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Professional Development > Part 3 > Flashcards

Part 3 Flashcards

1
Q

Precision/personalized medicine

A

Drug therapy specifically targeted to an individual’s genetic content

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2
Q

Essential nutrient and examples

A

Must be obtained externally because the body cannot produce it, water, carb, protein, lipids, vitamins, minerals

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3
Q

Ghrelin

A

Hormone released by the stomach upon lack of distension to stimulate appetite in the hypothalamus

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4
Q

Leptin

A

Hormone released by adipose tissues upon filling to decrease appetite in the hypothalamus, increase glucose uptake in muscle, decrease gluconeogenesis by liver

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5
Q

How much water do we need and why?

A

50% of weight in floz, Universal solvent, transport medium, heat regulation, lubrication

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6
Q

RDA’s

A

Recommended daily allowance, levels of intake of essential nutrients considered to be the general basis to meet the requirements of almost all healthy people

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7
Q

1 lb of body weight = how many calories

A

3500 Calories

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8
Q

definition of a calorie

A

Energy required to raise one gram of water one degree celcius

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9
Q

Fat soluble vitamins

A

A,D,E,K… remaining are water soluble

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10
Q

BMI calculation

A

Weight in kg/height in m^2

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11
Q

Adipose tissue as an organ releases what hormones?

A

-TNF-a, leptin, adiponectin

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12
Q

Adiponectin function

A

Acts on the muscle to encourage glucose uptake, acts on liver to decrease gluconeogenesis

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13
Q

Parts of the small intestine absorption

A

Duodenum - iron, ca2+, magnesium
Jejeunum - simple sugars and water soluble vitamins
Ileum - amino acids, fatty acids, B12, sodium, cholesterol, alcohol ***most important, if removed will need supplemental nutrition for life

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14
Q

Ox phos ATP yield

A

32, + 4 from glycolysis and TCA gives 36-40

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15
Q

RBC’s lack mitochondria and therefore…

A

…cannot create ATP, must get it from the blood stream

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16
Q

Hormones that increase blood sugar

A
  • glucagon
  • epinephrine
  • growth hormone
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17
Q

Cori cycle/lactic acid cycle

A

Liver uses lactate from muscle to make glucose, takes 3 times the energy to perform than energy that is produced

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18
Q

B1 name and what deficiency can cause

A

Thiamine, deficiency causes eye paralysis, congestive heart failure (wet beriberi), hyporeflexia, neuropathy (dry beriberi) and wernike korsakoff syndrome

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19
Q

B6 name and what deficiency can cause

A

Pyroxidine, peripheral neuropathy

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20
Q

B12 name and what defiency can cause

A

Cyanocobolamine, optic neuritis and loss of proprioception and vibration sensitivity, megaloblastic anemia

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21
Q

B2 name and deficiency canc

A

Riboflavin, angular stomatitis cheilosis

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22
Q

what does Vitamin A deficiency cause

A

Dry conjunctiva (bidots spots), corneal uceration, dry skin, poor night vision

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23
Q

what does vVitamin C deficiency cause

A

Gingivial hypertrophy and bleeding

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24
Q

Vitamin D

A

Osteomalacia, musclular hypotonia

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25
Q

B3 Niacin deficiency can cause the 3 d’s

A

(pellagra) Dermatitis, diarrhea, dementia,

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26
Q

Sinemet (carbidopa and levodopa) interaction with this common OTC supplement

A

Iron, inactivates it

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27
Q

marfan syndrome diagnostic criteria

A

Presence of family history and 1 of the cardinal features, or genetic testing in the setting of family history, or in the absence of family history 2 cardinal features (aortic root dilation and ectopia lentis)

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28
Q

Beighton score

A

Test for ehlers danlos involving scoring of right and left extremities in tests of hypermobility with a 1 being positive and 0 negative, includes hyperextension of pinky >90 degrees, apposition of thumb to flexor aspect of forearm, hyperextension of elbow >10 degrees, and knees, and touching palms of hands to floor without bending knees

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29
Q

Which arm forearm bone rotates?

A

The radius, the head of the radius is rounded and allows for spinning over the ulna

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30
Q

Bones that are particularly susceptible to injury in the wrist

A
  • Carpal navicular/scaphoid is prone to fracture, blood supply becomes compromised resulting in long healing periods
  • Lunate disloation is easy
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31
Q

Most likely spot for a clavicle break and most common mechanism to cause a clavicular fracture?

