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5 star topic: couple questions > vitamins > Flashcards

vitamins Flashcards

1
Q

fat-soluble vitamins

A

ADEK

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2
Q

fat malabsorption diseases = diseases with ADEK deficiency

A

cystic fibrosis
pancreatic insufficiency
ILEUM pathology (absorption of ADEK)

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3
Q

roles of vitamin D (calcitriol)

A

intestine: ↑Ca absorption - ↑ expression of Ca binding protein, ↑PO4 + Mg absorption
kidney: ↑ PTH-dependent Ca reabsorption
bone: ↑Ca reabsorption

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4
Q

types of vitamin D deficiency

A

1) inadequate dietary vitamin D
2) impaired hydroxylation to make 25-OH vitamin D (liver)
3) impaired hydroxylation to make 1,25-(OH)2 vitamin D (kidney)
4) end-organ insensitivity to vitamin D

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5
Q

complications of vitamin D deficiency

A

demineralization of bone: low vitamin D → no absorption of Ca, PO4 from intestine →↓ serum Ca →↑ PTH → PTH mediated ↑ serum Ca via bone resorption, PTH mediated ↓ PO4 secretion in kidney → no source of Ca or PO4 for strong bones in future

symptoms: bone tenderness, muscle weakness, skeletal deformities - bowing, pathologic fractures, dental problems
children: rickets
adults: osteomalacia

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6
Q

does breast milk have adequate amounts of vit. D

A

NO. need to supplement

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7
Q

vitamin D toxicity

A

1) too much vit. D supplementation
2) sarcoidosis: macrophages in granulomas ↑conversion of 25-OH vit. D3 → 1,25-OH2 vit. D3
hypercalcemia: STONES, BONES, GROANS, pyschiatric OVERTONES

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8
Q

role of vitamin K

A

post-translational modification of various clotting factors (co-factor for gamma-carboxylation of glutamic acid residues in clotting factors)

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9
Q

source of vitamin D

A

plants (D2)

milk + sunexposed skin (D3)

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10
Q

source of vitamin K

A

intestinal flora

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11
Q

clotting factors that require vitamin K for activation

A

CF: 2,7,9,10
protein C + S
prothrombin

CF decreased if take: warfarin (vit. K antagonist)

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12
Q

complications with vitamin D in newborns

A

newborn has sterile gut - can’t make vitamin K → no clotting factors → hemorrhage

newborns receive single IM dose of vitamin K at birth

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13
Q

vitamin K deficiency

A

drug-induced: warfarin (coumadin), anticonvulsants (phenytoin), antibiotics (no flora)

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14
Q

types of vitamin A

A

retinol: eye, immune system, maintenance of epithelial cells + mucous secreting cells
retinal
B-carotene: cleaved in intestine to 2 molecules of retinol
retinoic acid: unusable by body, but can treat some diseases

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15
Q

vitamin A treatment

A 
↓size + secretion of sebaceous glands:
mild-mod acne: tretinoin (topical)
mild severe acne: isotretinoin (oral)
measles
AML (M3 type)
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16
Q

vitamin A deficiency

A

night blindness
xerophthalmia (dry conjunctiva →corneal ulceration)
keratomalacia: wrinkle, clouded cornea
bitot spots: dry silver plaques on bulbar conjunctiva

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17
Q

corneal ulceration

A

vitamin A deficiency

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18
Q

vitamin A toxicity

A 
headache
N/V
stupor
↑ ICP: psuedotumor cerebri
dry and pruritic
hyperlipidemia
hepatomegaly +/- cirrhosis
bone + joint pain
alopecia
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19
Q

contraindication for vitamin A supplementation

A

pregnancy: teratogen

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20
Q

role of vitamin E (α-tocopherol)

A

antioxidant: prevent non-enzymatic oxidation of cell components by O2 free radicals (esp RBCs)

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21
Q

vitamin E deficiency

A

hemolytic anemia: RBC not protected
spinocerebellar degeneration → ataxia
peripheral neuropathy
proximal muscle weakness

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22
Q

antioxidants

A

vitamin E

vitamin C

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23
Q

water-soluble vitamins

A

B vitamins

vitamin C

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24
Q

B1 name

A

thiamine

active form: thiamine pyrophosphate (TPP)

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25
Q

B2 name

A

riboflavin
active forms:
flavin adenine dinucleotdie: FAD
flavin mononucleotide: FMN

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26
Q

B3 name

A

niacin
active form:
NAD+
NADP+

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27
Q

B5 name

A

pantothenic acid

componenent of coenzyme A (coA) which transfers acyl groups

28
Q

B6 name

A

pyridoxine
active form:
pyridoxal phosphate: PLP

29
Q

B7 name

A

biotin: apoenzymes for carboxylation reactions

“carboxylase” require B7

30
Q

B9 name

A

folate/folic acid
synthesis (purine + pyrimidines) + repair of DNA
rapid cell division + growth
biologically active form = tetrahydrofolate (THF): coenzyme for 1 C transfer/methylation

31
Q

B12 name

A

cobalamin
co-factor for homocysteine methyltransferase: homocysteine → methionine + THF (active form of folate)
need for DNA synthesis

32
Q

role of vitamin C (ascorbic acid)

A

hydroxylation of prolyl + lysyl residues of collagen
dopamine ßhydroxylase needs Ca: dopamine → NE
antioxidant: protect RBCs
facilitates IRON absorption in gut: vitamin C keeps iron in reduced state = easier to absorb (take iron with OJ)

