Sherwood Flashcards
1
Q
what is the importance of vitamins, minerals and trace elements
A
-they play a role in enzymes which help us create energy
2
Q
What vitamin is used for the maturity of cells in measles, cancer, infections that destroy cells, and burn patients
A
vitamin A
3
Q
what vitamin is used for parathyroid hormone
A
vit A
4
Q
what vitamin is used for CSF production
A
vit A
5
Q
what vitamin is used for epithelial cell maturation
A
vit A
6
Q
what vitamin is used as a mild antoxidant
A
vit A
7
Q
If PTH is involved serum calcium and phosphorus will go in what direction?
What direction does calcium go in compared with PTH
A
- opposite
- same direction as PTH
8
Q
If you have low calcium and high phosphorus what disease do you have
A
hypoparathyroidism
9
Q
If you have retinoic acid receptor defect what vitamin are you deficient in?
A
vit A
10
Q
If a patient has moans, groans, bones and stones what vitamin are they deficient in and why?
A
- vit A
- moans and groans are from the pancreatitis b/c of the calcium deposits imitating fat behind the pancreas
- bones are going to hurt b/c PTH is destroying the bones
- stones can be caused by the excess of calcium causing gallstones, or kidney stones or calcification throughout out the body-metastatic calcification
11
Q
what is the most common abdominal pain
A
pancreatitis
12
Q
Most common cause of free radical formations in the body is
A
viral infections
13
Q
How are free radicals formed
A
secreted by neutrophils through the enzyme NADPH oxidase
14
Q
why do you get cancer after radiation therapy
A
b/c of the free radicals
15
Q
what is the most common cause of pancreatitis in children
A
- trauma
- infections (cox sackie)
- Increased triglycerides
- increased calcium
16
Q
what is the most common cause of pancreatitis in adults
A
- gall stones
- alcohol
- Increased triglycerides
- increased calcium
17
Q
A patient comes complaining of a headache, has papilledema, CT scan shows enlarged ventricles in the CT scan. What does he have and is at risk for? treatment?
A
Pseudotumore cerebri
- risk for blindness
- tx: discontinue vitamin A, do serial lumbar punctures to rule out infections
18
Q
Why remove less than 30 ccs of CSF/24hrs?
A
osmotic shift will occur in the brain damging the pons
19
Q
what disease causes intracranial pressure without herniation
A
Pseudotumore cerebri
20
Q
what carbonic anhydrase inhibitor decrease intracranial pressure
A
mannitol and acetazolamide
21
Q
Pseudotumore cerebri mcc is
A
obesity and vitamin A deficiency
22
Q
vitamin b1
A
thiamine
23
Q
vit b1 is necessary for what important enzymes
A
- pyruvate dehydrogenase
- alpha-ketoglutamate dehydrogenase
- branched chain amino acid dehydrogenase
- transketolase
24
Q
what dehydrogenase does the heart need
A
- pyruvate dehydrogenase
- alpha-ketoglutamate dehydrogenase
- branched chain amino acid dehydrogenase
25
what enzyme does the heart use
-transketolase
26
a patient comes in being thiamine deficient, having short term memory, family says that they are always confabulating. You noticed during examination of the CT scan you seen mamillary bodies. What is the diagnosis
wernicke-korsakoff
27
a patient comes in having receptive aphasia and thiamine deficient
wernicke aphasia
28
wernicke encephalopathy
located in the posterior lobe
| responsible for receiving spoken or written language
29
a patient heart has given out and has massive dilation. thiamine deficiency
beri beri
30
what is the difference between dry and wet beri beri
dry= heart failure
| wet=when there is fluid in the lungs and have massive ventricular dilation
31
Best source for milk
vit b2
32
vit b2
riboflavin
33
used in cofactors like FAD
vit B2
34
vitamin deficiency associated with angular cheilosis
vit b2
35
necessary for cofactors NAD, NADH, NADP, NADPH
vit b3
36
This vitamin is needed by
- pyruvate dehydrogenase
- alpha-ketoglutamate dehydrogenase
- branched chain amino acid dehydrogenase
niacin
37
a patient comes in with dermatitis, diarrhea, and dementia and ends up dying later on. What disease?
Pellagra
38
what is hartnup disease and what amino acid is needed?
