FOM Week 3 Flashcards
Explain the Effects of Buspirone and Erythromyosin When Taken Together
Both of the drugs get metabolized by the same enzyme, CYP3A4, in the liver. These two act as competitive inhibitors to each other thus slowing down the metabolism of them and causing side effects
Pharmocodynamic Interactions
The capability of one drug to affect another drugs response directly
Can be beneficial or harmful
What is the main form of lipids in our diet
Even carbon triglycerols
Two Essential FAs of Human Diet
Omega 3 and Omega 6
Where are lipids stored in the body
White adipose tissue
Liver
Where in the cell does beta oxidation occur
The matrix of mitochondria
What is the activating step of beta oxidation
The fatty acid gets converted into fatty acyl CoA
This turns ATP into AMP
Occurs in the cytosol of cell
How does fatty acyl CoA cross the inner membrane of mitochondria
It uses the Carnitine Transport Protein
Explain how malonyl CoA regulates beta oxidation
Malonyl CoA is produced by glucose metabolism in lipogenesis. This inhibits the carnitine transferase so no FAs are metabolized
When you are using glucose to make lipids there is no need to metabolize FA (occurs after consuming lots of sugar)
Explain what happens when you eat lots of fatty acids
Acyl CoA inhibits lipogenesis of from glucose occuring
If you just consumed lots of lipids, you dont want to be making them
Explain the oxidation of even saturated FAs
1) Activate them by turning them to acyl CoA
2) Oxidize and create FADH2
3) Hydrolyze
4) Oxidize to create NADH
5) Cleave using CoASH to create acetyl CoA and a 2C shorter acyl CoA
Explain the difference of beta oxidation in unsaturated fatty acids
Since there is already a double bond present you skip the first oxidizing step so no FADH2 is created
Explain the difference of beta oxidation in uneven fatty acids
Proponiol CoA is formed instead of acetyl CoA and then converted into succinyl CoA
Ketonegenesis vs Ketogenolysis
Occurs in the liver
Occurs in the muscle and brain during starvation
Byproduct is acetone which leads to ketoacidosis
Cartilage consists of
Chondrocytes
Matrix (ground substance + fibers)
How does cartilage get nutrition and oxygen
Through diffusion
It lacks blood vessels
Characteristics of Bone
It has a hard compact outside
It has a soft spongy inside
On the inside there are lots of neurons and vessels
It is constantly being remodeled
Diaphysis vs Metaphysis vs Epiphysis
Diaphysis is the long shaft bone
Metaphysis is near the edge of the bone
Epiphysis is the edge of the bone where it rounds
Types of Cells in the Bone
Osteoprogenitor cells- create osteoblasts
Osteoblasts- synthesis collagen type 1 and alkaline phosphotase
Osteoctyes- Osteoblasts that are surrounded by calcium
Osteoclasts- giant multinucleated cells derived from monocytes that have a ruffled border. They secrete acid to resorb bone
Osteiod
Only type 1 collagen and proteoglycans
They are unmatured and uncalcified
ARF Cycle
They cycle bone goes through once it gets damaged Activation Resorbtion Reversal Formation
Effects of PTH
It works to increase Ca in the blood
Binds to osteoblasts which will then secrete RANK-L. This will then bind to RANK on the osteoclasts and activate them which results in calcium being released
Denosumab and Osteoprotegerin
They both bind to RANK-L to prevent osteoclasts from binding to it and therefore prevent its activation
Biphosphonates
Used to treat osteoperosis
Work by causing the osteoclasts to undergo apoptosis
3 Types of Cartilage
Hyaline- smooth and made up of collagen type 2. Found in the bone
Elastic- has elastic fibers that make it not smooth. Made up of collagen type 2 and found in ear and larynx
Fibrocartilage- made up of collagen type 1 and 2. Found in the vertebrae disks
Where does substrate from the TCA cycle come from
Acetyl CoA from glycolytic pyruvate
Acetly CoA from beta oxidation
Succinyl CoA from beta oxidation
Amino acid catabolism
How does pyruvate get into the mitochondria
