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Pathopharm 2 > Final > Flashcards

Final Flashcards

1
Q

Which vitamin is associaed with induced hydrocephalus?

A

Vitamin A

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2
Q

Which vitamin is associated with induced hypercalcemia?

A

vitamin D

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3
Q

Supplemental vitamins my abe needed in special cases:

A

-pregnancy.lactation
-improper absorption (due to diarrhea, hyperthyroidism, alcoholism, liver disease)
-abx therapy(may lower GI bacterial synthesis of Vitmain K)
-hemodialysis
-hyperailmentation
-poor diet

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4
Q

Function of Thiamine (B1) (water soluble)

A

-converted to active coenzyme (thiamine pyrophosphate
-needed for decarboxylation reactions (pyruvate to Ac-CoA)
-pyruvate necessary to produce Acetyl-CoA
-also used by pentose in hexose-monophosphate shunt

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5
Q

What is indicative of thiamine deficiency?

A

high pyruvate plasma concentration

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6
Q

BeriBeri is due to low ____________

A

thiamine

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7
Q

BeriBeri causes:

A

-muscle weakness,
-decreased appetitie
-peripheral edema
-decreased BP and
-decreased temperature

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8
Q

Severe deficiency of Thiamine (B1)

A

Korsakoff’s syndrome (alcoholics)
associated with peripheral polyneuritis, loss of feeling in legs, memory impairment and encephalopathy

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9
Q

What ECG changes are associated with thiamine deficiency?

A

T-wave flattening and inversion and prolonged Q-T interval

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10
Q

Hyperailmentation (high glucose) requires more_____

A

B1 thiamine

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11
Q

In cases of high carb load, what vitamin do you need more of?

A

Thiamine B1

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12
Q

Function of Riboflavin (B2)

A

-converted to coenzymes flavin mononucleotide and flavid dinucleotide
-important in hydrogen ion transport oxidative enzyme processes
-Chlorpromazine and TCA’s intervene with flavokinase conversion to coactive coenzymes

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13
Q

Riboflavin deficiency (B2)

A

-pharyngitis and angular stomatitis; first symptoms followed by glossitis, denuded lips and dermatitis of face, trunk and extremities
-anemia, peripheral neuropathy, cataracts may occur

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14
Q

function of nicotinic acid (Niacin)

A

converted to nicotinamide adenine dinucleotide (NAD) and NAD phosphate (NADP) coenzymes
-required for oxidation/reduction reactions in tissue respiration

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15
Q

What is Pellegra

A

nicotinic acid (niacin) B3 deficiency

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16
Q

symptoms of Pellegra (niacin deficiency)

A

-dermitits
-diarrhea
-salivation
-N/V
-swollen tongue
-dementia
-motor and sensory nerve disturbances

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17
Q

What blocks the conversion of nicotinic acid to NAD?

A

INH
isoniazid

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18
Q

niacin toxicity seen as

A

-flushing
-prurutis
-hepatotoxicity
-hyperuricemia
-peptic ulcers

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19
Q

niacin needs can also be filled by:

A

nicotinamide and tryptophan which are converted to niacin

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20
Q

function of pyridoxine (B6) water soluble

A

-converted to pyridoxal phosphate by pydridoxal kinase
-acts as coenzyme for conversion of tryptophan to serotonin and methionine to cysteine necessary for amino acids

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21
Q

defiicencys of Pyridoxine (B6) commonly seen in

A

alcoholics

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22
Q

symptoms of Pyridoxine (B6) deficiency

A

symptomes include:
-dermititis
-CNS dysfunction
-seizures
-peripheral neuritis
decreased seizure threshold due to decreased GABA production (required B6)

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23
Q

INH and hydralazine inhibit__________

A

pyridoxal kinase (B6 deficiency)

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24
Q

pyridoxine increases decarboxylation of L-dopa which may then be contraindicated in patients taking L-dopa unless they are also taking carbidopa (Sinequan)

