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Chapter 2: vitamins, minerals, trace elements Flashcards

1
Q

Which vitamin is the cofactor for PTH?

A

Vitamin A

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2
Q

PTH

A

causes osteoclast activity: Ca up and P down

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3
Q

If Ca and P are both down, which vitamin is missing?

A

Vitamin D (allows more Ca to be absorbed)

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4
Q

Which vitamins needed for night vision?

A

Vitamin A

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5
Q

Vitamin for CSF production?

A

Vitamin A

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6
Q

For which pts should we give Vitamin A?

A
  1. Measles (regenerate epithelium of lung)
  2. Cancer t(15,17)
  3. infections that destroy cells
  4. Burn pts
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7
Q

What is the most common cause of free radical formation?

A

infection, mcc viruses

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8
Q

Which cells make free radicals and using which enzyme?

A

neutrophils via NADPH oxidase

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9
Q

Too much vitamin A?

A
  1. hyperparathyroidism (Ca up and get moans, groans and stones) 2. pseudotumor cerebri CSF up, brain ventricles dilate causing headache and papilledema
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10
Q

Headache with Papilledema steps to diagnosis

A
  1. Rule out mass (non contrast CT)
  2. rule out infection (LP)
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11
Q

Tx for Pseudotumor Cerebri

A

1.discontinue Vitamin A
2. if acute: serial lumbar puncture 30cc/24hours
3.chronic: weight loss, CA inhibitor: acetazolamide or mannitol

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12
Q

carbonic anhydrase inhibitor

A

acetazolamide

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13
Q

criteria for bariatric surgery

A

BMI greater than 40
BMI greater than 35 with cormorbidity
BMI greater than 30 with 2 comorbidities

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14
Q

Thiamine important for 4 enzymes

A
  1. pyruvated dehydrogenase
    2.alpha-ketoglutarate dehydrogenase
    3.branched chain amino acid dehydrogenase
    4.transketolase (pentose phosphate pathway)
    All use TPP (thiamine pyrophospate)
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15
Q

which organs use thiamine?

A

brain uses transketolase; heart uses dehydrogenases

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16
Q

Where is the Wernicke area?

A

posterior temporal lobe

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17
Q

What is Wernicke’s function?

A

receive spoken or written language

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18
Q

Wernicke’s aphasia?

A

receptive aphasia

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19
Q

Wernicke-Korsakoff

A

from alcoholism: mamillary bodies involved; confabulation; unable to move short term memory into long term memory

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20
Q

What is beriberi and what are the two types?

A

Heart gives out from massive dilation; dry beriberi (until you have heart failure); wet beriberi (fluid in lungs, massive ventricular dilation) from Vita B1 deficiency

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21
Q

What is a sign of B2 deficiency?

A

angular cheilosis

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22
Q

What is B2 name?

A

riboflavin

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23
Q

What is B2 used for?

A

for cofactors (FAD)

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24
Q

5 enzymes needed by pyruvated dehydrogenase, a-ketoglutarate dehydrogenase and branched chain AA dehydrogenase

A

Tender Loving Care For Nancy:
Thiamin
Lipoic Acid
CO-A (B5)
FAD (B2)
NAD (B1)

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25
Q

What AA is the precursor to Niacin?

A

Tryptophan

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26
Q

4 Ds of Niacin deficiency

A

diarrhea, dermatitis, dementia, and death (Pellagra)

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27
Q

What is the problem in Hartnup’s disease?

A

defective renal transport of tryptophan, causing tryptophan to leak into urine (presents like Pellagra)

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28
Q

Besides Niacin, tryptophan also is needed to make what?

A

serotonin

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29
Q

another disease that uses up tryptophan

A

carcinoid syndrome, serotonin excreted out rapidly, using a lot of tryptophan

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30
Q

Niacin supplements can be used for which disorder?

A

hypertriglyceridemia

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31
Q

What are the side effects of using niacin supplements?

A

flushing, itching due to release of prostaglandins; insulin resistance (because blocks insulin receptors); gout (competes with uric acid)

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32
Q

What is the acute management of gout?

