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Pharmacology and Biochemistry > Biochem lecture 4 > Flashcards

Biochem lecture 4 Flashcards

1
Q

Between what 2 things does “normal” plasma enzymes (PE) levels represent a balance?

A

1- the rate of synthesis and release into plasma during cell turnover, and
2- the rate of clearance from the circulation

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2
Q

what are 3 physiological processes that may result in PE levels mean?

A

1- increase in cell damage
2- proliferation of cells
3- reduced clearance from plasma

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3
Q

what are 2 physiological processes that may result in a decrease in PE levels (rare occurrence)?

A

1- reduced synthesis

2- congenital or inherited variants

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4
Q

How can we analyse PE levels in a more useful way (3 ways)?

A

1- one or more enzymes being analysed
2- isoenzymes differentiation (ex: CK: MB, BB, MM)
3- serial enzymes

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5
Q

What are 4 possible causes of increased PE levels?

A

1- non-specific illness
2- moderate exercise
3- large intramuscular injection
4- drugs

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6
Q

What are 3 factors in a patient that influence the results of a blood test on PE levels?

A

1- age
2- sex
3- physiological conditions

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7
Q

Transaminases

  • 2 types
  • which organs are they found mostly
  • what may a marked increase mean for both?
  • what may a moderate increase mean for both?
A

2 types:
. ALT (Alkaline T.) - found mostly in LIVER (tip: L-L)
. AST (Aspartate T.) - found mostly in Myocardium, Sk. muscles and Liver

Marked increase in AST and/or ALT:
. MI
. Acute or Toxic Hepatitis
. Circulatory failure

Moderate increase in AST and/or ALT:
. sk. muscle disease
. Liver disease: cirrhosis, mononucleosis, cancer
. cholesterol
. post: trauma, surgery (less so if raised ALT)
. severe haemolytic episode

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8
Q

Creatine Kinase (CK)

  • main 3 organs found in…
  • 3 isoenzymes, and where they are found most
  • what may a marked increase mean?
  • what may a moderate increase mean?
A

. Muscles: Skeletal, Myocardium
. Brain

Marked increase may indicate:

  • MI (CK-MB)
  • Shock and circulatory failure
  • muscular dystrophies (CK-MM)

Moderate increase may indicate:

  • post-trauma: muscle injury, surgery (for about a week)
  • physical exertion
  • IM injection
  • hypothyroidism
  • alcoholism
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9
Q

CK-MB

A

Creatine kinase isoenzyme MB

. myocardium: 35% CK-MB, 5% CK-MM

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10
Q

CK-MM

A

Creatine kinase isoenzyme MM

. Skeletal muscles

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11
Q

CK-BB

A

Creatine kinase isoenzyme BB

. Brain

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12
Q

Amylase
. action
. main diagnosis if found elevated in plasma

A

Pancreatic digestive enzyme
. allows b/d of starch and glycogen to maltose
. If plasma levels raised: ACUTE pancreatitis

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13
Q

Alkaline Phosphatases (ALP)

  • action
  • 2 isoenzymes’ organs
  • main 5 organs found in…
  • what may raised levels of ALP mean?
A

. Action: hydrolysis (b/d) of phosphates in high pH
. 2 isoenzymes: bone, liver

. found mostly in:

  • osteoclasts (bone)
  • cells of hepatobiliary tract (liver, gall bladder)
  • placenta
  • intestinal wall
  • renal tubules

. Raised ALP levels may indicate:

  • bone disease (rickets/osteomalacia, Paget)
  • Liver disease (cholestasis)
  • Tumour (bone, liver or direct tumour)
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14
Q

Gamma-Glutamyl Transferase (GGT)

  • main organs
  • main indication of raised levels
  • patient factor that affect levels
A

Liver, Kidneys, Pancreas, Prostate

Raised levels may indicate:

  • alcoholism, drugs
  • liver disease (cholestasis, hepatocellular damage)

Usually levels higher in men > women

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15
Q
  • Heart disease / MI, and plasma enzymes activity

- other more sensitive/specific? blood findings

A
  • Raised CK-MB: can be detected from 6 hours after infarct, with peak levels at 18-24 hours
  • Cardiac Troponin I and T
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16
Q

Liver disease

A
  • Raised AST, ALT, ALP, GGT
17
Q

Cholestasis

A
  • ALP

- GGT

18
Q

Muscular dystrophy

A
  • CK-MM

- AST, ALP

19
Q

Neurogenic myopathies

A

PE Levels usually normal

20
Q

List relevant plasma enzymes

A
  • Transaminases (AST, ALT)
  • Phosphatase (ALP and bone or liver IEs)
  • Creatine Kinase (CK and IEs: MM, BB, MB)
  • GGT
  • Amylase
21
Q

Name the 3 main functions of plasma proteins

A

1- inflammatory response and infection control (ex: CRP)
2- transport (ex: LDL, transferrin)
3- control of ECF (ex: albumin, sodium)

22
Q

Plasma proteins indicating acute inflammation

A
  • C-Reactive Protein (CRP, a complement activator, raise rapidly in acute inflammation)
  • ESR
  • IgM, IgG (first response)
  • WBCs: Neutrophilia, Lymphocytes etc
23
Q

5 Plasma proteins indicating Rheumatoid or AI inflammation

A

ESR, RhF, ANA, IgM, IgG

24
Q

ANA is NOT found in which autoimmune inflammatory disease? (but found in which ones?)

A

Not in: Ankylosing Spondylitis, Reiter’s syndrome

found in: RA, SLE, Scleroderma, Sjogren

25
Q

RhF is NOT found in which AID?

and found in which ones?

A

Not in: Ankylosing Spondylitis, Reiter’s syndrome

found in: RA, Sjogren

26
Q

Anaemia is often found in inflammatory AI disorders such as…

A

RA, Scleroderma, Sjogrens, and Reiter’s

NOT mentioned in A/S

27
Q

HLA-B27 gene found in…

A

A/S (up to 90%)

Reiter’s (65-96%)

28
Q

Tumour markers are often not… so mostly used to …

A

sensitive and specific … screen for early disease and prognosis of a tumour

29
Q

Alpha-fetoprotein

A

Oncofoetal protein => can be very high in LIVER cancers, and TERATOMAS (can also be raised without malignancy)

30
Q

CEA - Carcinoembryonic Antigen

A

Some tumours, esp. Colorectal Ca. (usually a bad prognosis if very high level) (tip: C-C)
(can also be raised without malignancy and in disease of GIT!)

31
Q

PSA - Prostatic Specific Antigen

A

Prostate Ca (can also be raised in benign prostate hypertrophy)

32
Q

CA - Carbohydrate Antigen (group of tumour markers)

  • used for…
  • 2 more specific types and indications
A
  • … to monitor response to treatment and recurrence of certain tumours
  • CA-125: Ovarian (tip 1: One… O-O)
  • CA-19-9: Pancreatic Ca, Colorectal Ca

Pharmacology and Biochemistry (10 decks)

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