It freely passes the outer membrane but gets into the matrix from a carboxylic acid transporter in the inner membrane
Ways to Generate Oxaloacetate if None is Present
PEP
Pyruvate
Malate can all be used to make oxaloacete
TCA will not occur unless oxaloacetate is present
Function of Thiamine
Cleaves C-C bonds
Function of Riboflavin
Involved in redox rxns of FAD
Function of Niacin
Involved in redox rxns of NAD
Products of the TCA Cycle
CO2
NADH and FADH2 for the ETC
Explain How Cytosol NADH Enter Matix
Malate aspartate shuttle–> NADH
Glycerophosphate shuttle–> FADH2
Effects of Azide and CO on ETC
They bind to heme group and prevent oxygen from getting to tissues. Since oxygen is the final electron acceptor the ETC would stop and this would cause a build up of lactate
Delta G Naught vs Delta G
G naught is when the rxn is in equilibrium (G=0)
G is a snapshot of the rxn and must be negative for a rxn to occur
Importance of Free Energy Being a State Function
This means it is independent of its path
Because of this we can use free energy to do work such as couple with unfavorable rxns and make them occur
How enzymes work
Creatine Kinase and Phosphocreatine
They serve as a buffer system in the muscle
Explain How Mutated Proteins Affect G Naught
Mutations in proteins generally change the equilibrium of the folded state
Mutated proteins have a higher G Naught which means the reaction is less favorable
Useful Ways Our Body Uses ROS
Signaling
Immunity
Energy Production
Explain How NO Effects Vessels
NO is produced by NO synthase and binds to guanyl cyclase in the smooth muscle causing them to relax which serves as a vasodilator
Nitroglycerin vs Viagra
Nitrogylcerin causes more NO to be produced
Viagra makes the NO signal last longer
ROS In ETC
1-4% of electrons leak off and can bind with O2 to form superoxides
Is thought to serve as a signal to tell cell the current metabolic state
Ways to Prevent ROS Formation in ETC
Add more ADP
Slow down the TCA
Produce uncoupler proteins
How do metals affect ROS
Metals serve as a catalyst to forming ROS
H2O2 can bind to metals to form very toxic ROS
Ways ROS can attack our cells
They can cause mutations in DNA
They can cross link amino acids making them not able to be degraded
The can decrease the amount of unsaturated FAs in the membrane and thus depleting fluidity
Enzymatic Ways to Control ROS
They are located all throughout the cell
Dismutase takes superoxide and converts it to H202
Catalase then take H2O2 and converts it to oxygen and water
Non Enzymatic Ways to Control ROS
These are vitamins that accept the electrons and by doing so they become radical species
They are just more stable because of resonance
Some will also bind to metals to prevent less radicals from forming
Importance of Physical Exam
The MH interview allows you to get an idea of the diagnoses. The physical exam is a way to confirm it
"Normal" Vital Signs for: Heart Rate Respiratory Rate Blood Pressure Temp
60-100. Anything below is bradycardia. Anything above is tachycardia
12-20 respirations per minutes
120/80
36-38 degrees celcius
Which parts go under each of the SOAP categories
S- All of patient interview
O- Physical exam and vitals
A- Assessment of everything. What you think it is
P- Plan. What you are going to do to treat it
4 Reasons Why Documentation is Important
Billing
Legal record
Memory Aid
Communication with other professionals
2x2 Table
Exposure is on the Top
Disease is on the right side
What measures can we establish in cohort study
Cumulative incidence, incidence rate, hazard, risk ratio, relative risk, absolute risk
What measures can we establish in a case study
Odds ratio
Odds Ratio Formula
AD/BC
If it equals 1 there is no correlation
If it is greater than 1, exposure is a risk factor
If it is less than 1, exposure is a protective factor
Risk Ratio Formula
(A/A+C) / (B/B+D) or Risk in exposed/Risk in unexposed
Relative Risk Difference
1 - Risk Ratio (If protective)
Risk Ratio - 1 (If risk factor)
Normally used if exposure is a protective faster
