum levels should be repeated every 6-12 weeks to avoid serious adverse effects. Persistent elevation in liver enzymes may require discontinuation of the drug.
side effects: HA, dizziness, alterations of tast, insomnia, diarrhea, flatulence, abdominal cramping and or pain, and photosensitivity. |
Statins
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Ezetimibe,a ______ inhibitor, acts at the surface of the small intestine to block absorption of dietary cholester. This action reduces the amount of cholesterol delivered to the liver and facilitates clearance of cholesterol from the blood. This drug is approved for use alone, in combo with statins or bile acid sequestrants for the treatments of hypercholesterolemia. It has a low incidence of adverse effects.
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cholesterol absorption inhibitor
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_____ appears to reduce the level of the VLDL and LDL, lipoproteins responsible for carrying triglycerides and cholesterol in dose-dependent manner. At the same time, fat metabolism in adipose tissue is inhibited, and lipoprotein lipase (TG breakdown) is stimulated. Consequently the plasma lipid level is significantly reduced. The immediate release preparation increases HDL, while the sustained release product reduces total cholesterol and LDL preferentially.
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Niacin
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Nicotinic acid or (_____) causes nausea, vomitting, diarrhea, and vasodilation, flushing, tingling ,itching, or headache, alters liver function. Aspirin taken 30 minutes before dosing also mitigates the vasodilation in many patients.
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Niacin
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Niacin may also increase uric acid levels in the blood (hyperuricemia). Individuals with high uric acid levels may develop symptoms of ___.
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gout
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____ _____ _____, Gemfirozil (Lopid) and fenofibrate (Tricor) are derivatives of fibric acid that decrease triglyceride and VLDL, and increase HDL. In addition to inhibiting the breakdown of fats into triglycerides, liver production of triglycerides is inhibited. They cause nausea, vomitting, diarrhea, and flatulence, dizziness, blurred vision, and myopathy.
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fibric acid derivitives
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Cholestyramine binds with fat-soluble vitamins (A,D, and K), folic acid, and many drugs, thus reducing their _______.
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GI Absorption
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It is recommended that any other medications be taken 1 hour before or at least ? hours after cholestyramine to avoid interaction w/in the intestinal tract that would delay or inhibit absorption of the concomitant medication.
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4 hours
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____ should not be taken during pregnancy because of their ability to affect metabolism and critical growth factors in the developing fetus.
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Statins
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