A
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25
Q

function of pantothenic Acid (water soluble)

A

-converted into coenzyme A
-needed for enzymatically driven acetylation reactions

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26
Q

deficiency of pantothenic acid

A

-rare due to its presence in many foods and production by intestinal bacteria
-thus no obvious need for supplementation even though it is usually a component of multivitamins

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27
Q

function of biotin (water soluble)

A

coenzyme for carboxylation reactions and fatty acid synthesis

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28
Q

deficiency of biotin

A

symptoms:
-glossitis
-anorexia
-dermititis
mental depression
-seen more frequently in infants, so formulas should contain supplements
-may be seen in prolonged hyperalimentation

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29
Q

function of folic acid

A

-absorped from SI in a transport form
-B12 required for conversion to active form (tetrahydrofolate)
-acts as a carbon transfer agent in conversion of homocysteine to methionine, serine to glycine, purine and DNA synthesis
-can cause anemia
-diet is primary source
-high level of enterohepatic recirculation lowers dietary needs
-cooking (heat) destroys up to 90% infood)

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30
Q

deficiency of Folic acid

A

-GI diseases and disorders most common cause
-alcoholism decreases food intake and may decrease enterohepatic recirculation
-some drugs (methotrexate, trimethoprim) inhibit conversion enzyme (dihydrofolate reductase)
-leucovorin used as a rescue agent
-most common symptom is megaloblasic anemia
-onset usually faster than seen in B12 deficiency due to limited storage

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31
Q

Cyanocobalamin (B12) function

A

-generic terms for a group of cobalt-containing compounds
-binds to glycoprotein intrinsic factor in stomach and is transported via carrier into the circulation in the ileum
-binds to transcobalamin II in blood for transport to tissues
-liver acts as a storage site
-needed for DNA synthesis so tissues with high turnover need most

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32
Q

deficiency of B12

A

-rare since found in most foods
-unless caused by decreased intrinsic or gastric achlorhydria
-GI bacterial infections may decrease availability
-nitrous oxide oxidizes cobalt atom in B12 thus rendering it ineffective
-symptoms usually involve blood (erythrocytes most) and nervous systems
-megaloblastic anemia usually first sign
-demyelination of nerves in spinal cord and cerebral cortex causes neuron death and is seen as paresthesias

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33
Q

What test is used to test for B12 deficiency?

A

Schilling’s test

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34
Q

treatment of B12 deficiency

A

-folic acid corrects anemias but not nervous system symptoms
-because most involve improper absorption oral supplements little value
-IM admin of B12 and oral dosing of folic acid best in severe cases
-while hematopoietic system usually responds rapidly (iron supplement?) nervous system response slower and may never fully recover
-therapy must continue monthly due to decrease in GI carriers

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35
Q

Function of Ascorbic Acid (vitamin C) Water soluble

A

-structurally related to glucose
-acts as coenzyme in many reactions
-well absorbed from GIT
-found in high levels in citrus fruits (juice) and used in foods as antioxidant
-megadoses widely claimed to be able to treat colon cancer and the sommon cold

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36
Q

what deficiency causes scurvy

A

vitamin C (ascorbic acid)

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37
Q

are hummans able to synthesize vitamin C

A

no

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38
Q

symptoms of Ascorbic acid (vitamin C) deficiency

A

-gingivitis
-petechia
-decreased wound healing

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39
Q

Vitamin C deficiency common in

A

-alcoholics
-drug addicts
-elderly

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40
Q

excretion of vitamin C enhanced by

A

Tetracyclines
Barbiturates
salicyclates

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41
Q

Vitamin A function

A

-function of retina, mucosal and epithelial cells, bone development, reproduction and embryonic growth
-stabilizes membranes and controls membrane permeability
-may be involved in synthesis of certain proteins and has been implicated in controlling development of some cancers-high doses required to be antineoplastic are hepatiotoxic