Converts it into numbers that patient will get
Absolute Risk Increase
If exposure is protective: Risk in unexposed - Risk in exposed
If exposure is harmful: Risk in exposed - Risk in unexposed
*It will always be a positive number
Number Needed to Treat
1/ARR
You want this number to be low
Number Needed to Harm
1/Absolute Risk Increase
You want this number to be high
Attributable Risk
Risk in Exposed - Risk in Unexposed
Same as Absolute Risk Increase
Population Attributable Risk
Risk in Population - Risk in Unexposed
Tertiary Prevention
The disease has been ongoing
We are working to prevent it from getting worse
Secondary Prevention
The disease is relatively new
We catch it at the right time to prevent real damage
Primary Prevention
Preventing disease from happening in first place
Which region in KS has worst health outcomes
SouthEast
Wyandotte
Where are the largest % of hispanics in KS
SouthWest
This also has the lowest number of PCP
What filament do each motor protein bind to and which direction do each go: Myosin 1 Myosin 2 Kinesin Dynein
Actin and moves towards plus end
Actin and moves towards plus end
MT and moves towards plus end (periphery)
MT and moves towards minus end (body)
Gliding
When the motor proteins are anchored to a membrane or something. They can be used to move the filaments themselves to different parts of cell
Lamellipodium
The front part of the cell that has actin extending which causes the cell to move forward in its direction
Explain the Importance of Focal Adhesions in Cell Movement
Focal adhesions hold the cell down to the substrate
In order for the cell to move, the FA in the back have to get disassembled and then reform in the front
This is done by the assembly/disassembly of MT
Matrix MetalloProteases
They are proteins that degrade the BM and connective tissue. Very important in melanoma becoming invasive
TIMP-2
Required for MMP 1 to be active
Inhibits MMP 2
An example of moonlighting
How Touch Influences Cilia Movement
Cilia cells have mechanoreceptors that open upon touch. This causes an influx of Ca which makes the cilia move more rapid. The calcium also spreads to other cells via gap junctions
What tissues use glycolysis
All tissues but most occurs in the brain
Where does glucose come from
Diet (glucose/fructose/galactose)
Glycogen Storage in liver
Gluconeogenesis from amino acids
Explain the Steps in Glycolysis
1) Phosphorylate glucose to activate it
2) 2 rxns that attempt to make it symmetrical
3) 2 rxns that cleave and isomerize
4) 2 rxns that harness energy
5) 3 rxns that isomerize into pyruvate
What cofactors are used in glycolysis
ATP
NAD
Mg
K
What pathway products are produced by glycolysis
NADH
2 ATP
2 Pyruvate
What happens if no O2 is present
The ETC stops and thus no NAD+ is regenerated
This causes a back up in all the processes that require NAD+ (glycolysis/beta oxidation)
In order to regenerate NAD+ anaerobic respiration occurs
How is glycolsis and gluconeogenesis regulate
By enzyme inhibitors and free energy
Rxns that have a very low G are considered regulatory steps because they are irreversible (HK, PFK, PK)
Inhibitors and Activators of PFK
Inhibited by ATP and Citrate
Activated by AMP and F-2,6P
Inhibitors and Activators of FBPase
Inhibited by AMP and F-2,6P
Activated by ATP and Citrate
Goal of the Geriatric Comprehensive Assessment
To maintain function and well being
Focuses on quality of life rather than quantity
10 Parts to the Geriatric Assessment
AGING GAMES Audio/Visual Gait/Movement/Falling Insomnia Nutrition GI GU ADL Mood/Memory Environment Sexuality
DETERMINE for Nutritional Assessmenet
Disease Eating Poorly Tooth Loss Economic Hardship Reduction in Social Contact Medicines Involuntary Weight Loss Need for Assistance Elderly
Activities of Daily Living
DEATH Dressing Eating Ambulating Toileting Hygeine
Instrumental Activities of Daily Living
The first to go in dementia patients SHAFFT Shopping Housework Accounting Food Prep Transportation Telephone