A

S bend, FOOSH (fall on outstretched hands)

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32
Q

PIP joint

A

Proximal interphalangeal joint between proximal and intermediate phalanges

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33
Q

IP joint

A

Interphalangeal joint, between proximal and distal phalanges on digit 1

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34
Q

DIP joint

A

Distal interphalangeal joint, between intermediate and distal phalanges

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35
Q

Cephalic vein pathway and similarities to lower limb

A

Travels up the anterior face of the arm in the superficial fascia, up the deltopectoral groove and empties into the subclavian or axillary vein, pretty much identical to great saphenous in lower limb

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36
Q

Basilic vein pathway

A

Travels up the medial face of the arm in the superficial fascia before diving deep and emptying into the axillary vein

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37
Q

Median cubital vein

A

Junction between cephalic and basilic, used in phlebotomy

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38
Q

Trace the aortic arch and its branches

A

Aorta

  • brachiocephalic artery (right common carotid and right subclavian)
  • left common carotid
  • Left subclavian
  • Subclavian becomes axillary
  • Axillary becomes brachial
  • brachial becomes radial and ulnar
  • Radial becomes deep palmar arch
  • ulnar becomes superficial palmar arch
  • Anastamoses
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39
Q

Thoracoacromial trunk pathway

A

-Comes off axillary artery briefly after changing from subbclavian artery, sends blood vessels forward (pectoral branch) and backward (acromial branch)

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40
Q

Posterior and anterior humoral circumflex arteries

A

Surround the surgical and anatomical neck of the humerus

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41
Q

Lateral thoracic artery

A

Comes off the axillary artery to travel the chest wall and eventually dipping into latissimus dorsi muscle, sometimes shares a trunk with subscapular artery

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42
Q

Subscapular artery

A

Comes off the axillary artery distal to the lateral thoracic artery to supply the scapular muscles, sometimes shares a trunk with the lateral thoracic artery

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43
Q

What nerve follows profunda brachii artery?

A

radial nerve after the whole brachial plexus debacle

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44
Q

TAN acronym for contents of the cubital fossa

A

Biceps brachii tendon, brachial artery, median nerve

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45
Q

Common flexor tendon

A

Shared tendon between 3 forearm muscles on the medial epicondyle of the humerus, flexor carpi ulnaris, palmaris longus, flexor carpi radialis

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46
Q

Trigger finger syndrome

A

Because the tendons of flexor digitorum superficialis bifurcate at the middle phalanges and flexor digitorum profundus slides underneath, a lesion on profundus could cause an inability to unflex the finger, most commonly affecting the 4th digit and the thumb

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47
Q

Common extensor tendon

A

Shared tendon between 3 forearm muscles on the lateral epicondyle of the humerus, extensor carpi ulnaris, extensor digitorum, extensor digiti minimi

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48
Q

Extensor aponeurosis

A

The opposing side of the flexor retinaculum, features 6 tunnels for things to pass through

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49
Q

Tunnel 1 contents

A

abductor pollocis longus and extensor pollucis brevis

50
Q

Tunnel 2 contents

A

extensor carpi radialis longus and extensor carpi radialis brevis

51
Q

Tunnel 3 contents

A

extensor pollocis longus

52
Q

Tunnel 4 contents

A

extensor indices and extensor digitorum

53
Q

Tunnel 5 contents

A

Extensor digiti minimi

54
Q

Tunnel 6 contents

A

Extensor carpi ulnaris

55
Q

3 things that travel under the coracoacromial arch

A

Supraspinatus muscle, biceps brachii long head tendon, and bursa

56
Q

3 Borders of the thoracic outlet

A

Anterior scalenes muscle, clavicle, first rib

57
Q

Warfarin and VKORC1 gene and CYP2C9

A

Can be tested for to see if pt is especially sensitive to warfarin because they influence metabolism, however this is not routinely or widely recommended at this time

58
Q

Herbal medicinal and dietary supplements differ from traditional medicine in that…

A

…they are assumed safe unless disproven by the FDA, cannot put labels making medical claims - restricted to general statements about how the product affects people

59
Q

4 main processes of pharmacokinetic events

A

1) absorption - entrance of drug into blood stream
2) distribution - moving from blood stream into tissues of body
3) metabolism - physical and chemical alterations that a substance undergoes in the body
4) excretion - eliminating waste products of drug metabolism

60
Q

Characteristics of drugs that make them easier to absorb

A

-More lipid soluble
-Nonpolar

61
Q

Common sites of absorption of drugs

A

1) mucosa of stomach, mouth, small intestine, or rectum
2) Blood vessels in muscles or subcutaneous tissues
3) dermal layer

62
Q

Most common mechanism of drug absorption

A

passive diffusion

63
Q

Ficks law

A

Law of passive diffusion from higher concentration to lower concentration until equilibrium achieved, speed of which directly proportional to different concentration levels and inversely proportional to the thickness of the membrane

64
Q

Facilitated transport

A

Passive process to carry drug molecules passively down a conc. gradient facilitated through a carrier molecule