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42
Q

Major dietary sources of Vitamin A

A

-liver
-cheese
-butter
-milk
-fish
fruits and veggies

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43
Q

deficiency of vitamin A

A

-most common in infants and children
-symptoms not obvious unless severe deficiency
-skin lesions and infections early symptoms
-night blindness in severe deficiency
-pulmonary infections seen due to loss of bronchial cell secretions and drying
-urinary calculi, decreased spermatogenesis, spontaneous abortion
-taste and smell defieicny reports

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44
Q

hypervitaminosis vitamin A

A

-treat by removing source, symptoms usually resolve in 7 days
-symptoms irritability, vomiting, dermatitis
-loss of body hair, diplopia, nystagmus, gingivitis

Severe symptoms
hepatosplenomegaly with cirrhosis, increased intracranial pressure with neuro symptoms
-hypercalcemia due to bone destruction by increased osteoclast activity
-congenital defects when mothers consume abnormally high amounts

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45
Q

function of Vitamin D

A

-generic term for several sterols that acts as hormones
-responsible for proper maintenance of plasma calcium and phosphate levels
-regulates absorption of calcium and phosphate from GIT and mobilization from bone
-may act on proximal renal tubules to control calcium and phosphate exxcretion rate
-major sterol, 7-dehydrocholesterol, synthesized in skin and converted by sunlight to vitamin D
-also absorbed from GIT but requires bile salts
-hydroxylated in liver to calcitriol in active form
-calcitriol synthesis regulated by negative feedback system

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46
Q

Vitamin D deficiency

A

-seen as decrease in calcium and phosphate plasma levels
-this then stimulates parathyroid hormone secretion which tries to increase plasma calcium from bone
-in children this can cause rickets
-in adults=osteomalacia
-phenytoin decreases effectiveness of vitamin D and can lead to rickets and osteomalacia

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47
Q

vitamin D hypervitaminosis

A

symptoms:
-hypercalcemia
-muscle weakness
-fatigue
-headaches
-hypercalcemia affects the renal system causing pu/pd, proteinuria

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48
Q

treatment of vitamin D hypervitaminosis

A

-withdrawing source
-increasing fluid intake
-corticosteroids

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49
Q

Vitamin E functions

A

-found mainly in plants
-not much evidence for need in humans
-potent antioxidants
-seems to help absorption of Vitamin A
-used to prevent spontaneous aborptions but proof lacking
-antioxidant effects in preventing CAD by inhibiting oxidation of lipids

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50
Q

Function of Vitamin K

A

-required bile salts for absorption
-not stored for very long, need is continual
-used as cofactor in production of factors 2,7,9,10 from glutamic acid
-prothrombin time (2) measured as an index of vitamin K activity

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51
Q

Vitamin K 1

A

phytonadione
found in foods

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52
Q

Vitamin K 2

A

snythesized by gram + bacteria in GIT and supplies 50% of needed

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53
Q

deficiency of vitamin K may be due to :

A

-diet
-decreased bacteria flora
-decreased absorption
-hepatic disease

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54
Q

minerals are essential components in general function of body systems including:

A

-maintenace of osmotic pressure
-O2 transport
-nervous system function
-muscle function
-bone and tissue growth
-blood cell formation

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55
Q

Large minerals

A

-calcium
-phosphorus
-sodium
-potassium
-magnesium
sulfur
-chorline

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56
Q

trace minerals

A

-iron
-cobalt
-copper
zinc
-chromium
-selenium
-manganese
-molybdenum
-nickel
-tin
–silicon
-arsenic

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57
Q

hyperalimentation for prolonged periods may require ______supplementation

A

mineral

58
Q

more _____ in the body than any other mineral

A

calcium

59
Q

calcium is under control of________

A

vitamin D-parathyroid hormone-calcitonin system
-in blood also bound to albumin, phosphate or citrate
-arterial pH changes alter ionized concentration
-increased pH decreases concentration

60
Q

calcium important in:

A

neuro function
-muscle contraciton
-blood coagulation
-release of neurotransmitters and autocoids
-bone formation

61
Q

calcium cardiovascular effects

A

IV admin causes a brief increase in myocardial contractility and cardiac output while also decreasing heart rate
-arterial and venous pressure remain unchanged
-decreased heart rate due to increased vagal activity or a slowing of signal passage through the AV node

62
Q

hypocalcemia most commonly seen due to _________.