A

indomethacin (inhibits COX 1/2)

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33
Q

What is the most effective treatement for gout?

A

colchicine (blocks tubules); could cause renal failure

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34
Q

Which gout drug blocks xanthine oxidase?

A

Allopurinol

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35
Q

Which gout drug is a recombinant of urate oxidase (uricase) that metabolizes uric acid

A

Rasburicase

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36
Q

Which gout drug block reabsorption of uric acid?

A

Probenecid

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37
Q

Which vitamin is needed for all liver transaminases?

A

B6

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38
Q

Which vitamin is needed to make heme?

A

B6

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39
Q

Which TB drug must we supplement B6 (pyridoxine)?

A

Isoniazid (INH)

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40
Q

DOC for chronic neuropathy

A

TCA

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41
Q

MOA for TCA

A

blocks reuptake of catecholamine (levels rise); block Na, block alpha 1, antihistiminc

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42
Q

If heart disease which drug for neuropathy?

A

gabapentin

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43
Q

If shooting/stabbing neuropathy?

A

carbamazepine (blocks Na/Ca channel

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44
Q

What is the first vitamin to run out when a pt has rapidly dividing cells?

A

folate

45
Q

When are cells rapidly dividing?

A

0-2 years
4-7 years
puberty
pregnancy

46
Q

folate function

A

makes tetrahydrofolate (THF) that makes thymidine of DNA

47
Q

anemia of folate deficiency

A

megaloblastic anemia

48
Q

What could be complications of B9 deficiency in pregnancy?

A

neural tube defects

49
Q

Vitamin B12 is needed by which two enzymes?

A

Homocysteine methyltransferase (makes THF)
and Methyl Malonyl CoA mutase (recycles odd FA to make myelin, so deficiency causes neuropathy)

50
Q

How to distinguish B9 from B12 deficiency in megaloblastic anemia?

A
  1. B12 has neuropathy
  2. B9 very rapidly depleted; B12 takes years to deplete
    3.B12 def. will cause methylmalonic acid in urine to rise
51
Q

MCC of pernicious anemia in the US

A

Type A gastritis

52
Q

What is vita C used for?

A

hydroxylates proline and lysine in collagen and elastin

53
Q

Where does hydroxylation occur in a cell?

A

RER

54
Q

sign of vitamin C deficiency

A

bleeding from hair follicles and gums

55
Q

Why is it best to drink orange juice with iron supplements?

A

Vitamin C protects iron from being oxidized in GI tract

56
Q

Vitamin D deficiency in children

A

rickets

57
Q

Vitamin D deficiency in adults

A

osteomalacia

58
Q

If a girl has rickets and vitamin D doesn’t correct it, what should you suspect?

A

Vitamin D resistant rickets
(X linked dominant) Dad’s give daughters ; defective renal reabsorption of phosphorus

59
Q

Labs seen in Vitamin D resistant rickets?

A

Low calcium, low phosphorus even with Vita D supplementation.

60
Q

X-linked dominant diseases

A
  1. Vita D resistant rickets
  2. pyruvate dehydrogenase deficiency
    3.pseudohypothyroidism
61
Q

What is the main antioxidant in blood?

A

Vitamin E

62
Q

What is biotin necessary for?

A

carboxylation

63
Q

What is Vita K used for?

A

gamma carboxylation (adds third gamma carboxyl group to Vita K dependent clotting factors

64
Q

What are Vita K dependent clotting factors?

A

10, 9, 7, 2 Protein C and S

65
Q

What drug blocks all Vita K clotting factors?

A

Warfarin

66
Q

Why does warfarin cause clots at first?

A

Protein C (thrombolytic) is the first factor to lose its function, so there may be local clotting.

67
Q

Why do we give heparin before warfarin?

A

to prevent clotting

68
Q

How many days is the heparin bridge?

A

two days

69
Q

If you don’t want 2 day heparin bridge which drugs can you consider?