65
Q

Active transport

A

Requires ATP and carrier molecules to move a drug from a low to high conc area in an active process

66
Q

Oral administration

A

Used whenever possible, safest and most convenient route, onset of action is 30-60 min, most absorption occurs in small intestine, drug enters liver and can be metabolized

67
Q

First pass effect

A

Occurs when a drug is largely metabolized by the liver before reaching systemic circulation, often requires administration of higher dose as a result or can be dodged if drug is administered in other ways

68
Q

Sublingual administration

A

Used whenever rapid effects are needed, absorption directly through oral mucosa into blood stream, few minute onset of action, avoids first pass

69
Q

Rectal administration

A

Often used when a localized effect is needed or another route is not feasible (unconscious or vomiting), onset is 15-30 min, retention varies by patient

70
Q

Disadvantages of alimentary administration (3)

A

-Rate of absorption varies, can be a problem if small range in blood levels separates desired therapeutic and toxic effects
-patient compliance is not ensured
-first pass effect

71
Q

Intravenous administration

A

Bypasses absorption barrier, onset in several minutes, insoluble drugs cannot be delivered via IV

72
Q

Subcutaneous administration

A

Often done for drugs inactivated by stomach, action is several minutes

73
Q

Intramuscular administration

A

Onset of several minutes, provide sustained drug injection over period of time

74
Q

Disadvantages of parenteral administration (4)

A

-Rapid absorption can lead to adverse effects,
-sterile formulation and aseptic technique.
-local irritation at site of injection
-not suitable for insoluble substances

75
Q

Topical administration

A

Most oitments, gels, creams are applied to skin, eye or ear for local effects with onset of 1 hour, systemic absorption is relatively minimal

76
Q

If serum TSH is normal, then ____. If serum TSH is high, then order ____, if serum TSH is low, then order ____

A

no further work up, FREE T4, FREE T4 and T3

77
Q

Biotin (b7), commonly used in OTC advertised anti hair loss products, can interfere lab assay of what hormone?

A

Thyroid hormones

78
Q

Inhalation administration

A

Lungs have large surface for absorption with onset within 1 min, effects can be local or systemic

79
Q

Intranasal administration

A

DRug absorption can cause either local or systemic effects

80
Q

Vaginal administration

A

Local effects with onset of 15 minutes

81
Q

Weak acid type drug medications are more likely to be absorbed where and why?

A

In the stomach, because it has a very low pH (think aspirin and ulcers)

82
Q

Weak base type drug medications are more likely to be absorbed where and why?

A

The duodenum because it has a neutral pH 5-7

83
Q

Bioavailibility and how is this determined?

A

Amount of drug dose that reaches the systemic circulation ex) if 100mg administered and 50mg reaches blood stream, 50% bioavailable. Determined by comparing plasma levels of a drug via different routes of administration compared to injection (which has bioavailablility of 100%)

84
Q

A rated drug vs AB vs B rated drug

A

A rated means FDA has named generic as therapeutically equivalent to brand name, AB means there were bioequivalent problems that have been resolved with further studies, B rated means the generic is not bioavailability equivalent

85
Q

Prodrugs

A

Compounds pharmacologically inactive as administered then undergoes conversion into active form while in the body

86
Q

Phase 1 vs phase 2 metabolism

A

Phase one is nonsynthetic metabolism involves making the drug polar to be excreted such as via oxidation, phase 2 is synthetic metabolism involves combining a drug with a substrate to conjugate it and increase its polarity for excretion

87
Q
A
88
Q

Metabolic induction and example

A

When some drugs are taken repeatedly, they stimulate the drug microsomal meetabolizing syndrome, increasing the amount of enzymes and faster rate of drug metabolism, duration of action is decreased for all drugs metabolized by cytochrome P-450, formulates tolerance

89
Q

Metabolic inhibition

A

Some drugs inhibit rather than induce production of microsomal enzymes, excess drug may accumulate in the body and the dose requirement may need to be reduced to avoid toxicity

90
Q

1st order kinetics

A

For most drugs is proportional to the plasma concentration, conc. of drug diminishes logarithmically with time

91
Q

zero order kinetics

A

Occurs when drug elimination does not change with time

92
Q

Pharmacodynamics

A

Study of how drugs produce their effect on the body

93
Q

Signal transduction

A

Process by which a receptor binding a ligand leads to a cascade of biochemical events that results in physiological effect

94
Q

4 basic mechanisms of transmembrane signaling

A

1) Lipid soluble ligand crosses the membrane and acts on the intracellular receptor
2) Transmembrane receptor proteins that upon binding a ligand intracellular enzymatic activity is activated
3) Ligand gated ion channels opening or closing in result of binding
4) Transmembrane receptor stimulates a G protein that generates a 2ndary messenger (often use cAMP)