33
Q

vitamin C deficiency

A 
scurvy: collagen synthesis defect
sore, spongy gums
loose teeth
fragile blood vessels
swollen joints
hemarthrosis
impaired wound healing
anemia
34
Q

role of TPP (thiamine pyrophosphate): active form of B1

A

1) pyruvate dehydrogenase (TLC for Nobody = cofactors): pyruvate → acetyl CoA (link glycolysis to TCA)
2) α ketoglutarate dehydrogenase: α ketoglutarate → succinyl coA (TCA)
3) transketolase (HMP shunt = pentose phosphate pathway)

35
Q

thiamine deficiency (B1)

A

poor nutrition: alcoholism
malabsorption
↑ loss of water-soluble vitamins: dialysis
brain affected first
damage to medial thalamus + mammillary bodies of posterior hypothalamus + general cerebral atrophy
Wernicke-Korsakoff syndrome
Beriberi: dry or wet

36
Q

role of thiamine

A

co-factor for oxidative metabolism: need to breakdown glucose → ATP
BRAIN is affected first

37
Q

Wernicke-Korsakoff syndrome

A 
Wernicke encephalopathy: acute 
triad: encephalopathy, oculomotor dysfunction, gait ataxia
stupor, coma, hypotension, hypothermia
Korsakoff syndrome:
chronic, consequence of WE
memory loss: anterograde + retrograde
confabulation: invent memories
personality changes
apathy
38
Q

primary food is polished/dehusked rice

A

beriberi (thiamine deficiency)

39
Q

dry beriberi

A

NERVES
peripheral neuropathy with myelin degeneration: toe drop, wrist drop, foot drop
muscle weakness
hyporeflexia or areflexia

40
Q

wet beriberi

A

HEART
peripheral vasodilation → high output heart failure
peripheral edema
dilated cardiomyopathy

41
Q

treatment of thiamine deficiency (B1)

A 
thiamine supplementation (ALWAYS give BEFORE glucose)
*giving glucose to thiamine deficient or near-deficient pt → worsen WE
42
Q

vitamin B2 (riboflavin) deficiency

A

dermatitis
cheiolosis (scaling and fissures at corners of mouth)
angular stomatitis (mouth)
glossitis

43
Q

role of FMN/FAD

A

co-factors for redox reactions

any “dehydrogenase” enzyme requires B2 as cofactor

44
Q

role of NAD+/NADP+

A

used in redox reactions

45
Q

source of B3 (niacin)

A

tryptophan in diet: NAD+/NADP+

46
Q

B3 (niacin) deficiency

A

pellagra: 3 D’s
dermatitis
diarrhea
dementia

47
Q

causes of B3 (niacin) deficiency

A

1) Hartnup disease: ↓ tryptophan absorption
2) malignant carcinoid syndrome: ↑ tryptophan metabolism
3) INH (isoniazid): Inhibit B6 + B3

48
Q

niacin is used for the treatment of

A

dyslipidemia: ↑ HDL, ↓LDL
SE: flushing reaction: take aspirin 30 min before taking niacin

49
Q

vitamin B5 deficiency (pantothenate)

A

dermatitis
enteritis
alopecia
adrenal insufficiency

50
Q

role of pyridoxal phosphate (PLP)

A

coenzyme for many enzymes: esp amino acid metabolism (transaminations + deaminations)
conversion of amino acid precursors into: heme, niacin, histamine, GABA, dopa, NE, epi

51
Q

B6 (pyridoxine) deficiency

A 
similar to riboflavin (B2):
angular cheilosis
glossitis
CONVULSIONS: need B6 to make GABA (main inhibitor NT)
PERIPHERAL NEUROPATHY
52
Q

cause of B6 deficiency

A

INH for TB inhibits B6 + B3

add B6 to prevent

53
Q

cause of B7 (biotin) deficiency

A

avidin (egg whites) prevents absorption of biotin

antibiotics

54
Q

source of B9 (folic acid)

A

diet

55
Q

vitamin B9 (folic acid) deficiency

A 
meds (tx: give folic acid to counteract): 
phenytoin
sulfonamide
TMP
MTX
malnutrition
pregnancy: rapid growth of fetus
56
Q

complications of B9 (folic acid) deficiency

A 
in utero: neural tube defect (most common cause)
growth stage: growth failure
child/adult: megaloblastic anemia (need folate for rapidly dividing RBCs)
glossitis
diarrhea
depression
confusion
megaloblastic anemia
57
Q

vitamin B12 (cobalamin) deficiency

A 
NEURO sx:
parasthesia
ataxia (no vibration/position sense)
memory loss
dementia
severe weakness
megaloblastic anemia
↓B12 level
↑methylmalonic acid (MMA): needs B12 for metabolism
↑ homocysteine: need B12 for homocysteine → methionine
58
Q

cause of cavitamin B12 (cobalamin) deficiency

A

malabsorption of B12 in terminal ileum:
#1) pernicious anemia (autoimmune destruction of gastric parietal cells + IF)
2) gastric bypass (remove part of stomach)
only found in animal
3) chron’s, celiac, enteritis
4) found only in animal products: VEGETARIANS OR VEGANS if no supplementation

59
Q

absorption of B12 in GI gut occurs

A

B12-IF in duodenum → absorbed in terminal ileum

60
Q

treatment of B12 deficiency

A

oral or IM supplementation if can absorb B12

61
Q

determining cause of vitamin B12 (cobalamin) deficiency

A

check for Abs to IF
schilling test: radiolabeled B12 → see how much in urine later on
low: absorption problem

62
Q

vitamin deficiency with neuro symptoms

A

vitamin B1: WE
vitamin B6: seizure
vitamin B12: parasthesia, ataxia

63
Q

used in redox reactions

A 
vitamin B2 (riboflavin)
vitamin B3 (niacin)
64
Q

used in carboxylation reaction

A 
vitamin B7 (biotin)
vitamin K
65
Q

need for DNA synthesis

A

B9

B12

66
Q

vegetarians should supplement in diet

A

B12

5 star topic: couple questions (13 decks)

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