Chempath - enzymes and cardiac markers Flashcards
In cell necrosis, which enzymes are released first - cytosolic or sub cellular?
Cytosolic first, then subcellular
If an enzyme is released by many different tissues, how can you identify which tissue it is released by?
Enzyme isoforms - these can be specific to a tissue
name 4 tissues which release ALP at high concentrations
Liver
Bone
Intestine
Placenta
3 ways liver and bone ALP can be differentiated
GGT measurement
Electrophoresis
Bone specific ALP immunoassay
2 physiological causes of raised ALP
Pregnancy in the 3rd trimester
Growth spurt in childhood
> 5x the upper limit of normal ALP - give 4 pathological causes
Bone - PAGETS, OSTEOMALACIA
Liver - Cholestasis, cirrhosis
<5x the upper limit of normal ALP - give 5 causes
Bone - Tumours, fractures, osteomyelitis
Liver - infiltrative disease, hepatitis
When is ALP raised in osteoporosis
When it’s complicated by fractures
Amylase is raised in acute pancreatitis. Which test is more specific?
Lipase
3 forms of creatine kinase - which muscles release them?
MM = skeletal MB = cardiac muscles BB = brain (activity is minimal)
Risk factors for statin related myopathy
High statin dose
Prev Hx of statin related myopathy
Polypharmacy w other drugs also metabolised by CYP3A4
5 causes of a raised CK
Myopathy MI statin severe exercise Physiological - esp afrocaribbeans
An 82 year old women presented with bone pain, history of fractures and bowing of her tibia. Which enzyme measurement might be helpful with the diagnosis?
ALP
A 64 year old man who smokes and has a family history of cardiovascular disease has recently been started on atorvastatin. Three weeks after commencing the tablet, he complains of generalised muscle pain. What is the working clinical diagnosis?
Statin related myopathy
What measurement is taken in patients being considered for azathioprine/6-mercaptopurine?
TPMT