A

apixaban, rivaraxaban (direct factor X inhibitors)

70
Q

Anticoagulant for pregnant women?

A

LMWH until 9 months switch to unfractioned heparin

71
Q

What do you give first for venous clots?

A

heparin

72
Q

What do we check when a pt on warfarin?

A

PT

73
Q

If PT is too high in warfarin pt?

A

vita K complex IM; if bleeding acutely, prothrombin complex or FFP

74
Q

duration of warfarin treatment

A

1st clot with known cause, 3 months; second time with know cause, 12 months; 3rd time or if ever the cause is unknown, lifetime

75
Q

MCC genetic spontaneous venous clot

A

Factor V Leiden mutation

76
Q

Treatment of Factor V Leiden mutation?

A

lifetime warfarin

77
Q

desired INR with warfarin

A

2-3

78
Q

desired INR with warfarin for prosthetic valve pts?

A

2.5 to 3.5

79
Q

What factors does heparin block?

A

thrombin, and intrinsic pathway (9,10, 11, 12)

80
Q

What lab do we follow with heparin?

A

PTT

81
Q

heparin toxicity antidote

A

protamine sulfate; acutely bleeding FFP

82
Q

SE of heparin

A

bleeding, hyperlipidemia due to homorne sensitive lipase (milky white plasma); HIT1 from platelet clumping within first 2 days; HIT2 after day three

83
Q

HIT2 cause

A

Heparin acts as hapten on PLT causing antibodies to form; attack on PLT causing inflammation and vasculitis

84
Q

HIT2 treatment

A

switch to Argatroban (block thrombin directly); or fondaparinux (factor Xa inhibitor)

85
Q

What can we do if pt. has contraindications to heparin but has venous clots?

A

IVC filter

86
Q

4 cephalosporins inhibit vita K?

A

cefamandole, cefotetan, moxalactam, cefoperazone

87
Q

Which three vitamins need to be supplemented for pregnancy?

A

folate, Ca, Iron

88
Q

cofactor for all kinases

A

magnesium

89
Q

cofactors of PTH

A

vita A and magnesium

90
Q

Why should we give K bolus with Magnesium

A

K and Mg share cotransport protein

91
Q

Which mineral is needed for hair, skin, sperm and taste buds?

A

zinc

92
Q

Which mineral is needed by complex IV in electron transport chain?

A

Copper

93
Q

Which mineral is needed by lysine oxidase in formation of collagen?

A

copper

94
Q

Which disease is caused by ceruloplasmin deficiency?

A

Wilson’s Disease

95
Q

What does ceruloplasmin do?

A

transports copper from liver to duodenum for excretion; if deficient, cannot excrete copper and copper will accumulate in liver (cirrhosis); brain (basal ganglia) and cornea (Keyser-Fleischer rings)

96
Q

What is DOC for Wilson’s?

A

penicillamine ( cannot use if allergic to penicillin and may cause drug-induced lupus

97
Q

Which movement disorder is caused by trinucleotide repeats?

A

Huntington’s

98
Q

MCC of death in Huntington’s

A

suicide

99
Q

Which area of brain is affected by Huntington’s?

A

caudate nucleus

100
Q

DOC for Huntington’s?

A

antipsychotics (dopamine blocker)

101
Q

5 diseases that have trinucleotide repeats

A
  1. Huntington’s
  2. Fragile X
  3. mytonoic dystrophy
  4. Freidrich’s ataxia
    5.Prader-Willi (5% trinucleotide repeats)
102
Q

What gene is involved in Wilson’s?

A

ATP7B

103
Q

What gene is involved in Menke’s?

A

ATP7A

104
Q

What trace element if deficient may cause DM2?

A

chromium

105
Q

What is the inheritance pattern for structural proteins?

A

Autosomal dominant

106
Q

What is the inheritance pattern for enzymes?

A

Autosomal Recessive

107
Q

What is it called if you inherited the gene but don’t have the disease?

A

incomplete penetrance

108
Q

What is it called when many members of a family have the defective gene but have different problems?

A

variable expression

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