-like pellagra but defective renal transport of tryptophan, causing it to leak out into the urine
39
how would you differentiate between hartnup and pellagra?
tryptophan in the urine
40
what amino acid is needed to make niacin
tryptophan
41
what does probucol do?
blocks VLDL receptor in the liver, treating hypertriglyceridemia
42
which drug increases HDL better than any other drug on the market
niacin
43
what are the side effects of niacin? Prevention? Treatment?
- flushing, itching due to the release of prostaglandins, -blocks insulin receptors, leading to insulin resistance,
- competes with uric acid causing gout
- prevention is NSAIDS or aspirin
- tx: anti-histamines
44
For management of gout what is the most effective treatment? MOA
- colchine
- blocks microtubules, which block all rapidly dividing cells
- causes bone marrow suppression and renal failure
45
What is the current treatment of gout? MOA
indomethacin
| -reversibly inhibits COX 1 and 2
46
what do you do if you have gout and and renal failure
-inject with an IV steroid with the indomethacin
47
What do you give for chronic/ recurrent gout? MOA
- allopurinol-blocks xanthine oxidase
- rasburicase-breaks the uric acid crystals
- probenecid- increases excretion of uric acid
48
what is carcinoid syndrome?
- uses up tryptophan
| - secretes out serotonin and kallikrein
49
- pyruvate dehydrogenase
- alpha-ketoglutamate dehydrogenase
- branched chain amino acid dehydrogenase
is needed by this vitamin and it has no deficiency state
vitamin B4-lipoic acid
50
what is the difference between vit b4 and vit b5
coenzyme A
51
what are the 3 vitamins that are needed by
- pyruvate dehydrogenase
- alpha-ketoglutamate dehydrogenase
- branched chain amino acid dehydrogenase
vit B3, vit B4, vit B5
52
what vitamin is needed by heme
vit B6
53
what vitamin is needed by all transaminases
vit B6
54
what drug pulls pyridoxine out of the body?
INH
| -must give B6 with INH
55
what vitamin is the cofactor to pyridoxal phosphate
vit b6
56
If you have a vit B6 deficiency you will have? Treatments?
neuropathy
-amytryptaline- blocks reuptake of catecholamine-so levels increase
-Gabapentin-also good for heart disease- blocks presynaptic-so block Ca2+
Carbamezapine-block Na+ and Ca2+, good for shooting pain (ex: syphilis) and seizures
57
Action of TCA drugs
- block reuptake of catecholamines
- Anticholinergic( sympathetic) cannot sweat
- block alpha receptors
- block sodium channels
- block AV conduction
- Antihistamines
58
if a patient has side effects with amytryptaline what would you give?
-SSRI
59
without this vitamine DNA cannot be formed
folate
60
how long can folate last
24 hours
61
what type of anemia do patients with folate deficiency have?
-megaloblastic anemia
62
what vitamin do you see hypersegmented neutrophils
-folate
| cytoplasm divided, nucleus did not divide but tried to forming many segments
63
If you have a neural tube defect what vitamin is deficient? MCC
- folate
| - overcooked vegetables
64
when are cells most rapidly dividing?
- Pregnancy
- 0-2 years of age
- 4-7 years of age
- puberty
65
what groups of people have the highest life expectancy?
asians>whites>hispanics>blacks
66
what vitamin lasts for 6-9 months in the liver?
vit b12
67
what vitamin is needed by
- homocysteine methyltransferase
- methyl malonyl-CoA mutase
vit B12
68
what vitamin is needed to recycle odd-numbered carbon fatty acids
cyanocobalamin-b12
69
what vitamin is need to make tetrahydrofolate
cyanocobalamin-b12
70
Vitamin B12 is used in treatment in what type of poisoning
cyanide
71
when does B12 deficiency occur
3-4 years
72
Vitamin B 12 deficiency mcc in the US is
`pernicious anemia -type A gastritis b/c its autoimmune and anti-parietal antibodies
73
what are 3 ways to separate B12 from folate deficiency?