A

dereased albumin concentration

63
Q

other causes of hypocalcemia

A

-hypoparathyroidism
-Vitamin D deficiency
-renal failure with hyperphosphatemia
-acute pancreatitis
-rare: malabsorption of calcium or vitamin d

64
Q

smyptoms of hypocalcemia

A

-tetany
-increased neuromuscular excitability
-laryngospasm
-seizures
-hypotension

65
Q

treatment of hypocalcemia

A

-IV calcium (chloride, gluconate, gluceptate)
-IM calcium gluceptate as well as oral calcium in patients with minor calcium deficiency

66
Q

how much elemental calcium is in calcium chloride?

A

27mg/ml
-calcium chloride is irritating to veins and may cause discomfort

67
Q

how much elemental calcium is in calcium gluconate?

A

8mg/ml

68
Q

most common cause of hypercalcemia

A

-a cancer which activates osteoclasts by secretion of cytokines (such as TNF)

also
patients with hypoalbuminemia may appear to have normal free calcium but total plasma calcium is reduced
-hyperparathyroidism can cause milder form of hypercalcemia

69
Q

smyptoms of hypercalcemia

A

-sedsation
-vomiting
-ECG abn: prolonged P-R , wide QRS, shortened Q-T
renal damage

70
Q

treatment of hypercalcemia

A

-proper hydration
-bisphosponates given I to bind up excess calcium
-imporatnt not to decrease calcium too rapidly (best over 24-48 hours)
-also decrease osteoclast activity and thus are used to treat postmenopausal osteo
-other agents used to decrease calcium such as corticosteroids act more slowly (7-14 days)

71
Q

bisphosponates

A

-etidronate (Didronel)
-pamidronate (aredia
-alendronate (fosamax)

72
Q

role of K

A

-osmotic pressure control
-needed in many enzymatic reactions
-excitable cell membrane (nerves, cardiac and skeletal muscle
-kidney function

73
Q

aldosterone and ADH act at ______ to increase sodium reabsorption at the sacrifice of K

A

collecting ducts

74
Q

Beta adrenergic agonists shifts K _____cells

A

into
can be used to treat hyperkalemia

75
Q

Other drugs that shifts K into cells

A

theophylline
-insulin

76
Q

Which antibiotics cause K loss?

A

Penicillins
aminoglycosides

77
Q

symptoms of hypokalemia

A

-skeletal muscle weakness
-cardiac dysrhythmias

78
Q

first sign of hyperkalemia

A

ecg changes such as peaked T wave
as concentration further increases there is increased P-R and widened QRS

79
Q

treatment of hyperkalemia

A

-calcium given to help counteract cardiac effects
-sodium bicarb used as it shifts K into cells
-beta agonists

80
Q

phosphate

A

-imporatnt in energy metabolism and maintenance of acid-base balance
-acts as a buffer, allowing large amounts of H ions to be sequestered
-decreased plasma levels decrease bone deposition of calcium and increase plasma calcium levels

81
Q

______increases phosphate abosrption from GIT and proximal renal tubules

A

vitamin D

82
Q

hypophosphatemia

A

may limit ATP production and can lead to skeletal muscle weakness and CNS dysfunction

83
Q

magnesium ____% iin bone, ____% in muscle

A

50% in bone
20% in musucle

84
Q

mangesemia

A

mainly bound to proteins in plasma
-normal levels controlled via GI absorption and renal excretion of mechanisms
-usually see imbalances associated with other ion imbalances