95
Q

Example of drug that is less selective resulting in having multiple unintended consequences

A

Propranolol acts as a B blocker used to act on B1 and B2 receptors and inhibit effect of norepi on heart, but it is non specific and also has an impact on the lungs as well causing bronchoconstriction and therefore isn’t good to use in patients with asthma or COPD (except is it tho? Because some of the modern studies we’ve seen said B blocker benefit outweighs asthma COPD risk)

96
Q

Agonist

A

Drug that interacts with a receptor and produces a pharmacologic response, once inserted to a suitable receptor drug acts same way normal hormone would, has affinity and efficacy

97
Q

Antagonist

A

Drug that interacts with a receptor and produces no response, in presence of an antagonist drug, normal response reduced or completely prevented, antagonists have affinity for receptor but lack efficacy

98
Q

Partial agonist

A

Do not evoke maximal response compared to a strong agonist, efficacy somewhere between a full agonist and full antagonist, have affinity for receptor but often do not activate receptor resulting in decreased efficacy

99
Q

Chirality/sterioisomerism

A

Chemical structures that contain an assymetric carbon with all 4 valences utilized by different groups resulting in nonsuperimposible mirror images of each other

100
Q

Determining R or S chirality

A

Rank the valence groups off the central carbon from highest atomic number to lowest, if it goes clockwise then it is R, if it goes counter it is S

101
Q

Example of how isomers matter

A

Despite having the same chemical equation, the chirality of S-citalopram and R-citalopram result in S-citalopram being the most selective SSRI to have a therapeutic response while R has no clinical benefits and is not therapeutically active

102
Q

Therepeutic index

A

Describes relative safety of a drug expressed in a radion LD50/ED50

103
Q

LD50

A

Lethal dose that will kill 50% of animals given drug

104
Q

ED50

A

Effective dose that will produce therapeutic effect in 50% of animals given the drug

105
Q

The greater the Therapeutic index, the _____. The closer the TI is to 1, the ______

A

the safer the drug, greater potential danger to the patient

106
Q

Down regulation

A

Desensitization - if receptors are continually stimulated as is the case with chronic use of certain drugs, their responsiveness may decrease as a result of decrease in # of receptors or changing responsiveness to existing receptors

107
Q

Up regulation

A

Supersensitivity - prolonged decrease in stimulation of receptors can result in functional increase in receptor sensitivity, may occur with chronic use of receptor antagonist drugs, results increased production of receptors

108
Q

Placebo

A

Preparation that is devoid of intrinsic pharmacologic activity, any response is solely the patient’s psychologic reaction and not to direct physiologic or biochemical action of the placebo itself

109
Q

List the essential amino acids (think of the acronym)

A

PVT TIM HALL
1) Histidine
2) isoleucine
3) leucine
4) lysine
5) methionine
6) phenylalanine
7) threonine
8) tryptophan
9) valine
10) arginine

110
Q

B9 folate deficiency can cause

A

megaloblastic anemia

111
Q
A
112
Q

Development pathway of an RBC

A

Pluripotential hematopoietic stem cell -> CFU-S (committed to the myeloid line) -> CFU-B -> CFU-E -> proerythrocyte -> reticulocyte -> erythrocyte

113
Q

Ferritin function, where is it found, and what is the precursor called before it binds iron

A

The storage form of iron in all types of cells, found in serum as well used to measure iron deficiency, in the liver is majority of stores, before binds iron is apoferritin

114
Q

Apotransferrin and transferrin. What is suggested if transferrin is high?

A

The transporter molecule of iron in the blood stream, apotransferrin lacks bound Fe and becomes transferrin upon binding Fe. Iron defiency anemia.

115
Q

Pernicious anemia

A

Anemia brought on by conditions such as gastric bypass which prohibit a patient from being able to absorb enough B12 and thus are deficient

116
Q

D antigen

A

The most immunogenic antigen on the surface of certain people’s RBC’s, form the basis of the rhesus factor Rh with individuals being Rh positive (they have the D antigen and thus no antibodies against it) or Rh negative (they lack the D antigen and thus have antibodies against it)

117
Q

Sensitivity

A

Measure of a test’s ability to pick up a positive value (regardless of false positives), a sensitive test with a negative diagnosis rules out a condition (snout)

118
Q

Specificity

A

Measure of a test’s ability to determine negative values (regardless of false negatives), a specific test with a positive diagnosis rules in a condition (Spin)

119
Q

Positive predictive value

A

Proportion of patients with a positve test who truly have the disease

120
Q

List 3 mandatory questions to ask every time you order a medication

A

Any prior drug allergies or reactions to meds in the past?
Any chance you could be pregnant or are breastfeeding?
Any other medications you are taking?

Professional Development (20 decks)

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