- methylmalonic acid is the urine
- neuropathy
- chronic state
74
what is the main antioxidant in the GI system
vitamin c
75
what vitamin hydroxylates proline and lysine in collagen and elastin
vitamin C
76
what vitamin is used for hydroxylation
vitamin C
77
what disease are you bleeding from hair follicles and gums
scurvy
78
what causes free radicals to be released into the body?what vitamin can you take to help fight with colds and flus
viruses
| vit C
79
what vitamin protects iron from being oxidized in the GI tract
vitamin C
80
what infection causes anterior bowing of legs
syphillis
81
what are some milder forms of anti-oxidants
- vitamin A
- beta carotene
- trace elements
82
where is vitamin E an antioxidant in
blood
83
what vitamin is an antioxidant in the GI
vitamin c
84
what vitamin mineralizes bone and teeth
vitamin D
85
what vitamin stimulates osteoblastic activity and osteoclastic activity
vit D
86
what vitamin stimulates calcium and phosphorus absorption from the GI tract
vit D
87
what vitamin helps with reabsorption from the bone
vit D
88
what vitamin helps with reabsorption from the kidney
vit D
89
what vitamin supresses PTH
vit D
90
what is number one vitamin deficiency in the US?why?
vitamin D
| -due to obesity
91
what is vitamin D deficiency is children? What do you see?
- rickets
| - lateral bowing of legs
92
what is vitamin D deficiency is adults?
-osteomalacia
93
vitamin D resistant rickets is diagnosed by? what would labs look like?
- administering a dose of vitamin D
| - low calcium, low phosphorus
94
how is vitamin D resistant rickets passed down
-x-linked dominant
95
what is resistant rickets caused
-defective renal absorption of phosphorus which leaks out, pulling calcium out with it.
96
what vitamin absorbs free radicals and is the main antioxidants in your blood
vitamin E
97
What diseases involve oxidation
- cancer
- alzheimer's
- coronary artery disease
- hemolytic anemia-G6PD
98
what vitamin is necessary for carboxylation
biotin
99
what vitamin is needed for gamma-carboxylation?
-vitamin K
100
what are the clotting factors for vitamin K
2,7,9, 10, Protein C and S
101
which vitamin K clotting factor has the shortest
Protein C-6 hours
| factor 7- 2 days
102
which vitamin is a competitor of vitamin K
-warfarin
103
what drug do you give first when you're treating venous clots
-heparin then warfarin
104
what anticoagulant drug is safe to give in a prengant women
heparin
105
which drug crosses the placenta and is teratogenic
warfarin
106
For heparin what do you follow PTT or PT or bleeding time?
PTT-intrinsic pathway
107
what pathway does warfarin follow
PT-extrinsic pathway
108
what is the INR in patients that take warfarin
-2 to 3x normal so less likely to form a clot
109
If a patient PT is too high you give them
vitamin k IM
110
if a patient is bleeding all over the floor your first give them
FFP bc it has all the clotting factors in it
111
If a patient has its first clot and is of known/ reversible causes how long are they on warfarin
-3 months
112
If a patient has a second clot/ or has a clot of unknown causes how long are they on warfarin
-12 months
113
If a patient has a 3rd clot/ or clot has irreversible causes they are on warfarin for how long
life long
114
why is heparin used before warfarin?
Protein C has half-life of 6 hours. Factor 7 has half-life of two days. Heparin activates anti-thrombin-3 so there is protection against clots till warfarin can kick in. That is why we stay on heparin for two days.
115
Protein C deficiency and using warfarin causes
skin necrosis bc of hypercoagbility
| -heparin block protein C
116
what is cofactor for antithrombin 3
heparin
117
what clotting factors does heparin block in the intrinsic pathway
9,10,11,12
118
what is the goal of INR for venous clots? cardiolipin antibody syndrome?metallic valves present?
- 2-3x venous clots
- 2.5-3.5 cardiolipin antibody syndrome
- 3-4 if mettalic valves
119
if patient is given heparin and there is no PTT change, what are you deficient in? what are some diseases associated with it
you're defeicient in antithrombin 3 (protein loss)
| - kwashikor, CIrrhosis, and Nephrotic Syndrome
120
what are some side effects of heparin
- bleeding, hyperlipidemia by activating hormone sensitive lipase -producing a milky white plasma
- HIT- thrombocytopenia precedes the clotting
- heparin acts as a hapten on platelets causing antibody to form. They then attack the platelets that are floating around the blood vessels causing inflammation. This leads to vasculitis and clot to stick on the sticky endothelium.