85
Q

role of magnesium

A

-very important in certain enzymatic reactions mainly related to energy production
-ATP chelated to magnesium
-regulates calcium entry into cells and cellular actions
-ats as antagonist of calcium

86
Q

common causes of hypomagnesemia

A

-alcoholism
-hyperalimentation
-malabsorption and continued V/D

87
Q

symptoms of hypomagnesemia

A

-skeletal muscle weakness
-spasms, seizures
coma

cardiac surgery requiring pump -bypass may be cause due to dilation by pump priming solutions or diuretic use

88
Q

hypermagnesemia

A

-rarely seen since mag is poorly abosrbed and renal excretion rapid
-can offur when given IV or in chronic renal failure

89
Q

symptoms of hypermagnesemia

A

-sedation
-myocardial depression
-decreased neuromuscular function from Ach release
-direct relaxant effect on skeletal muscles

90
Q

magnesium uses

A

-OB for prophylaxis and tx of convulsion in patient with gestational proteinuric HTN
-control arythmias associated with digitalis
-hypokalemia
-alcoholism
-MI

91
Q

iron is absorbed in SI then bound to ____ for transport to tissues

A

transferrin
transferrin def can lead to iron def
most enters bone marrow for incorporation into new erythrocytes

92
Q

patients should stop taking herbals_ ____prior to planned sx

A

2 weeks

93
Q

Echinacea uses

A

-boosts immune system
-helps fight colds and flu
-wound healing
used for UTIs and bronchitis

94
Q

concerns for echinacea

A

-hepatitis in conjunction with anabolic steroids and methotrexate
-hepatotoxicity
-decreased effectiveness of corticosteroids

95
Q

ephedra uses (Ma-Huang)

A

-diet aid
-asthma
-bronchitis
-antitussive

96
Q

concerns with ephedra

A

-arrythmias
-sympathetic crisis with MAOIs
increased BP and HR

97
Q

feverfew uses

A

-migraine headaches
-fever
-allergies
-arthritis
-rheumatic diseaes

98
Q

concerns of feverfew

A

-platelet inhibition-may increase bleeding, especially if used with other anticoags
-rebound migraines
-gi irritation.ulcers

99
Q

garlic uses

A

-cholesterol/lipid lowering
-antihypertensive
-anticoagulant

100
Q

concerns with garlic

A

-platelet inhibition-may increase bleeding, especially if used with other anticoags

101
Q

ginger uses

A

-antiemetic
-antispasmotic

102
Q

concerns with ginger

A

inhibits thromboxane synetase, resulting decreased clotting

103
Q

ginkgo biloba uses

A

increased blood circulation and oxygenation
-enhanced mental alterness and memory

104
Q

concerns of ginkgo biloba

A

-platelet inhibition-may increase bleeding, especially if used with other anticoags

105
Q

ginseng uses

A

-increased physical stamina
-enhanced mental concentration
-antiox

106
Q

concerns for ginseng

A

-platelet inhibition-may increase bleeding, especially if used with other anticoags
-post menopausal bleeding
0increated BP /HR
mania with phenelzine (nardil)
decreased effectiveness of warfarin

107
Q

goldenseal uses

A

-laxative
diuretic
antiinflammatory

108
Q

goldenseal concerns

A

-enhanced sodium retention
-edema
HTN

109
Q

Kava kava used

A

-anxiolytic
-muscle relaxant

110
Q

concerns with Kava KAva

A

increased duration of anesthetics
enhanced efefcts of other CNS depressants
increased suicidal risk in depressed patients
-hepatotoxicity
-aggravation of parkinsons disease symptoms

111
Q

licorice uses

A

GI ulcers
antitussive

112
Q

concerns with licorice

A

may increase BP and edema and cause hypokalemia

113
Q

uses of saw palmetto

A

BPH

114
Q

concerns with saw palmetto

A

may interact with other hormone therapies
may increase bleeding times

115
Q

st johns wort uses

A

CNS depression or anxiety
sleep disorders

116
Q

concerns for St. Johns wort

A

may prolong the effects of anesthesia
decreased effectiveness of administered HIV protease inhibitors and reverse transcriptase inhibitors
-may decrease plasma digoxin levels

