Pharmacology Unit 3

Ch. 23-30

False

T or F: Plasma doesn’t make plaque

MI which can lead to death

Angina (clogging of the arteries) can lead to what?

Cholesterol

building blocks for cortisol, aldosterone, progesterone, estrogen, testosterone; you can either take it in from diet or make it

Cholestryl Esters

Cholesterol vasculature is made from?

TAG (trigylcerides)

Major means of transporting fatty acids; whithin tissue to realease fatty acids, for energy or fat membranes

Fatty acid families

n-3, n-6, n-9

25n-3(EPA), 226-3(DHA)

What are the two omega 3 fatty acids in fish oil?

204n-6(more bioactive) and 205n-3(less bioactive)

Which two fatty acids compete for cox1/cox?

Medium Chain (MCT)

influence n-3/ n-6 metabolism

Statins

increase LDL receptor which increases half-life of LDL which decreases oxLDL; decreases cholesterol synthesis by inhibiting HMG-coA which leads to SCAP Cleves SREBP in the nucleaus, which increases expression of all things Chat and LDLR which decreases LDL half life.

statins

soften plaque and treat hypercholesterimia, not for kids and is Preg X, CoQ10 can be decreased.

Rhabdomyolysis

Statin induced muscle breakdown, shuts down kidney function which can lead to kidney failure

Ezetimibe

failed drug by itself but a good combo drug, inhibits NPC1L1 (cholesterol transporter in enterocyte), causes a 10% decrease in plasma cholesterol

Phytosterols

go in by NPC 1L1 and go out MDR (multiple drug resistant transporter), competes with cholesterol for the same spot

Cholestigmine

bile acid sequestering, bead, bind bile acids; can’t recirculate; liver ma less more- decreases cholesterol, is similar to statins; great us for kids

Niacin

#1 in tissue flushing; decrease LDL 20% which decreases ULDL which decreases TAG; can also increase HDL

niacin and moderate exercise

Ways to increase HDL

niacin, fibrates

Ways to decrease TAG (also decreases VLDL)

Fibrates (Gemfibrozil)

Increases LPL which increases metabolism of TAG which decreases half life and increases rate of degredation; binds to PPAR

PPAR

goes to nucleus and controls lipid metabolism genes

n-3 fatty acids

incosapent (vascepa)- 96% EPA

Epanova Lovaza

EPA/ change in HA is 1:1; decreases TAG levels

Lipid Control via Lifestyle Changes

exercise (decreases HDL), weight, no tobacco, decrease saturated fatty acids, decrease trans fatty acids, increases soluble fiber, BMI (not that effective).

good

High cortizone in urine

bad

high cortisol in urine

high BP

high cortisol in the urine contributes to

kidney

What is the major controller of BP

11b dehydrogenase

cortisol can change to cortisone (doesn’t bind) with what?

cortisol and cortisone

What glands resond to aldosterone?

cortisol binds to minimal corticoid receptor and competes with aldosterone

Why does 11b dehydrogenase have high activity?

Aldosterone (in kidney)

minimal corticoid receptor, saves Na pees out K+

Kidney

important for HTN

sprionolactone

inhibits minimal corticoid receptor (doesn’t see cortisol), K+ sparing diuretic, mild diuresis, can combine with other diuretics for better effect, well tolerated, inhibits aldosterone receptor; important to watch K+ levels

nephrotoxic drugs

long term use causes nephrotoxicity which decrease nephrons which decreases kidney function

Nephrotoxic Drugs

Amphotericin B (systemic antifungal), Cisplatin and carboplatin (cancer), Cyclosporine and tacrolimus (immunosuppressant

amino glycoside antibiotics

massively increase ototoxicity

Loop Diuretics (Furosemide (Lasix))

very effective diuretic, Na+ goes out but so does K+; Need to assess Li levels due to poor clearance, Side Effects include, heart issues (dysrhythmia), cramps, dehydration, hypokalemia

Hydrochlorothiazide

standard use for HTN, Na+ (H2O follows Na+) goes out but so does k+ which decreases volume, used heavily, no ototoxicity potential; side effects heart issues (dysrhythmia), cramps, dehydration, hypokalemia

Hypokalemia

k+ pills to treat, K+ helps with insatiable thirst

Renin

cleaves angiotensynogen, Ang 1(Lungs) changed to Ang 2 (Heart), Ace- angioten; kidney senses when BP and when low releases more of this.

Erythropoietin (EPO)

doping; increases RBC- thickens blood

Calcitrol

active form Vitamin D