121
If a patient has HIT what other medications can they take
- lepirudin, agatroban-block thrombin directly
| - fondaparinux block factor 10a
122
what type of drug can a patient take tha thas few side effects then heparin, cost less, and has less bleeding time
LMWH
123
where is heparin contraindicated in
- recent head injury
- recent CPR
- bleeding ulcer
- use a greenfield filter/IVC
- HTN
124
what is the difference in type 1 HIT and type 2
Type 1 HIT- just follow platelet count
Type 2- platelet count should never be below 75,000- stop heparin and switch to a direct thrombin inhibitor which is agatroban
125
If you have DVT that turns into a stroke what type of stroke is it
it is a pardoxical stroke and you have a shunt in your heart
126
why do patient with DKA have hyperlipidemia
-they lack insulin which causes glucagon to activate HSL causing an excess of ketones and glucose. Causing hyperlipidemia. You will also see a milky white plasma in test tubes when blood settles. Showing glycogen
127
what is the gut flora made up of? and what do they help absorb
- 90% of vitamin K, biotin, folate, and pathothenic acid
| - help absorb vitamin b12
128
when do you not have enough gut flora
- newborns- this is why we give vitamin K to all newborn IM and also hemorrhagic disease of the newborn can occur because they are vit k deficient and factor 7 is 2 day half life. which is why hemorrhagic disease can occur at day 2.
- broad-spectrum antibiotics
129
what 4 cephalosporins inhibit vitamin K
- cefamandole
- cefotetan
- moxalactam
- cefoperazone
130
what are some minerals
- calcium
- magnesium
- zinc
- copper
- iron
131
what mineral is needed for all muscle contraction
calcium
132
what type of muscle uses extracellular calcium for second messenger systems
smooth muscle
133
what are two membranes that uses calcium to depolarize
atrium and thalmus
134
Cardiac ventricles have a calcium-induced calcium released phenomenon which means
cardiac ventricles depend on extracellular calcium to trigger off its intracellular calcium
135
what mineral is used for axonal support
calcium
136
what mineral is needed for release of all neurotransmitters
presynaptic influx of calcium is needed
137
If babies in utero do not get enough calcium what might be the end result
they may be born with mental retardation
138
which mineral is a cofactor to all kinases and uses ATP
magnesium
139
which mineral is cofactor for kinases and PTH
magnesium
140
which mineral is a cotransport for potassium and calcium and where does it interact with potassium
- early distal convoluted tubules of the kidneys
| - magnesium
141
If a patient is experiencing hypokalemia and is treated accordingly but potassium levels are not increase what might be the underlying issue?
magnesium
142
this mineral is needed by hair, nails, and skin
zinc
143
if you have zinc deficiency what can you not do
dysgeusia- cannot taste food
144
what is copper needed for
- lysine oxidase in the formation of collagen
| - complex 4 in the ETC
145
what disease do you have copper deficiency
menke kinky hair syndrome
- orange hair color
- hair feels copper wire
146
what are some identifying symptoms or markers of wilson's disease
- autosomal recessive
- low ceruloplasmin
- copper deposition in the lenticular nucleus (basal ganglia)
- kayser fleicher rings in the iris
- cirrhosis in the liver
147
How do you treat wilson's disease
pencillamine
148
what disease you have copper excess
wilson's disease
149
what is needed for the formation of heme and hemoglobin
iron
150
what mineral is need by complex 3 and 4 of ETC
Iron
151
what is the difference between ferrous iron and ferric iron
ferrous binds to oxygen and ferric has been oxidized
152
what are the trace elements
- chromium
- selenium
- molybdenum
- manganese
- tin
- fluoride
153
what enzyme is deficient in diabetic
-chromium
154
what does chromium do?
enhance insulin action there fore delaying progression of the disease
155
what is selenium primarily needed by
the heart
156
selenium in excess smells like and leads to
garlic or arsenic and leads to dilated cardiomyopathy
157
what two trace elements are needed by glycolysis
molybendum and manganese
158
xanthine oxidase needs what two minerals
molybendum and manganese
159
what is the enzyme needed to make uric acid
xanthine oxidase
160
tin is needed to do what
hair growth
161
what blocks eolase of glycolysis causing low energy state
fluoride
162
what trace element is needed for teeth and bone growth
fluoride