117
Q

valerian uses

A

sedative or anxiolytic

118
Q

concerns for valerian

A

potentiation of other CNS depressants including anesthetics

119
Q

Black licorice (Glycyrrhiza) can cause _______

A

potassium loss and subsequent cardiovascular instabilities
prolongs PR and QT intervals

120
Q

Tyramine containin foods that may increase nervous system activity and blood pressure especially in patients taking MAOIs

A

-chocolate
-hot dogs
-processed meats
-aged cheese
-draft beer

121
Q

which herbals can cause decreased clotting and increased bleeding:

A

Garlic
Ginger
Ginkgo Biloba
Ginseng
Feverfew
-saw palmetto

122
Q

which herbals increase duration of anesthesia and enhance effect of other CNS stimulants

A

Kava-Kava
-St. Johns wort
valerian root

123
Q

Ephedra linked to

A

cardiac arrythmias
increased BP /HR

124
Q

Pregnancy Class A

A

reasonable research shows no increased risk of fetal abnormalities.

125
Q

Pregnancy Class B

A

Animal studies have not demonstrated increased risk to the fetus, however human studies lack proof of safety.

126
Q

Pregnancy Class C

A

No proof of safety in animal or human studies. Animal studies may indicate an increased risk.

127
Q

Pregnancy Class D

A

Human studies have shown an increased risk to the fetus. However, risk/benefit ratio may override risk.

128
Q

Pregnancy Class X

A

Human and/or animal studies have demonstrated a definite link to fetal abnormalities. Drugs in this category are considered contraindicated during pregnancy or in women who may become pregnant.

129
Q

Maternal CO can be increased by _____% in first trimester which will increase absorption rate of drugs via topical routes

A

50

130
Q

Pregnancy: pulmonary uptake is enhanced due to:

A

increased minute ventilation and decreased FRC
this will not increase induction rate of IA due to tissue redistribution which is not effected

131
Q

which enzymes have increased metabolism during metabolism

A

CYP3A4 (midazolam), CYP2D6 (propranolol), CYP2C9 (phenytoin) , and UGT (morphine) isozyme metabolism

132
Q

Which enzymes are decreased during pregnancy

A

CYP1A2 (theophylline), and CYP2C19 (warfarin) activity is decreased.

133
Q

How is pseudocholinesterase activity affected in pregnancy:

A

While pseudocholinesterase activity is decreased in pregnancy, the expected increase in duration of succinylcholine is not seen primarily due to an increased volume of distribution.
Postpartum patients may show an increased duration of succinylcholine due to the volume of distribution returning to normal

134
Q

Renal blood flow in pregnancy

A

Renal blood flow is increased up to 80% and GFR up to 50% (less near term) causing an increased elimination of renally excreted drugs (e.g. cephalosporins, digoxin).

135
Q

The placenta contains a high concentration of UGT isozymes and may contribute to increased maternal metabolism by that route.

A
136
Q

Are lipid soluble drugs a major determinant of drug transfer?

A

no

137
Q

Which drugs are demonstrated to be present in high enough concentrations to cause CNS depression in breastfeeding infants?

A

meperidine and codeine

138
Q

Pain thresholds are increased in pregnancy by the endogenous opiates and seem to be related to estrogen and progesterone concentrations.
Primary pathways effected are spinal delta and kappa opioid systems along with descending spinal alpha-2 noradrenergic pathways.

A
139
Q

In US propofol is _______ in pregnancy

A

not recommended and may cause neonatal depression

not not contraindicated

140
Q

Tocolytics

A

CCB (Nifedipine)-may delay delivery up to one week
Beta 2 agonists (Salbutamol)
NSAIDS (Sulindac
Magnesium

141
Q
A

Pathopharm 2 (4 decks)

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